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Background: A ureteral double-J stent (D-JS) is a hollow tube used to redirect urine from the kidneys to the bladder, Aim: This research aimed to compile data on patients in upper Egypt to understand better the rate of neglect of double-J ureteral stents (DJS), the reasons for this neglect, the associated consequences, and the current methods for dealing with these issues. Patients and Methods: This hospital-based prospective clinical investigation was conducted in The Urology Department, Al-Azhar University Hospitals, Assiut, Egypt. It comprised all patients who presented with neglected DJS (indwelling time > 6 months) between January and July of 2022. DJ stents were implanted after URS in 37.3% of patients. The DJ stent insert was used before SWL in 20.3% of patients and after percutaneous nephrolithotomy (PCNL) in 12.8% of cases. Results: 22 patients (55%) received medical treatment for UTIs, 16 instances (40%) received conservative treatment for gross hematuria, & the other cases required several treatment modalities due to mixed pathology. And we watched that different approaches were required for stent removal. The majority of cases (24%) were removed with simple cystoscopy, 9 cases (22%) via URS, 2 cases via PNL, 3 cases (7.5%) via cystolithotripsy, and the remaining cases (2%) via combination endoscopic and/or open surgical techniques. Conclusion: DJS indwelling time-related problems are more likely in patients who are noncompliant or who have disregarded their stent. In spite of the widespread use of endourological procedures, avoiding problems should always be the first concern. Potential consequences from ignored DJS can be avoided if regular operating procedures for placement and removal are followed. [ABSTRACT FROM AUTHOR]

Background: Nephrolithiasis is the third most common disease of the urinary tract with a 1-year recurrence rate of 7% and 10-year recurrence rate of 50%. Shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS), and percutaneous nephrolithotomy (PCNL) are different surgeries to treat renal stones. Percutaneous nephrolithotripsy (24- 30F) remains the standard procedure for treating large renal calculi. While achieving high SFR, it also has many drawbacks such as bleeding, postoperative pain, and a long recovery period due to its large access tract, so the Ultra mini percutaneous nephrolithotripsy (12-14F) with a smaller tract size came into existence to reduce renal parenchymal injury associated with standard PCNL. ESWL is a minimally invasive intervention with good patient tolerance; it is regarded as the first line treatment for nephrolithiasis < 20 mm in size. Aim andObjectives: Compare results, safety and outcome of Ultra mini PCNL versus stented extracorporeal shock wave lithotripsy (ESWL) for the management of renal calculi from 10 - 20 mm. Materials and Methods: This study was conducted at Urology department, Faculty of Medicine, Ain Shams University. Patients were recruited from the outpatient urology clinic between March 2021 till September 2022. Inclusion criteria included patients between 18 and 60 years, having radioopaque renal stones ranging from 10-20 mm with BMI not exceeding 40. Exclusion criteria were patients who had radiolucent stones, smaller than 10 mm or larger than 20 mm, with congenital renal anomalies or spinal deformity or BMI exceeding 40. Patients with uncorrected bleeding diathesis or pregnant females or untreated UTI were also excluded. After meeting our inclusion and exclusion criteria, 90 patients were thoroughly informed about the study, feeling well about participating in it, an informed written consent was taken from them. Patients were randomized to either Ultra-Mini-Percutaneous nephrolithotomy group or stented SWL group via the closed envelope method(each group 45 patients). Results: Stone free rate was higher in the Ultra-mini-PCNL group compared to the stented ESWL group with no statistically significant difference with P-value = 0.316. As for the need for retreatment was slightly higher in the stented ESWL group compared to the Ultra-mini-PCNL group yet this difference was statistically insignificant with P-value 0.681. No statistical significant difference between both groups regarding post operative complications fever, hematuria and need for blood transfusion respectively. Operative time and hospital stay were significantly higher in the ultra-Mini-PCNL group compared to the stented ESWL group with P-value <0.001 for both. Conclusion: Both stented ESWL and Ultra-Mini-PCNL are good treatment choices for renal stones less than 2 cm with low complication rates. Denying Ultra-Mini-PCNL from patients with medium sized stones for fear of complications is considered unwarranted. Stone size indices were significant predictor for the need of retreatment. Further studies to compare stone free rate based on stone size in both interventions are needed. [ABSTRACT FROM AUTHOR]

Objectives: To compare the outcomes of miniaturised percutaneous nephrolithotomy (mini‐PCNL) and extracorporeal shockwave lithotripsy (ESWL) in the management of 10–20 mm, non‐lower pole, renal stones. Patients and Methods: This prospective randomised double‐arm trial was conducted at a tertiary care hospital in Egypt from February to December 2020. Adult patients with single, non‐lower pole, high‐density (≥1000 HU) renal stones were randomised to receive mini‐PCNL or ESWL. The stone‐free rate (SFR); operative, fluoroscopy and hospitalisation times; blood loss; auxiliary procedures; retreatment; unscheduled hospital readmission; and complications were compared between the groups. Results: The primary analysis included 34 patients in the mini‐PCNL group and 33 in the ESWL group. Overall, the SFR was 97.1% in the mini‐PCNL group vs 30.3% in the ESWL group (P < 0.001). All patients in the ESWL group required retreatment, and none of them were stone‐free after the first ESWL session. None of the patients in the mini‐PCNL group required retreatment. The overall operative time, fluoroscopy time, auxiliary procedure, retreatment, and unscheduled hospital readmission were significantly higher in the ESWL group. The hospital stay and decrease in the haemoglobin level were significantly higher in the mini‐PCNL group. The groups were comparable for the overall complication rate. Conclusions: Mini‐PCNL is more effective than ESWL for treating 10–20 mm, high‐density, non‐lower pole renal stones. Mini‐PCNL has the advantages of a high SFR and abolishing the need for retreatment and re‐hospitalisation. [ABSTRACT FROM AUTHOR]

