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OBJECTIVE: To determine the frequency of stone-free rate after extracorporeal shockwave lithotripsy (ESWL) and its relationship with Hounsfield Units (HUs) of renal calculi. METHODOLOGY: This observational study was carried out at the Department of Urology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan, from June 2015 to December 2015. All patients were evaluated for serum creatinine, coagulation profile, urinalysis and culture and imaging studies including non-contrast computed tomography (NCCT). All were evaluated with X-ray and ultrasound KUB at six weeks of ESWL session. Patients with residual fragments more than 4 mm in size were offered another session of ESWL. In case of persistent stone fragments more than 4 mm in size, stones were labeled as ESWL-refractory and alternative treatment options offered. RESULTS: A total of 139 patients were included in this study. The mean age was 40.0 ± 8.9 years and 91 (65.47%) were males. The mean stone size and mean HUs of all patients were 12.7 ± 3.6 mm and 616.9 ± 304.3, respectively. On last follow-up, out of 139, 95 (68.3%) patients were in stone-free group and 44 (31.6%) in residual stone group, with a mean HUs value of 565 ± 62.1 and 905 ± 61.7, respectively (p=0.001). The mean HUs of stone-free group was significantly lower than that of residual stone group. CONCLUSION: Our findings suggest that the HU measurement of renal calculi on pretreatment NCCT might be helpful in predicting stone-free rate after ESWL. [ABSTRACT FROM AUTHOR]

PURPOSE: To determine the pattern and outcome of renal tumors in young adults in a large surgical series in Pakistan. MATERIALS AND METHODS: We retrospectively analyzed 133 young adults (age: >= 16 to <= 40 years) with 136 renal tumors, who underwent surgical treatment for suspected renal cancer from 1994 till 2010. The clinical and pathological parameters were determined and their impact on final outcome was analyzed. RESULTS: The mean age of the patients was 33.3 ± 6.2 years. Of 136, 121 (88.9%) renal tumors were malignant and 15 (11%) were benign. Among malignancies, 76 (62.7%) patients had stage I or II tumors, 22 (18.1%) stage III, and 23 (19%) stage IV at surgery. The overall cancer-specific survival for malignant tumors at 1, 5, and 10 years was 97%, 83%, and 83%, whereas the cancer-free survival (CFS) was 80%, 63%, and 37%, respectively. Patients with age <= 35 years had 1 and 5-year CFS of 83% and 71%, respectively, as compared with 76% and 49% for patients > 35 years (P = .02; odds ratio = 2.3; P = .03). Regarding tumor size, 1 and 5-year CFS for tumors <= 10 cm was 93% and 75%, while tumors > 10 cm showed CFS of 56% and 41%, respectively (P = .0001; odds ratio = 4.2; P = .0001). For stage I tumors, CFS at 1 and 5 years was 98% and 84%; for stage II, 82% and 63%; and for stage III, 62% and 50%,respectively. One-year survival for stage IV was 48% only (P = .0001). CONCLUSION: A wide heterogeneity of renal tumors is seen in young adults with delayed presentation. [ABSTRACT FROM AUTHOR]