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Percutaneous nephrostomy catheters (PCNs) are commonly utilized in patients with gynaecological cancers due to intrinsic or extrinsic urinary obstruction. Unfortunately, these foreign medical devices may be associated with several infectious complications, including: pyelonephritis, renal abscess, and bacteraemia, which may lead to further delay of life-saving cancer therapy. To evaluate the performance of our multidisciplinary algorithm for diagnosis and treatment of PCN-related infections (PCNIs) and identify risk factors for recurrent urinary device-related infections. Patients with gynaecological cancers having PCNIs were prospectively evaluated at our institution from July 2019 to September 2021. All patients were managed by our standardized algorithm and followed-up until reinfection or routine PCN exchange. Of 100 consecutive patients with PCNIs, 74 had adequate follow-up, and were analysed in three groups according to clinical outcome: reinfection with the same organism (26%), reinfection with a different organism (23%), and no reinfection (51%). Their median age was 54 years, and the most common cancers were cervical (65%), and ovarian (19%) with 53% being metastatic. The most frequently recovered micro-organisms were Pseudomonas (32%), Enterococcus (27%), and Escherichia (24%) species. The main risk factors for recurrent PCNI with the same organism were pelvic radiation therapy (P= 0.032), pelvic fistulas (P= 0.014), and a PCNI with the same pathogen within the previous year (P = 0.012). Our algorithm has allowed for accurate diagnosis, staging, and treatment of and identification of several key risk factors for recurrent PCNIs. These results may lead to further preventive measures for these infections. [ABSTRACT FROM AUTHOR]

Mini-percutaneous nephrolithotomy (MPCNL), which has a smaller tract size (14–20 Fr) than conventional percutaneous nephrolithotomy, has been shown to be safe and effective in pediatric patients with large and complex upper urinary tract stones. This study aimed to compare the efficacy and safety of MPCNL between the supine and prone positions in a pediatric population. The data of pediatric patients who underwent MPCNL at our center between January 2010 and March 2023 were retrospectively analyzed. According to the surgical position, the patients were divided into the prone (Group P) and supine (Group S) groups. In both groups, dilatation was performed using 14–18 Fr metallic dilators. The two groups were compared in terms of perioperative data, postoperative stone-free rates (SFRs), and complications. There were 36 (59%) patients in Group P and 25 (41%) patients in Group S. Stones were mostly located in the pelvis (49.2%) and second most frequently in the lower pole (27.9%). Fluoroscopy time was shorter in Group S but did not statistically significantly differ compared to Group P (p = 0.181). However, operation time was statistically significantly shorter in Group S (73.8 ± 35 vs. 99.8 ± 37.4 min, p = 0.008). Although there was no significant difference, relatively higher SFR were detected in Group S (88% vs. 83%, p = 0.725). Endoscopic combined intrarenal surgery (ECIRS) was performed on six (24%) patients in Group S, and the SFR was 100% among these patients. There was no significant difference between the two groups in terms of the presence of complications (16.7% vs. 16%, p = 0.945). Both supine and prone MPCNL appear to be safe and effective in the pediatric age group, with similar stone-free and complication rates. In the supine procedure, the operation time is shortened compared to the prone. In addition, simultaneous retrograde access has the potential to increase the overall success rate of surgery. [ABSTRACT FROM AUTHOR]

To the Editor, Upper urinary tract obstruction (UUTO) is a common scenario in clinical practice, and it is caused by a variety of diseases. Lithiasis, tumours and strictures are some of the principal aetiologies. Multiple factors may influence both the need for decompression of the obstructed collecting system and the urgency of procedure... [ABSTRACT FROM AUTHOR]

