We evaluated possible factors predicting testicular cancer in patients undergoing testis sparing surgery. Materials and Methods: We retrospectively analyzed the records of all patients who underwent testis sparing surgery for a small testicular mass at a total of 5 centers. All patients with 1 solitary lesion 2 cm or less on preoperative ultrasound were enrolled in the study. Testis sparing surgery consisted of tumor enucleation for frozen section examination. Immediate radical orchiectomy was performed in all cases of malignancy at frozen section examination but otherwise the testes were spared. Univariate and multivariate analysis were performed and ROC curves were produced to evaluate preoperative factors predicting testicular cancer. Results: Overall 147 patients were included in the study. No patient had elevated serum tumor markers. Overall 21 of the 147 men (14%) presented with testicular cancer. On multivariate analysis the preoperative ultrasound diameter of the lesion was a predictor of malignancy (OR 6.62, 95% CI 2.26e19.39, p[0.01). On ROC analysis lesion diameter had an AUC of 0.75 (95% CI 0.63e0.86, p[0.01) to predict testicular cancer. At the best cutoff of 0.85 the diameter of the lesion had 81% sensitivity, 58% specificity, 24% positive predictive value and 95% negative predictive value. Conclusions: Our study confirms that small testicular masses are often benign and do not always require radical orchiectomy. Preoperative ultrasound can assess lesion size and the smaller the nodule, the less likely that it is malignant. Therefore, we suggest a stepwise approach to small testicular masses, including tumorectomy, frozen section examination and radical orchiectomy or testis sparing surgery according to frozen section examination results.

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Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Pelvic lymph‐node dissection during radical prostatectomy for prostate cancer is certainly a fundamental staging procedure but its therapeutic role is yet under debate. This retrospective study suggests that, in patients with intermediate‐ and high‐risk of prostate cancer, the greater the number of lymph‐nodes removed, the lower the risk of biochemical relapse, even in the presence of 1 or 2 lymph‐node metastasis. However, the Will Rogers phenomenon must be considered due to the retrospective nature of the present study. OBJECTIVE To assess the impact of pelvic lymph node dissection (PLND) and of the number of lymph nodes (LNs) retrieved during radical prostatectomy (RP) on biochemical relapse (BCR) in pNX/0/1 patients with prostate cancer according to the clinical risk of lymph node invasion (LNI). PATIENTS AND METHODS We evaluated 872 pT2‐4 NX/0/1 consecutive patients submitted to RP between October 1995 and June 2009, with the following inclusion criteria: (i) a follow‐up period ≥12 months; (ii) the avoidance of neoadjuvant hormonal therapy or adjuvant hormonal and/or adjuvant radiotherapy; (iii) the availability of complete follow‐up data; (iv) no pathological T0 disease; (v) complete data regarding the clinical stage and Gleason score (Gs), the preoperative prostate‐specific antigen (PSA) level and the pathological stage. The patients were stratified as having low risk (cT1a‐T2a and cGs ≤6 and PSA level < 10 ng/mL), intermediate risk (cT2b‐T2c or cGs = 7 or PSA level = 10–19.9) or high risk of LNI (cT3 or cGs = 8–10 or PSA level ≥ 20). The 872 patients were divided into two LN groups according to the number of LNs retrieved: group 1 had no LN or one to nine LNs removed; group 2 had 10 or more LNs. The variables analysed were LN group, age, PSA level, clinical and pathological stage and Gs, surgical margin status, LN status and number of LN metastases; the primary endpoint was the BCR‐free survival. RESULTS The mean follow‐up was 55.8 months. Of all the patients, 305 (35%) were pNx and 567 (65.0%) were pN0/1. Of the 567 patients submitted to PLND, the mean number of LNs obtained was 10.9, and 49 (8.6%) were pN1. In the 402 patients at low risk of LNI, LN group was not a significant predictor of BCR at univariate analysis, while in the 470 patients at intermediate and high risk of LNI, patients with ≥10 LNs removed had a significantly lower BCR‐free survival at univariate and multivariate analysis. CONCLUSION In our study population, a more extensive PLND positively affects the BCR‐free survival regardless of the nodal status in intermediate‐ and high‐risk prostate cancer.

What's known on the subject? and What does the study add?• Without age being a limiting risk factor, recent reports have shown that almost any version of percutaneous nephrolithotomy (PCNL) can be safely applied in children. As there has been no standardisation in the age categorisation of children, there are inconsistencies among the age subgroups in the current literature.• To achieve a standard terminology and thus a common language, the World Health Organization age classification criterion was used in the present study. Based on the findings, we can suggest that PCNL can be applied safely and effectively in children in different age groups. Objectives• To present the overall results of paediatric percutaneous nephrolithotomy (PCNL) compared with adults.• To present the indications, complications and outcomes of patients treated in the participating centres in the PCNL Global Study, as categorised in different age groups. Patients and Methods• The Clinical Research Office of the Endourological Society (CROES) Study was conducted from November 2007 to December 2009, and included 96 centres and >5800 patients.• All children aged Յ14 years in the PCNL Global Study database were the focus of the study. Results• In all, 107 children aged Յ14 years were included in the analysis.• The PCNL procedure was conducted in 13 patients (12.1%) in the supine position; tubeless PCNL was performed in 15 patients (14%); and balloon dilatation was preferred in 22 patients (20.5%). The overall mean operative duration was 97.02 min; blood transfusion rate, fever and stone-free rates were 9%, 14% and 70.1%, respectively. • A comparison of the paediatric PCNL cases according to age groups showed no statistically significant differences between the subgroups for patient characteristics, co-morbidities, renal anomalies, or previous surgical history. • In the evaluation of the operative details, the mean sheath size and nephrostomy tube size were larger in school-age children than the preschool children (P = 0.01 and 0.002, respectively). There was a difference in the preferred methods for confirming stone-free status, with ultrasonography preferred more in preschool children (P < 0.001).• The PCNL procedure position, puncture site, dilatation method, postoperative tube application, and surgical outcomes were comparable in school-and preschool-age children. While operative details showed some differences between children and adults, the surgical outcomes were comparable.