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Objectives: To compare the outcomes of standard- and mini-percutaneous nephrolithotomy (PCNL) for the treatment of staghorn stones. Patients and Methods: The data of consecutive adult patients who underwent PCNL for the treatment of staghorn stones, between July 2015 and December 2019 from three hospitals, were retrospectively reviewed. All cases were performed in a prone position under fluoroscopic guidance. The nephrostomy tracts were dilatated to 30 F in standard-PCNL and to 18–20 F in mini-PCNL. Stones were fragmented with pneumatic lithotripsy in both groups. Fragments were removed with forceps in the standard-PCNL, while they were evacuated through the sheath using the vacuum clearance effect in mini-PCNL. A ureteric stent was inserted after mini-PCNL, while a nephrostomy tube was inserted after standard-PCNL. Results: The study included 153 patients; 70 underwent standard-PCNL and 83 underwent mini-PCNL. The stone-free rates of PCNL monotherapy were comparable for both groups (83% for mini-PCNL and 88.6% for standard-PCNL, P = 0.339). The incidence (12% vs 24.3%, P = 0.048) and severity of complications were significantly lesser with mini-PCNL (P = 0.031). Standard-PCNL was associated with increased rate of blood transfusion (12.9% vs 2.4%, P = 0.013) and a significant decrease in haemoglobin (P = 0.018). Hospital stay was significantly longer for standard-PCNL than mini-PCNL (median stay of 6 vs 3 days, P

Objective To compare emergency with elective ureteroscopy (URS) for the treatment of a single ureteric stone. Patients and methods The files of adult patients with a single ureteric stone were retrospectively reviewed. Patients with fever or turbid urine on passage of the guidewire beside the stone underwent ureteric stenting or nephrostomy drainage. Patients who underwent URS were included and divided into two groups: the emergency (EM) Group, those who presented with persistent renal colic and underwent emergency URS within 24 h; and the elective (EL) Group, who underwent elective URS after ≥14 days of diagnosis. Patients with ureteric stents were excluded. The technique for URS was the same in both groups. Safety was defined as absence of complications. Efficacy was defined as the stone-free rate after a single URS session. Results From March 2015 to September 2018, 179 patients (107 in the EM Group and 72 in the EL Group) were included. There were significantly more hydronephrosis and smaller stones in the EM Group (P = 0.002 and P = 0.001, respectively). Laser disintegration was needed in more patients in the EL Group (83% vs 68%, P = 0.023). Post-URS ureteric stents were inserted in more patients in the EM Group (91% vs 72%, P = 0.001). Complications were comparable for both groups (4.2% for EL and 5.6% for EM, P = 0.665). Stone-free rates were also comparable (93% in the EL Group and 96% in the EM Group, P = 0.336). Conclusions Emergency URS can be as safe and effective as elective URS for the treatment of a single ureteric stone if it is performed in patients without fever or turbid urine. Abbreviations: EL Group: elective group; EM Group: emergency group; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; MET: medical expulsive therapy; NCCT: non-contrast CT; SFR: stone-free rate; SWL: shockwave lithotripsy; URS: ureteroscopy

Objectives: To develop and validate a scoring system to assess the need for emergency intervention (EI) in patients with uncomplicated acute renal colic (ARC) due to ureteric stones. Patients and methods: From May 2017 to April 2019, 382 adult patients presented to emergency department with ARC due to ureteral stones diagnosed by non-contrast computed tomography. Patients with solitary kidney, complications secondary to obstruction (intractable vomiting, fever or sepsis), bilateral ureteric stones, Stage ≥3 chronic kidney disease or those who underwent treatment of urolithiasis within the past 6 months were excluded. EI was performed in cases with persistent or recurrent pain despite analgesics. Multivariate analysis was performed for the first 200 patients to detect risk factors for EI. The score was developed from significant factors. Sensitivity and specificity of the ARC score were calculated using receiver operator characteristic (ROC) curve analysis. The data of last 182 patients were used for validation of the score. Results: In the first 200 patients, EI was needed in 119 patients (59.5%) and included ureteric stents in 92, ureteroscopy in 25 and percutaneous nephrostomy in two. Significant factors for EI were stone location (relative risk [RR] 3.34, P = 0.026), creatinine level (RR 1.04, P

I have read with interest this retrospective study that reviewed the results of fluoroless endourological treatment of 183 cases of complex renal and ureteric stones. All cases were performed by an...