INTRODUCTION: In line with Canadian provincial directives due to the COVID-19 pandemic, certain elective urologic surgical cases that are normally performed as inpatient procedures were performed as same-day discharge procedures to reduce hospitalization and the usage of scarce healthcare resources. Since the pandemic, we began performing laser enucleation of the prostate (LEP), robotic-assisted radical prostatectomy (RARP), and percutaneous nephrolithotomy (PCNL) as outpatient surgeries. This was supported by recent evidence demonstrating the safety and feasibility of performing these minimally invasive surgeries as same-day procedures. As such, we sought to retrospectively evaluate the clinical outcomes and safety during the COVID-19 era at our institution for same-day discharge LEP, RARP, and PCNL procedures. METHODS: All patients operated for LEP, RARP, or PCNL between May 2020 and March 2022 at two academic institutions were included. Surgeries were classified as planned sameday discharge or inpatient surgery. Same-day discharge patients were compared to inpatients for each procedure type. This comparison assessed the occurrence of same-day failure, postoperative complications, and re-admission rates at 30 days. This study was approved by the scientific ethics committee of the Centre de Recherche de l'Université de Montréal (CRCHUM). RESULTS: A total of 413 subjects were included in this study. Among LEP patients (n=169), 104 (62%) were identified as same-day procedures and 65 (38%) were inpatient. Among RARP patients (n=194), 46 (24%) were identified as same-day procedures and 148 (76%) inpatient. Among PCNL patients (n=50), 38 (76%) were identified as same-day procedures and 12 (24%) were inpatient. Of the patients who underwent planned same-day LEP, RARP, and PCNL, 77.9%, 73.9%, and 71.1% were successfully discharged home, respectively. Patients who underwent LEP as inpatients had a higher incidence of overall postoperative complications compared to same-day LEP (23.1% vs. 8.7%, p=0.017). The rates of 30-day emergency department (ED) visits and hospital re-admission were similar between inpatient and same-day LEP (9.2% vs. 3.8%, p=0.27; and 4.6% vs. 1.0%, p=0.32, respectively). Inpatient RARP, however, was associated with more 30-day ED visits compared to same-day procedures (17.4% vs. 4.1%, p<0.01). No statistically significant differences were found for postoperative complications (15.2% vs. 6.1%, p=0.097) and re-admission rates (1.4% vs. 4.3%, p=0.51). There were no significant differences on overall postoperative complications, 30-day ED visits, and re-admission rates in inpatient vs. same-day PCNL. CONCLUSIONS: Our results suggest that same-day discharge for LEP, RARP, and PCNL is safe and feasible in select patients, with an acceptable complication rate. These results should be validated in a larger, prospective clinical trial comparing same-day and inpatient procedures. [ABSTRACT FROM AUTHOR]

Introduction: Despite its minimally invasive nature, percutaneous nephrolithotomy (PCNL) may be associated with significant pain. Challenges in pain control may prevent timely discharge (and expose patients to adverse effects of opioid use). We sought to evaluate whether our patients who underwent erector spinae plane (ESP) regional blocks experienced improved postoperative pain control and decreased opioid use after PCNL (compared with those who did not receive blocks). Methods: We retrospectively reviewed consecutive PCNL cases on patients admitted for greater than 24 hours without pre-existing opioid regimens for chronic pain. Cases were completed by a single high-volume surgeon. Patients who accepted an ESP block were compared to those who did not receive a block. Patients received either a single injection or a disposable pump delivering intermittent boluses of ropivacaine 0.2%. Demographic and perioperative data were analyzed. The primary outcomes were opioid use measured in morphine milligram equivalent (MME) and patient-reported pain scores during the first 24 hours of hospitalization. Results: From March 2019 to August 2021, 44 patients were identified meeting criteria -- 28 of which received an ESP block (including 14 continuous blocks). The patients who received blocks had significantly decreased opioid use (18.3 vs. 81.3 MME, p=0.004) and a longer mean time to first non-zero pain score (p=0.004). Continuous blocks had similar opioid use to single shot blocks (21.0 vs. 15.6 MME, p=0.952). Conclusions: ESP regional blocks appear to offer an effective adjunct method for pain control after PCNL and may reduce post-PCNL opioid use while maintaining adequate patient analgesia. [ABSTRACT FROM AUTHOR]

This retrospective study aimed to determine the impact of percutaneous nephrostomy (PCN) on the quality of life (QOL) and kidney function of women with advanced carcinoma of the cervix and obstructive uropathy in Kenyatta National Hospital by utilizing data from 2016 to 2019 and a follow-up patient interview in 2020. Sociodemographic data from patient records was reported as descriptive statistics. Serum urea, hemoglobin and creatinine levels before PCN and 72 hours, 1 month and 3 months after PCN were obtained. The changes were analysed using a paired t-test. Quality of life data before and after PCN tube insertion were collected using the structured Functional Assessment of Cancer Therapy and a cervix cancer-specific subscale (FACT-Cx) questionnaire, responses scored and an aggregate tallied. The QOL and kidney function data variables before and after PCN tube insertion were compared with statistical significance set at p < 0.05. Fifty eight study participants were enrolled, with an 80% power to detect a 5 fold change in kidney function. Percutaneous nephrostomy had an overall improvement in the quality of life (FACT-Cx total p = 0.041) with changes in aspects of physical well-being (p = 0.018) and additional concerns sexual function, self-esteem, appearance, urinary function, appetite and gastrointestinal function (p ≤ 0.001); but none in other aspects of the tool. Improvement was noted 72 hours after PCN tube insertion in 62% of patients' urea (p = 0.033) and 64% of creatinine (p ≤ 0.001) levels but not sustained after 1 month and did not revert to normal levels. Hemoglobin levels did not improve. Percutaneous nephrostomy was found to have a short-term added value in management of women with obstructed uropathy in advanced carcinoma of the cervix as two aspects of their QOL improved while serum urea and creatinine levels improved slightly with no functional recovery. [ABSTRACT FROM AUTHOR]

