Achieving access to the pyelocaliceal system in percutaneous nephrolithotomy (PCNL) is routinely performed using fluoroscopic guidance. We compared ultrasonography-guided access for PCNL with conventional fluoroscopy-guided access. In a clinical trial, 100 patients with no abnormality of the upper urinary tract were selected from among candidates for PCNL and randomly assigned to two 50-patient groups: ultrasonography-guided access (group 1) versus fluoroscopy-guided access (group 2). In group 1, location of the target calix was identified in the transverse and sagittal planes by real-time ultrasonography when patients were in the prone position. Puncture of the target calix was attempted with a Chiba needle attached to the side of the ultrasound probe. If access to the collecting system was achieved, the site of puncture was controlled using fluoroscopy. In group 2, access was achieved using fluoroscopy guidance. Tract dilatation and stone extraction were the same in both groups. The mean age of patients was 40.7 +/- 12 years and 41.6 +/- 13.7 years in groups 1 and 2, respectively (P = 0.4). The male to female ratio in groups 1 and 2 was 34/16 and 31/19, respectively (P = 0.5). On average, duration of access was 11 +/- 3.5 minutes and 5.5 +/- 1.7 minutes in groups 1 and 2, respectively (P = 0.0001). Duration of radiation exposure, on average, was 0.69 +/- 0.26 minutes and 0.95 +/- 0.44 minutes in groups 1 and 2, respectively (P = 0.0001). Access for PCNL using ultrasonography guidance is an acceptable alternative to fluoroscopy and decreases radiation hazards.

Quercetin is a flavonoid agent detected in fruits and vegetables with anti-inflammatory, antioxidant, and anticancer effects. This flavonoid can suppress cell cycle transition and induce apoptosis in neoplastic cells. Therapeutic effects of quercetin have been assessed in diverse cancers including prostate cancer through the establishment of in vitro and in vivo experiments. Moreover, this agent might prevent the initiation of this type of cancer as it indirectly blocks the activity of promoters of two important genes in the pathogenesis of prostate cancer i.e. androgen receptor (AR) and prostate specific antigen (PSA). Several in vitro investigations have identified the differential influence of quercetin on normal prostate cells versus neoplastic cells, emphasizing its specific cytotoxic effects on cancerous cells. The most appreciated route of quercetin effect on prostate cancer cells is the detachment of Bax from Bcl-xL and the stimulation of caspase families. Besides, quercetin might enhance the effects of other therapeutic options against prostate cancer. For instance, a combination of TNF-related apoptosis-inducing ligand (TRAIL) and quercetin has been recommended as a novel modality for the treatment of prostate cancer. These kinds of strategies might overcome resistance to apoptosis in cancer cells. In the current paper, we summarize the recent data about the preventive and therapeutic influences of quercetin in prostate cancer.

Patients with nephrolithiasis and hyperoxaluria generally are advised to follow a low-oxalate diet. However, most people do not eat isolated nutrients, but meals consisting of a variety of foods with complex combinations of nutrients. A more rational approach to nephrolithiasis prevention would be to base dietary advice on the cumulative effects of foods and different dietary patterns rather than single nutrients. Randomized controlled trial. Recurrent stone formers with hyperoxaluria (urine oxalate > 40 mg/d). The intervention group was asked to follow a calorie-controlled Dietary Approaches to Stop Hypertension (DASH)-style diet (a diet high in fruit, vegetables, whole grains, and low-fat dairy products and low in saturated fat, total fat, cholesterol, refined grains, sweets, and meat), whereas the control group was prescribed a low-oxalate diet. Study length was 8 weeks. Primary: change in urinary calcium oxalate supersaturation. Changes in 24-hour urinary composition. 57 participants were randomly assigned (DASH group, 29; low-oxalate group, 28). 41 participants completed the trial (DASH group, 21; low-oxalate group, 20). As-treated analysis showed a trend for urinary oxalate excretion to increase in the DASH versus the low-oxalate group (point estimate of difference, 9.0mg/d; 95% CI, -1.1 to 19.1mg/d; P=0.08). However, there was a trend for calcium oxalate supersaturation to decrease in the DASH versus the low-oxalate group (point estimate of difference, -1.24; 95% CI, -2.80 to 0.32; P=0.08) in association with an increase in magnesium and citrate excretion and urine pH in the DASH versus low-oxalate group. Limited sample size, as-treated analysis, nonsignificant results. The DASH diet might be an effective alternative to the low-oxalate diet in reducing calcium oxalate supersaturation and should be studied more.

Multiple procedures have been introduced for the management of urinary stones in the upper ureter. In this randomized clinical trial, we compared three surgical options in this regard. From September 2004 to May 2006, we enrolled in the study 150 patients with upper ureteral stones who were referred to our center. We included patients with a stone size >or= 1.5 cm in the greatest diameter. Using the random table, patients were divided into three 50-patient groups by treatment: Group A, retrograde ureteroscopic lithotripsy using a semirigid ureteroscope; group B, transperitoneal laparoscopic ureterolithotomy; and group C, percutaneous nephrolithotripsy. All procedures were performed in a training program. The stone-free rates for patients in groups A, B, and C, at discharge and 3 weeks later, were 56%, 88% and 64% and 76%, 90% and 86%, respectively. Conversion to open surgery and repeated laparoscopy was necessary for two and one patients in group B. Urinary leakage continued more than 3 days in eight (16%) and nine (18%) patients in groups B and C after operation, respectively (P = 0.7). Although the success rate of ureteroscopy was not significantly lower than the two other options, the complications seen with this technique were negligible. Consequently, the procedure of choice for large proximal ureteral stones seems to depend on surgeon expertise and availability of equipment.

To present totally ultrasonography-guided percutaneous nephrolithotomy (PCNL) in the flank position, its preliminary results, and the practical considerations. From January 2007 until July 2007, a total of 30 candidates for PCNL (22 men and 8 women), with a mean age of 40.69 +/- 13.9 years (range 18-65 yrs), were included in this study. We eliminated radiography, and both access to the collecting system and tract dilation were performed under ultrasonographic guidance. The patients were placed in the standard flank position. Twenty-five (83.3%) patients had complete stone clearance. The stone-free rate was 88.9% in the patients with a single calculus (18 cases), and it was 75.0% in the patients with staghorn or multiple calculi (12 cases). There was no major complication intraoperatively or postoperatively. The mean operative time was 68.75 +/- 34.48 minutes (range 30-150 min). The mean hospitalization time was 3.8 +/- 1.15 days (range 3-7 d). Totally ultrasonography-guided PCNL has satisfactory outcomes compared with the standard technique of PCNL, without any major complications and with the advantage of preventing radiation hazards and damage to the adjacent organs. Furthermore, using this technique, anesthesia is more tolerable in the flank position.