Objectives To investigate the effect of stone fragmentation on late stone recurrence by comparing the outcome of extracorporeal shockwave lithotripsy (ESWL) and non-fragmenting percutaneous nephrolithotomy (PCNL), and to investigate factors contributing to recurrent calculi. Patients and methods We evaluated stone recurrence in 647 patients who initially achieved a stone-free status after ESWL and compared the outcomes to 137 stone-free patients treated with PCNL without stone fragmentation. Patients were evaluated every 3 months during the first year and every 6 months thereafter to censorship or time of first new stone formation. Stone recurrence rates were calculated using the Kaplan–Meier method. The effects of demographics, stone characteristics, and intervention on the recurrence rate were studied using the log-rank test and the Cox-regression analysis. Results For ESWL the recurrence rates were 0.8%, 35.8% and 60.1% after 1, 5 and 10 years, which were comparable to the 1.5%, 35.5% and 74.9%, respectively found in the PCNL group (P = 0.57). Stone burden (>8 mm) and a previous history of stone disease were significantly associated with higher recurrence rates regardless of the method of stone intervention (P = 0.02 and P = 0.01, respectively). In the ESWL group, a stone length of >8 mm showed a higher recurrence rate (P = 0.007). In both the ESWL and PCNL groups, there was a significant shift from baseline stone location, with an increased tendency for most new stones to recur in the calyces as opposed to the pelvis. Conclusions In comparison with PCNL, ESWL does not increase long-term stone recurrence in patients who become stone-free. The stone burden appears to be the primary factor in predicting stone recurrence after ESWL.

Objective To compare the efficacy, safety and cost of extracorporeal shockwave lithotripsy (ESWL) and percutaneous nephrolithotomy (PNL) for treating a 20–30 mm single renal pelvic stone. Patients and methods The computerised records of patients who underwent PNL or ESWL for a 20–30 mm single renal pelvic stone between January 2006 and December 2012 were reviewed retrospectively. Patients aged

Objective To validate the Arabic version of the Ureteral Stent Symptoms Questionnaire (USSQ). Patients and methods The English version of the USSQ was translated into Arabic using a multi-step process by three urologists and two independent translators. The Arabic version was validated by asking 37 patients with temporary unilateral ureteric stents to complete the questionnaire at 2 weeks after stent insertion. The second group included 53 healthy individuals who agreed to complete the Arabic version of the questionnaire. The reliability of the Arabic version was evaluated for internal consistency using Cronbach’s α test. Domain structures were examined by interdomain (section) associations using Spearman’s correlation coefficient (r). The discrimination validity was evaluated by comparing the scores of patients with those of healthy individuals, using the Mann–Whitney test. Results Internal consistency was high for the sexual index and intermediate for urinary, pain and general health indices. There were good correlations of urinary symptoms with body pain (r = 0.596) and general health (r = 0.690). There was also a good correlation between body pain and general health (r = 0.681). For discrimination validity, there were significant changes in all domain scores when comparing patients with ureteric stents and healthy individuals (P

Objective To assess the perioperative morbidity of transvesical open prostatectomy (OP) and its predictors as a treatment for benign prostatic hyperplasia (BPH), and to update knowledge about the morbidity of OP using a standardised morbidity scale (Clavien), thus providing a platform for comparison with the newly developed techniques. Patients and methods We retrospectively review men with BPH who were treated with transvesical OP between April 2002 and December 2012. Preoperative patients’ data were reviewed for relevant variables. Operative details, the postoperative course, and 30-day relevant data were assessed. The study cohort was stratified based on the resected prostate weight, with group 1 having a resected weight of ⩽120 g and group 2 >120 g. Results The review identified 163 patients. The mean (SD, range) duration of catheterisation after OP was 7.9 (2.2, 5–20) days and the duration of hospitalisation after OP was 8.1 (1.8, 5–15) days; both were significantly longer in group 2. All patients were able to void spontaneously by the first follow-up visit. Of 163 OP procedures, there were 106 perioperative complications in 69 (42.3%). Low-grade complications (grade ⩽2) included 38 (45.2%) and 53 (67%) in groups 1 and 2, respectively (P = 0.8). High-grade complications (⩾3) included 3 (3.5%) and 12 (15.1%) in groups 1 and 2, respectively (P = 0.02). The blood transfusion rate was 24.5%, the perioperative mortality rate was 1.2% and the re-admission rate within the first 30 days after OP was 1.2%. High-grade complications were significantly associated with a greater resected prostate weight (odds ratio 1.08, 95% CI 1.001–1.17, P = 0.046). Conclusion The OP procedure is associated with a significant perioperative morbidity that correlated significantly with the resected prostate weight, especially for high-grade complications.

