Impact of Residual Fragments following Endourological Treatments in Renal Stones

Today, shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), and flexible ureterorenoscopy (URS) are the most widely used modalities for the management of renal stones. In earlier series, treatment success of renal calculi assessed with KUB radiography, ultrasound, or intravenous pyelography which are less sensitive than CT that leads to be diversity of study results in reporting outcome. Residual fragments (RFs) after interventional therapies may cause pain, infection, or obstruction. The size and location of RFs following SWL and PCNL are the major predictors for clinical significant symptoms and stone events requiring intervention. There is no consensus regarding schedule for followup of SWL, PCNL, and flexible URS. Active monitoring can be recommended when the stones become symptomatic, increase in size, or need intervention. RFs <4 mm after SWL and <2 mm after PCNL and flexible URS could be actively monitored on an annual basis with CT. Early repeat SWL and second-look endoscopy are recommended after primary SWL and PCNL, respectively. There is insufficient data for flexible URS, but RFs can be easily treated with repeat URS. Finally, medical therapy should be tailored based on the stone analysis and metabolic workup that may be helpful to prevent regrowth of the RFs

Zoledronic acid effects interleukin-6 expression in hormone-independent prostate cancer cell lines

OBJECTIVE: To investigate the inhibitory effects of zoledronic acid (ZA) on tumor related growth factor IL-6 in hormone resistant prostate cancer cell lines. The association between apoptosis and IL-6 inhibition was also assessed. MATERIALS AND METHODS: PC-3 and DU145 cell lines were treated with different concentrations of ZA (1-100µM) at various intervals (24-72 h.). The cell viability was investigated by XTT assay and apoptotic effect was evaluated by cell death detection ELISA kit. Caspase 3/7 activity assay was performed to confirm apoptosis. IL-6 levels were measured by ELISA in the supernatant, and these data were also confirmed by IL-6 mRNA analysis using RT-PCR. RESULTS: PC-3 and DU145 cell lines were sensitive to ZA mediated cytotoxicity in a dose- and time-dependent manner. However, the apoptotic effect was significantly different among PC-3 and DU145 cells (p < 0.05). IL-6 secretion was significantly lower in both cell lines, compared to the untreated control cells (p < 0.05). Although the increased inhibition of IL-6 secretion was associated with increased apoptosis in DU145 cells (p = 0.002), there was no similar association for PC-3 cell line (p = 0.347). When compared to the untreated controls, the number of cDNA copies was significantly lower in the ZA treated DU145 cell line at doses of 30 and 90µM (p < 0.05), suggesting a reduced expression of IL-6 mRNA. CONCLUSION: ZA exhibited a time- and dose-dependent apoptotic effect on PC-3 and DU145 prostate cancer cell lines and this effect was associated with inhibited secretion of IL-6 in DU145 cell line

Comparison of Shockwave Lithotripsy and Laser Ureterolithotripsy for Ureteral Stones

Objective: This study aimed to compare shockwave lithotripsy (SWL) with ureteroscopic lithotripsy (URS) for ureteral stones in terms of stone-free rates, complication rates, and overall treatment costs. Materials and Methods: Data of 886 adult patients who underwent URS or SWL were retrospectively evaluated, of which 184 patients underwent SWL and 702 underwent URS. The groups were compared in terms of patient characteristics, stone-free rates, complications, and costs. Results: No significant differences were found between the groups in terms of age, gender, and relevant sides (p>0.05). A significant difference was observed in favor of SWL for upper ureteral stones <10 mm regarding treatment success (p=0.018), and no significant difference was observed between the two groups in terms of mid- and distal ureteral stones (p=1 and p=0.655, respectively). Complications were classified according to the modified Clavien-Dindo grading system. No major complications were observed in the two groups, except for one patient with Clavien-Dindo grade IVa complication. SWL was significantly more economical than URS (p<0.001). Conclusion: The results of this study suggest that SWL can be recommended as the primary treatment option for upper ureteral stones <10 mm because of its high stone-free rates and low overall costs