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Objective: We aimed to evaluate and compare the functional characteristics, safety profile and effectiveness of two commonly used ureteral access sheaths (UAS) during flexible ureteroscopy. Methods: After institutional review board approval, patients with proximal ureteral or kidney stones requiring flexible ureteroscopy and UAS were prospectively randomized to group I or group II according to the type of access sheath used. Primary outcome was incidence of intraoperative complications. Results: Eighty-eight patients were enrolled in the study, 44 patients in each group. Sheath size 12/14 FR was used in both cohorts. Median (IQR) stone size was 10 mm (7-13.5) and 10.5 mm (7.37-14) in group I and II respectively (p = 0.915). Nineteen and twenty patients, in group I and II respectively, were pre-stented. Subjective resistance with insertion of the UAS was observed in 9 and 11 patients in group I and II respectively (p = 0.61) while failed insertion was encountered in one patient in group I. Traxer grade 1 ureteral injury was noted in 5 and 6 patients in group I and II respectively while grade 3 injury was seen in 1 patient for both cohorts (p = 0.338). There was less resistance for UAS placement in pre-stented patients (p = 0.0202) but without significant difference in ureteric injury incidence (p = 0.175). Emergency department visits were encountered in 7 (group I) and 5 patients (group II) (p = 0.534). Conclusions: The studied UASs were comparable regarding safety and efficacy in the current study. Pre-stented and dilated ureters had less resistance to insertion although this was not reflected on incidence of ureteric injury.

INTRODUCTION AND OBJECTIVES: Programmed death ligand-1 (PD-L1), as a promising anti-tumor target, has proved its significant clinical value in many malignancies. However, the expression of PD-L1 in Xp11.2 translocation renal cell carcinoma (Xp11.2 RCC) and association with clinical outcomes remains unclear. This study amid to investigate the expression of PD-L1 in Xp11.2 RCC and to assess its prognostic value.METHODS: Immunohistochemistry was conducted on formalinfixed paraffin-embedded (FFPE) specimens from 42 adult Xp11.2 RCC patients who were histologically confirmed by FISH analysis. Students's t-test and Chi-square test were used to evaluate the relationship between PD-L1 expression and clinicopathological parameters. Cox regression models were used to evaluate the prognostic value of all parameters.RESULTS: Among 42 assessed Xp11.2 RCC patients, 13 (31.0%) patients showed high expression of PD-L1 and 29 (69.0%) patients showed low PD-L1 expression. High PD-L1 expression was correlated with the presence of advanced tumor stage (P¼0.001), regional lymph node metastasis (P<0.001) and distant metastasis (P<0.001). In the multivariate analysis, N stage (HR: 4.206, P ¼ 0.035), M stage (HR: 14.311, P ¼ 0.009) and high PD-L1 expression (HR: 4.617, P ¼ 0.006) were independent prognostic factors of PFS. Moreover, high PD-L1 expression (HR: 6.463, P ¼ 0.007), along with distant metastasis (HR: 9.203, P ¼ 0.017), was independent prognostic factors for OS after adjusting for covariates.CONCLUSIONS: High PD-L1 expression is independently associated with tumor progression and predictive of adverse prognosis for Xp11.2 RCC patients. Importantly, our findings may provide a basis for the use of immunotherapy targeting the PD-1/PD-L1 pathway as a potential novel treatment for Xp11.2 RCC patients.

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