To present the results of percutaneous nephrolithotomy (PCNL) for treating staghorn stones.A database was compiled from the computerised files of patients who underwent PCNL for staghorn stones between 1999 and 2009. The study included 238 patients (128 males and 110 females) with a mean (SD) age of 48.9 (14) years, who underwent 242 PCNLs, and included staghorn stones that were present in the renal pelvis and branched into two or more major calyces. PCNL was performed or supervised by an experienced endourologist. All perioperative complications were recorded. The stone-free status was evaluated after PCNL and again after 3 months.Multiple tracts were needed in 35.5% of the procedures, and several sessions of PCNL were needed in 30% of patients. There were perioperative complications in 54 procedures (22%); blood transfusion was needed in 34 patients (14%). The stone-free rate for PCNL monotherapy was 56.6% (137 patients). Secondary procedures were required for 51 patients (21%), and included shock-wave lithotripsy for 49 and ureteroscopy for two. The 3-month stone-free rate was 72.7% (176 patients). Multiple tracts resulted in an insignificantly higher overall complication rate than with a single tract (P = 0.219), but the reduction in the haemoglobin level was statistically significant with multiple tracts (P = 0.001).PCNL for staghorn stones must be done by an experienced endourologist in a specialised centre with all the facilities for stone management and treatment of possible complications. The patients must be informed about the range of stone-free and complication rates, and the possibility of multiple sessions or secondary procedures.

Objective To evaluate the detectability, size, location and density of urinary stones with unenhanced computed tomography (CT), using the half-radiation (low) dose (LDCT) technique, compared with the standard-dose CT (SDCT), in obese patients. Patients and methods The study included 50 patients with a body mass index of >30 kg/m2 and bilateral renal stones diagnosed with SDCT, and managed on one side. All the patients had LDCT during the follow-up and SDCT was used as a reference for comparison. Results Of the 50 patients, the right side was affected in 27 and the left side in 23. In all, 35 patients had a single stone while the remaining 15 had multiple stones. With SDCT, 95 stones were detected; there were 45 of ⩽5 mm, 46 of 6–15 mm and only four of >15 mm. LDCT barely detected three stones of

Objective To present the results of percutaneous nephrolithotomy (PCNL) for treating staghorn stones. Patients and methods A database was compiled from the computerised files of patients who underwent PCNL for staghorn stones between 1999 and 2009. The study included 238 patients (128 males and 110 females) with a mean (SD) age of 48.9 (14) years, who underwent 242 PCNLs, and included staghorn stones that were present in the renal pelvis and branched into two or more major calyces. PCNL was performed or supervised by an experienced endourologist. All perioperative complications were recorded. The stone-free status was evaluated after PCNL and again after 3 months. Results Multiple tracts were needed in 35.5% of the procedures, and several sessions of PCNL were needed in 30% of patients. There were perioperative complications in 54 procedures (22%); blood transfusion was needed in 34 patients (14%). The stone-free rate for PCNL monotherapy was 56.6% (137 patients). Secondary procedures were required for 51 patients (21%), and included shock-wave lithotripsy for 49 and ureteroscopy for two. The 3-month stone-free rate was 72.7% (176 patients). Multiple tracts resulted in an insignificantly higher overall complication rate than with a single tract ( P = 0.219), but the reduction in the haemoglobin level was statistically significant with multiple tracts ( P = 0.001). Conclusions PCNL for staghorn stones must be done by an experienced endourologist in a specialised centre with all the facilities for stone management and treatment of possible complications. The patients must be informed about the range of stone-free and complication rates, and the possibility of multiple sessions or secondary procedures.