Malignant ureteral obstruction (MUO) is an unpleasant finding resulting from a wide range of malignancies with limited survival prognosis. Its presentation and progression show that it can resist treatment with some stents, including single polymer ureteral stents. With most treatment failures, several treatments are available for the initial management and treatment of benign ureteral obstruction, including therapy with percutaneous nephrostomy (PCN), metallic stents, tandem stents, and other stents. Considering the variety of methods and the heterogeneous population of patients, evaluating the merit of each approach is challenging and needed. Due to the lack of significant studies in this field, these methods leave their performance up to the individual provider. This review aims to provide a framework for urologists to use for individual care and apply it appropriately to patients with MUO. Prospective clinical studies are needed to empower patients with MUO to receive evidence-based treatment and recommendations. [ABSTRACT FROM AUTHOR]

Ureteral obstruction is blockage in one or both of the tubes (ureters) that carry urine from the kidneys to the bladder which is a potential common cause of reversible renal injury. It can be caused by benign or malignant pathologies. Decompression of the obstruction is considered a vital step in management. Percutaneous nephrostomy (PCN) and ureteral stenting are the two common diversion surgical techniques used for the treatment of obstruction. In cases of benign ureteric obstruction, the choice between PCN or stenting is highly arguable among urologists and is dependent on factors such as the cause, severity of obstruction availability of treatment modalities, and surgeon experience, and both techniques are considered similar successful in treating such case. For ureteric stones, urologists typically try stenting first and resort to PCN if stenting fails. The choice between the two is dependent on the availability of resources and surgical experience. On the other hand, PCN is the preferred initial method in cases of malignant obstruction because of high late failure rates in cases of ureteral stenting. Percutaneous nephrostomy cases had the drawback of the need for a collection instrument placed externally which impacted the patient’s life [ABSTRACT FROM AUTHOR]

Background: While tubeless Percutaneous Nephrolithotomy (PCNL) is becoming more popular, there might still be doubt in performing it on single kidney patients. This study is performed to assess outcomes and complications of tubeless PCNL in patients with single kidney. Methods: In this cross-sectional study, 134 single kidney patients who underwent tubeless PCNL for renal stones, were assessed for outcomes including stone-free rate, duration of operation, length of hospital stay, changes in serum creatinine and hemoglobin levels, bleeding, infectious complications, damage to adjacent organs, and mortality. These outcomes were compared based on age, sex, history of comorbidities, history of interventions for kidney stones and the number of accesses during the operation. Results: Mean duration of operation was 139.14 minutes. Mean length of hospital stay was 2.59 days. In total, 11.9% of patients required intraoperative blood transfusion and 3.7% required ICU admission due to complications. The most common postoperative complications included fever, hematuria and UTI. Initial stone-free rate after surgery was 67.2% and two weeks later 76.9%. No mortality was reported. Postoperative serum creatinine levels increased slightly in short term, however, improved significantly in long-term. Comorbidities such as diabetes mellitus, hypertension, ischemic heart disease, and chronic kidney disease were associated with a higher incidence of minor and major complications of tubeless PCNL and a lower rate of stone-free rate. Conclusion: Tubeless PCNL is a relatively safe, feasible and efficient method with acceptable complications in single kidney patients. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to review the current role of endoscopic combined intrarenal surgery (ECIRS) in the management of renal stones, with a focus on its efficacy and safety. The secondary outcome was to highlight the tips and tricks to improve the urologist's experience with ECIRS. Methods: A scoping review of the literature, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, was performed, using ECIRS and flexible ureteroscopy and percutaneous nephrolithotomy as the search terms. All original articles were screened and included. Results: Thirty-three studies were included in the analysis. ECIRS showed a good efficacy and safety profile, with an excellent stone-free rate and a low rate of complications, mostly Clavien--Dindo I/II. With ECIRS, a reduction in the need for multiple access tracts was noted and direct visualization of the targeted calyx during the puncture increased the ability to attain transpapillary punctures, thereby reducing the amount of bleeding. Conclusion: ECIRS, as the first-line minimal access intervention, is safe and efficacious, particularly for achieving a stone-free status in patients with large complex stones in a single stage. The ability to gain access under direct vision and the reduction in the number of tracts, in both the supine and the prone positions, makes this procedure an attractive surgical choice. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study evaluated the efficacy and safety of temporary ureteral occlusion combined with urinary diversion using a single-access route created by inserting a balloon catheter through a pigtail nephrostomy drainage catheter. With this approach, we aimed to offer an alternative for patients with ureteral leaks who are suboptimal surgical candidates. Materials and Methods: This retrospective study included nine patients (eight of which were bilateral cases and one was unilateral, totaling seventeen cases) who underwent the surgery between September 2023 and March 2024. The method involved gaining percutaneous access to the pelvicalyceal system, inserting a 4-French Fogarty balloon catheter through a pigtail nephrostomy catheter, and inflating the balloon at the proximal or mid-ureter. Results: All 17 cases achieved technical successful with no major complications. The procedure effectively relieved symptoms associated with urinary leakage in most patients. However, the significant deflation of the balloon catheter occurred in five cases (29.4%), with three (17.6%) experiencing complete deflation. In these five cases, the final balloon size was 5.81 mm (range: 0–8.9 mm), confirming a 25.0% decrease in size from pre- to post-procedure. Ureteral occlusion was 28.3 d long on average (range: 8–57 d). All patients experienced symptom relief during temporary ureteral occlusion. Except for two patients lost to follow-up, three patients showed symptom improvement with only PCN and four patients underwent surgical closure of the fistula tract before or after balloon catheter removal. Conclusions: This study confirms that this approach is safe and effective.

