We assessed the impact of traditional prognostic factors and tumor location on the survival of patients treated for upper tract transitional cell carcinoma (TCC). We retrospectively analyzed the data on 86 patients with upper tract TCC who underwent nephroureterectomy with a bladder cuff (95%) or parenchymal sparing surgery (5%). Mean patient age was 59.5 years and median followup was 43.8 months. The influence of traditional prognostic factors such as age, gender, tumor stage, grade and location on 5-year disease specific and recurrence-free (local recurrence or distant metastasis) survival rates was analyzed. The difference in survival rates between renal 45 pelvis and 41 ureteral cases was analyzed according to the respective T stage and grade. Overall 5-year disease specific and recurrence-free survival rates were 83% and 72%, respectively. The significant prognostic factors for survival rates by univariate analysis were T stage, grade and location. N stage was significant for 5-year recurrence-free survival. On multivariate analysis tumor location was the only independent prognostic factor for the 2 survival rates, while N stage was significant for 5-year recurrence-free survival. Patients with ureteral tumor had a worse prognosis than those with pelvis tumor at the same stage or grade (p = 0.036). Pelvis and ureteral TCC are not the same disease in terms of invasion and prognosis. Ureteral TCC is associated with a higher local or distant failure rate than renal pelvis TCC. A radical surgical approach including meticulous lymphadenectomy may be therapeutic in patients with invasive ureteral TCC.

Purpose: We performed this study to evaluate factors related to urinary retention after a tension-free vaginal tape (TVT) procedure for female stress urinary incontinence.Materials and Meth...

Purpose: We prospectively compared the sensitivity of antegrade pyelography (AGP), plain film radiography (KUB film), and noncontrast thin-slice abdominal CT for detecting residual stones after percutaneous nephrolithotomy (PCNL). Patients and Methods: We prospectively evaluated 50 patients (53 renal units) who underwent PCNL for radiopaque renal pelvic stones with noncontrast abdominal CT 1 month postoperatively. We compared the number and size of residual fragments, as determined by immediate postoperative AGP and 1-month KUB film and CT scan. Results: Stone-free rates according to AGP, KUB film, and noncontrast CT were 73.6% (39/53), 62.3% (33/53), and 20.8% (11/53), respectively. However, if clinically insignificant residual fragments are included in the success rates, these rates increased to 84.9% (45/53), 83.0% (44/53), and 41.5% (22/53), respectively. Of the 22 patients in whom residual stones were detected by CT but not by KUB film, 10 (45.5%) had stones >4 mm in diameter on CT, with a mean size of 7.4 mm. The sensitivity for the detection of residual fragments was 47.6% for KUB films as judged by noncontrast CT. After CT, seven patients received extracorporeal shockwave lithotripsy for residual stones. Conclusions: Noncontrast thin-slice abdominal CT was the most accurate imaging method to determine the stone-free rate after PCNL. Noncontrast abdominal CT gives accurate information for selecting patients who may benefit from additional treatment and for planning follow-up.

We investigated whether tumor location has independent prognostic significance in upper tract transitional cell carcinoma cases and which factor determines it. We reviewed data on 122 renal pelvis and 102 ureteral tumor cases, including the recurrence pattern. Tumor location and other clinicopathological variables were evaluated regarding cancer specific and recurrence-free survival. Stage pT3 tumors were stratified into those invading renal parenchyma or peripelvic/periureteral fat. Overall 5-year cancer specific survival and recurrence-free survival rates were 77.0% and 71.6%, respectively, at a mean followup of 60.7 months. Of the clinicopathological parameters T stage was the most significant prognosticator of the survival rate, while nodal involvement, high grade and ureteral tumor location were also significant for lower survival rates. Stratification analysis for matching pathological stage revealed that, while survival rates were similar in the renal pelvis and ureteral tumor groups at stage pT2 or less, renal pelvic tumors were associated with significantly higher survival rates than ureteral tumors for stage pT3. Specifically renal pelvic tumors invading the renal parenchyma were associated with a lower local failure rate, and higher cancer specific and recurrence-free survival rates than tumors invading peripelvic or periureteral fat, ie 77.5% vs 49.7% 5-year cancer specific survival and 75.6% vs 32.0% 5-year recurrence-free survival (p = 0.014 and 0.003, respectively). Tumor location is an independent prognostic factor for pT3 upper tract transitional cell carcinoma. The overall better prognosis of renal pelvic tumors was mainly attributable to pT3 tumor outcomes, specifically lesions invading the renal parenchyma. These findings may be due to the protective role of thick renal parenchyma against local tumor spread.