Background As laparoscopy becomes a standard approach in many urological procedures, researchers strive to make minimally invasive surgery less invasive. Our objective was to apply recent innovations in equipment and surgical approaches to develop the technique and perform laparo-endoscopic single site radical prostatectomy (LESS-RP). Methods The technique for LESS-RP was derived by combining existing techniques of standard laparoscopic RP and developing techniques of urological LESS. This incorporated newly available low-profile trocars, flexible instruments and a flexible-tip laparoscope. The procedure was performed through a single 3-cm transverse infra-umbilical incision. LESS-RP was completed successfully via a single operative site without auxiliary needles or trocars. Perioperative variables and postoperative outcomes were recorded and measured. Results The operative time was 424 min and the hospital stay was 10 days because of a vesicourethral leak and ileus. The anastomotic leak resolved and the urethral catheter was removed at 4 weeks after surgery. The final pathology showed negative margins and Gleason 3 + 4 pT2c prostatic adenocarcinoma. Conclusions LESS-RP is feasible by replicating laparoscopic RP techniques and incorporating the LESS technique with the advent of flexible-tip laparoscopes and flexible instruments. After a learning curve has been overcome, this should be further tested prospectively to compare oncological and functional outcomes with laparoscopic and robotic-assisted RP.

Objective To report on a case of traumatic testicular displacement (TTD) and torsion, which is a rare consequence of pelvic trauma. Methods A 34-year-old motorcycle rider who presented immediately following a head-on collision with a car. His past surgical history included bilateral inguinal varicocoele repair. The patient recalled that his genitals collided with a part of the motorcycle before coming off the vehicle. He complained of left-sided groin pain and was found to have an empty left hemi-scrotum, a tender palpable lump in the left suprapubic region, and bruising in the area. A contrast-enhanced computed tomography (CT) scan revealed an empty scrotum and an ovoid structure measuring 5 × 3 × 4 cm in the subcutaneous tissue with an adjacent spermatic cord and surrounding fat stranding. He was immediately transferred to the operating theatre for surgical exploration of the lower abdomen. Results After anaesthesia, the testis was repositioned into the scrotum and then we proceeded with exploration of the scrotum that revealed a torted left testicle. De-torsion, warm fomentation and orchidopexy of a viable left testicle was performed. He made an uneventful recovery. He was then transferred to a tertiary trauma centre for further management of his injuries. TTD is defined as migration of one or both testicle outside the scrotum. The most common mechanism of trauma is a rapid deceleration straddle injury against a motorcycle fuel tank. Predisposing factors include inguinal hernia repair, wide external inguinal ring, and atrophic testes. Radiological examinations of choice include colour-flow Doppler ultrasonography and CT scans of the abdomen and pelvis. Management consists of either closed reduction of the testicle or surgical exploration. Conclusion Early diagnosis and management of TTD is imperative to preserve the displaced testicle.

Objective To compare the results of emergency vs elective ureteroscopy (URS) for the treatment of a single ureteric stone. Methods We prospectively constructed a database for patients who underwent URS in the Al-Amiri Hospital from March 2015 through December 2017. Inclusion criteria were adult patients with a single ureteric stone diagnosed by computed tomography of the kidneys, ureters and bladder. Patients who had fever or ureteric stents were excluded. The emergency URS group (EM Group) included patients who presented to the emergency department with persistent renal colic and underwent emergency URS. The elective URS group (EL Group) included patients who underwent elective URS after admission through the outpatient appointment system. The technique for URS was the same in both groups. Safety was defined as absence of complications, whilst effectiveness was defined as stone-free rate after a single URS session. The chi-squared and t -test were used to compare the data of both groups. Results The study included 124 patients with a mean (SD) age of 41.4 (12.6) years. The EM Group included 67 patients and the EL Group included 57 patients. Laser disintegration was needed in 48 patients (84%) in the EL Group and 43 (64%) in the EM Group ( P = 0.012). Post-URS stents were placed in 43 patients (75.4%) in the EL Group and 60 (89.6) in the EM Group ( P = 0.037). Complications were comparable (3.5% for the EL and 4.5% for EM groups, P = 0.785). Ureteric perforation in one patient in the EM Group was treated with a JJ stent. Sepsis in one patient in each group was treated with culture-sensitive antibiotics. Upper tract obstruction after removal of the ureteric catheter in one patient in the EL Group required a JJ stent. Haematuria in one patient in EM Group was treated with blood transfusion. Stone-free rates were comparable, 93% in the EL Group and 97% in the EM Group ( P = 0.297). Conclusion Emergency URS in selected cases can be as safe and effective as elective URS for treatment of a single ureteric stone.

