INTRODUCTION: To determine the risk factors contributing to pulmonary complications among patients who undergo upper pole prone percutaneous nephrolithotomy (uPPCNL). This will serve as a guide to urologists who utilize uPPCNL among their patients, so that they may monitor them more closely for these events. METHODS: A retrospective chart review was done on all patients who underwent uPPCNL from January 2015 to December 2017. Patient characteristics (age, gender, BMI, co-morbidity) and stone demographics (Stone size, Guy’s Stone score, laterality, stone location) were summarized as well as intraoperative parameters inclusive of operative time, number of tracts, estimated blood loss, and length of hospital stay. Point biserial correlation and Pearson Chi-square for independent tests were used to identify the independent predictors of pulmonary complications. RESULTS: Nine hundred ninety-two patients underwent uPPCNL during the study period. Fifty-two (5.2%) had pulmonary complications. Sixty-seven pulmonary complications were tallied because some had two complications at one time. The most common was pleural effusion 35(48%), followed by atelectasis in 16(30%), hospital-acquired pneumonia 14(27%) and acute respiratory distress syndrome 2(4%). Forty-one (78.8%) and 11(21.2%) required medical and surgical interventions, respectively. Higher Guy’s stone scores, larger stone size, and longer hospital stay were significant predictors for developing pleural effusion. Patients with higher preoperative serum creatinine and longer hospital stay were significantly associated with surgical management (p < 0.05). CONCLUSION The incidence of pulmonary complications after uPPCNL is low and only a minority need surgical management. When risk factors are present, these patients need to be monitored closely so that a timely intervention may be done to avoid life-threatening consequences.

BACKGROUND: Prostate cancer is the most common malignant tumor among adult men worldwide andthe second most common cause of cancer death. Gleason grading system is a powerful predictor in theprognosis and treatment outcome of prostate carcinoma. OBJECTIVE: This retrospective study aims to evaluate the accuracy of transrectal ultrasound (TRUS)-guided biopsy of the prostate compared to radical prostatectomy specimen in predicting thepathological grading of prostate adenocarcinoma using the Gleason scores between specimens. METHODS: This is a review of 69 patients who underwent radical prostatectomy due to prostate cancerin 2010-2015. The Gleason scores of the transrectal ultrasound biopsies were compared with thesurgical specimen. RESULTS: The biopsy Gleason scores obtained from the TRUS biopsy and the radical prostatectomyspecimens were similar in 79.7% of the cases. In patients with moderately differentiated tumors onbiopsy (Gleason score of 5 to 7), the concordance rate was 83% with upgrading after surgery in 16%of the cases. In poorly-differentiated tumors on biopsy (Gleason score of 8 to 10), 74% revealed thesame score on histopathological examination after radical prostatectomy, while 25% of the caseswere given lower Gleason scores after operation. Overall, 20.3% cases were discrepant by 1 or moreGleason scores after radical prostatectomy. There was a good histopathological correlation betweenTRUS biopsy and prostatectomy specimen {AUC =0.787(p=0.001)}. CONCLUSION The overall accuracy of Gleason score on transrectal ultrasound-guided biopsies inpredicting prostatectomy specimen grade is favorable. It plays a significant role in clinical decisionmaking of patients with prostate carcinoma.