Purpose: Standard prone position (PP) during percutaneous nephrolithotomy (PNL) has multiple drawbacks. We aimed to compare PNLs performed in split-leg (SL) modified lateral position (MLP) and those performed in standard PP. Methods: A prospective, randomized, unblind, double arm trial was conducted at a tertiary care academic medical center in Egypt, between November 2017 and October 2019. Adult patients with renal stones undergoing PNL were included. According to renal anatomy and stone complexity, stratified randomization was performed and study participants were allocated into either SL-MLP group or PP group. The stone free rate (SFR), total operative time, track formation time, fluoroscopy time, auxiliary procedures, and complications were compared. Results: There were 61 patients in SL-MLP group and 63 patients in PP group. Both groups had similar baseline characteristics. The SFR was comparable between groups: 75.4% in SL-MLP group and 77.8% in PP group (p = 0.755). The mean total operative time was shorter and mean track formation time was longer in SL-MLP group (55.33 ± 20.73 vs. 98.49 ± 9.23, p < 0.001 and 7.89 ± 3.68 vs. 6.52 ± 1.77, p = 0.002). There was no significant difference in fluoroscopy time, total complication rates, hemoglobin reduction and need for blood transfusion between the groups. In SL-MLP group, all PNL procedures as well all the associated procedures were performed with the patients in the same position. Conclusion: SL-MLP PNL has a short operative time and similar SFR and complication rate compared to PP PNL. SL-MLP allowed antegrade and retrograde access to the urinary tract without patient repositioning. [ABSTRACT FROM AUTHOR]

Purpose: We compared slow vs fast shock wave frequency rates in disintegration of pediatric renal stones less than 20 mm. Materials and Methods: Our study included 60 children with solitary 10 to 20 mm radiopaque renal stones treated with shock wave lithotripsy. Patients were prospectively randomized into 2 groups, ie those undergoing lithotripsy at a rate of 80 shock waves per minute (group 1, 30 patients) and those undergoing lithotripsy at a rate of 120 shock waves per minute (group 2, 30 patients). The 2 groups were compared in terms of treatment success, anesthesia time, secondary procedures and efficiency quotient. Results: Stone clearance rate was significantly higher in group 1 (90%) than in group 2 (73.3%, p = 0.025). A total of 18 patients in group 1 (60%) were rendered stone-free after 1 session, 8 required 2 sessions and 1 needed 3 sessions, while shock wave lithotripsy failed in 3 patients. By comparison, 8 patients (26.6%) in group 2 were rendered stone-free after 1 session, 10 (33.3%) required 2 sessions and 4 (13.3%) needed 3 sessions to become stone-free. Mean general anesthesia time was significantly longer in group 1 (p = 0.041). Postoperatively 2 patients in group 1 and 4 in group 2 suffered low grade fever (Clavien grade II). Significantly more secondary procedures (percutaneous nephrolithotomy, repeat shock wave lithotripsy) were required in group 2 (p = 0.005). The predominant stone analysis was calcium oxalate dihydrate in both groups. Efficiency quotient was 0.5869 and 0.3437 for group 1 and group 2, respectively (p = 0.0247). Conclusions: In children with renal stones slow delivery rates of shock wave lithotripsy have better results regarding stone clearance than fast delivery rates. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety, feasibility and efficacy of tubeless percutaneous nephrolithotomy (PNL) in a supine position in selected cases with renal stones. Materials and methods: This descriptive study enrolled 120 patients who presented to the urology department at Benha Faculty of Medicine with renal stones between June 2009 and June 2010. All patients were evaluated based on their history, a physical examination, kidney, ureter, bladder (KUB), pelviabdominal U/S and spiral CT of the abdomen and pelvis without contrast or IVP in selected cases. The patients were followed up for postoperative pain, leakage and fever. Perinephric collection with ultrasound (U/S) was performed, and the Hb% and hematocrit were determined after 12 hours. Results: The access to the stones was achieved through the lower calyx (70.8%) and middle calyx (29.2%) with a stone clearance rate of 100%, and there was no need for a 2nd session. The mean operative time was (67.1±19.2 min.), and the mean length of the hospital stay was (3.4±1.7 days). Three cases had perinephric collections <100 cc, which were managed conservatively and resolved within one week. Prolonged leakage occurred in three cases and also resolved spontaneously within five days. Three cases required a one-unit blood transfusion postoperatively. Stone-free status was achieved in all cases through the use of either the lower or middle calyx in the supine position during the operation. A single dose of non-steroidal anti-inflammatory drugs (NSAID) was needed in 30 cases for postoperative analgesia. Conclusion: Tubeless PNL with the patients in the supine position can be used in selected cases with a favorable outcome and minimal morbidity with the potential advantage of deceases in the postoperative pain, analgesia requirement and hospital stay. [ABSTRACT FROM AUTHOR]