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Objective To develop a technique that helps avoid colonic injury during percutaneous nephrolithotomy (PCNL) in these patients. Patients and Methods PCNL was prospectively performed in a cohort of adults with renal stones in a horseshoe kidney (HSK). PCNLs were done using a standardized technique in prone position in all patients. The colon was radiologically delineated by injecting air—through a catheter in the anal canal—to help localize its position in relation to the pelvicalyceal system (PCS). Patients were observed in hospital for 48 hours postoperatively to detect any potential complications related to the PCNL or to the colon insufflation modification. Results Thirteen adult patients (11 men and 2 women) with renal stones in a HSK were included in the study. The colon was well radiologically delineated with air in all cases. The PCS was successfully accessed, subcostally, with a single access at the upper calyx in 11 cases and multiple accesses in 2 cases. The colon was in the way of the puncture in 2 cases in which we used a more medial access and the colon was successfully avoided. Stones were completely removed during the PCNL in 11 of the 13 cases (84.6%). One case necessitated intraoperative blood transfusion. No other complications were reported by any of the patients who were discharged home after 48 hours. Conclusion Colonic radiological delineation technique is helpful in accessing the PCS quickly, saving the colon, and causing no discomfort to patients with renal stones in a HSK.

To evaluate the use of penile circular skin graft versus flap as a ventral onlay for bulbo-penile stricture urethra.Between 2003 and 2009, 37 patients with bulbo-penile stricture were randomized to penile methods circular skin graft (PCG = 18) or flap (PCF = 19). Inclusion criteria included postinstrumentation or idiopathic stricture. Exclusion criteria were unhealthy skin and previous urethrotomy/urethroplasty. Patients had urethrogram at three weeks, three months, one year, and urethroscopy when needed. Any subsequent urethrotomy/urethroplasty was considered a failure. Chi-square and Student's t test were used for analysis.Patients' ages were 45.3 (range: 30-65) and 45.5 (35-60) yr in PCGPCF respectively. Stricture length was 15.2 (10-22)14.1 (9-21) cm in PCGPCF respectively. The stricture was postinstrumentation in 9 and 11 and idiopathic in 9 and 8 patients in PCGPCF respectively. Mean follow up was 36.2 (12-60) and 37.1 (range: 13-24) months in PCG and PCF respectively. Operative time was significantly shorter in PCG than in PCF (203.3 and 281.6 min, respectively; P = .000). Early postoperative complications were similar in both groups. Superficial skin necrosis occurred only in the PCF group (3 cases). Late complications of mild postvoid dribbling occurred similarly in both groups. One patient in PCF had a urethro-cutaneous fistula at the level of fossa navicularis that was repaired later. Stricture recurred in 5 (27.7%) and 4(21%) patients in PCG and PCF, respectively (P = .249). Four patients had visual internal urethrotomy (2, 2), four needed anastomotic urethroplasty (2, 2) in PCG and PCF, respectively, and one needed buccal mucosal graft in the PCG group.At intermediate follow-up, both penile circular graft and flap had similar and high success as a ventral onlay for repair of long bulbo-penile stricture with a low rate of complications.