Objectives To assess the probability of spontaneous stone passage and its predictors after drainage of obstructed kidney by JJ stent, as insertion of an internal ureteric stent is often used for renal drainage in cases of calcular ureteric obstruction. Patients and methods Between January 2011 and June 2013, patients for whom emergent drainage by ureteric stents were identified. The patients’ demographics, presentation, and stone characteristics were reviewed. The primary endpoint for this study was stone-free status at the time of stent removal, where all patients underwent non-contrast spiral computed tomography (NCCT) before stent removal. Ureteroscopic stone extraction was performed for CT detectable ureteric stones at the time of stent removal. Potential factors affecting the need for ureteroscopic stone extraction at the time of stent removal were assessed using univariate and multivariate statistical analyses. Results Emergent ureteric stents were undertaken in 196 patients (112 males, 84 females) with a mean (SD) age of 53.7 (16.2) years, for renal obstruction drainage. At the time of stent removal, 83 patients (42.3%) were stone free; with the remaining 113 patients (57.7%) undergoing ureteroscopic stone extraction. On multivariate analysis, stone width [odds ratio (OR) 15.849, 95% confidence interval (CI) 2.83; P = 0.002) and radio-opaque stones (OR 12.035, 95% CI 4.65; P

Objective To determine the use of the prostate specific antigen (PSA) level and digital rectal examination (DRE) findings to estimate the resected tissue weight (RTW) before transurethral resection of the prostate (TURP). Patients and methods We retrospectively analysed 983 patients who underwent TURP between December 2006 and December 2012. The primary outcome was the RTW required for clinical improvement, and was not associated with re-intervention. Age, PSA level, body mass index (BMI) and DRE findings were correlated and modelled with the RTW. The DRE result was defined as DREa (small vs. large) or DREb (small vs. moderate vs. large) according to the surgeon’s report. Equations to calculate RTW were developed and tested using receiver operating characteristic (ROC) curve analyses. Results There were significant correlations between PSA level (r = 0.4, P 30 g, and 84% and 63% for estimating a RTW of >40 g, respectively. Conclusions The PSA level and DRE findings can be used to predict the RTW before TURP.

In the original submission authors included a Conflict of Interest statement in their cover letter. Due to a procedural error the statement was not included in the final publication. The disclosure statement in full follows here: Given his role as an Editor-in-Chief and co-author of this paper, A. Shokeir, certifies that the journal is partially supported by Karl Storz GmbH. That support had no influence on the peer-review of this paper, which was entirely independent of Karl Storz.

Objectives To present treatments for kidney preservation in the management of emphysematous pyelonephritis (EPN), and to evaluate the functional outcome of preserved kidneys during the follow-up. Patients and methods The computerized files of patients with EPN from 2000 to 2010 were reviewed. After initial resuscitation, ultrasonography-guided percutaneous tubes were placed for drainage of infected fluid and gas. A radio-isotopic renal scan was done after stabilization of the patients’ condition. Preservation of the affected kidney was attempted when the differential function was >10%. A renal isotopic scan was taken during the follow-up to evaluate renographic changes in preserved kidneys. Results The study included 33 kidneys in 30 consecutive patients (mean age 51.7 years, SD 10.9). Kidney preservation was applicable for 23 kidneys (20 patients). Preservation methods included percutaneous nephrostomy for 12, percutaneous tube drain for two and conservative treatment for nine kidneys (six patients). Nephrectomy was performed for 10 kidneys (emergency in three and delayed in seven). The frequency of post-treatment septic shock after kidney preservation (10%) was significantly lower than after nephrectomy (20%, P = 0.005). The overall mortality rate was 7% (two patients). The follow-up was completed for 13 patients with 15 preserved kidneys for a mean duration of 21 months. During the follow-up, differential renographic clearance of the affected kidney was stable in 13 of 15 while two kidneys showed improvement. Conclusions Kidney preservation should be the primary goal in the treatment of EPN when the differential renal clearance is >10%. It was associated with fewer complications than nephrectomy and the follow-up showed a favourable functional outcome of the preserved kidneys.