Nephron sparing surgery (NSS) is considered for selected cases of upper tract urothelial carcinoma (UTUC) as it maintains renal function and avoids morbidity associated with radical nephroureterectomy (RNU). The appropriate selection of patients suitable for NSS without compromising oncological outcomes can sometimes be difficult, given the limitations of diagnostic modalities. Recurrence rates for UTUC can be as high as 36 to 54% after NSS. Intraluminal adjuvant therapy can be attempted following NSS to reduce recurrence, but delivery to the upper tract is more challenging than into the bladder. Bacillus Calmette-Guerin (BCG) and chemotherapy such as Mitomycin (MMC) have been administered via nephrostomy or ureteric catheter, which requires invasive/repeated instrumentation of the upper urinary tract. Drug delivery by reflux from bladder instillation along indwelling stents has also been tried but can potentially be unreliable. Recently, a gel formulation of mitomycin has been developed for the controlled exposure of the upper urinary tract to treatment over a number of hours. Drug-eluting stents to deliver chemotherapy to the upper urinary tract have been developed but have not yet entered clinical practice. Endoluminal phototherapy utilising an intravenous photosensitising agent is another novel approach that has recently been described. Intraluminal therapies may be beneficial in decreasing recurrence rates in UTUC, but currently have some limitations in their usage.

Abstract Background We aimed to evaluate the safety and efficacy of intraluminal iodine-125 seed strand brachytherapy and percutaneous nephrostomy in patients with ureteral carcinoma. Methods From January 2014 to January 2023, 48 patients with ureteral cancer not suitable for surgical resection were enrolled. Iodine-125 seed strand was inserted in 26 patients under c-arm CT and fluoroscopic guidance (Group A), and 22 patients underwent percutaneous nephrostomy without seed strand (Group B). The clinical outcomes (technical success rate, tumor sizes, hydronephrosis Girignon grade, complications, objective response rate (ORR), disease control rate (DCR), and survival time) were evaluated and compared. Results A total of 53 seed strands were successfully inserted and replaced in Group A, with a technical success rate of 100%. No procedure-related death or severe complications occurred in both group. Migration of seed strand or drainage tube was the most common complication. The Girignon grade of hydronephrosis was significantly improved 1, 3 and 6 months after procedure in both groups. DCR in Group A were 96.2%, 80.0%, and 70.0% at 1-, 3-, and 6-month follow up, respectively. At 1 and 6 months later, ORR in Group A were significantly higher than those in Group B (p

Abstract Background Most cervical cancer patients in developing countries seek care in health facilities with an advanced disease, often characterized by obstructive uropathy. This study aims to estimate the cost of an image-guided percutaneous nephrostomy (PCN), which was recently introduced at Muhimbili National Hospital to manage obstructive uropathy. Methods This was a cross-sectional study that was conducted between February and June 2021, from the provider’s perspective. The study involved forty-eight (n = 48) cervical cancer patients with obstructive uropathy. A micro-costing approach was used to identify, quantify and value both capital and recurrent cost items consumed by the patients. Cost data were collected in Tanzanian shillings and converted to USD with the relevant exchange rate. Analysis was performed in Microsoft Excel (Microsoft Excel®, Microsoft Corporation). Results The unit cost of image-guided PCN at Muhimbili National Hospital was estimated at 380.4 USD. The main cost drivers were the single-use Nephrostomy catheters, Amplatz guide wire, and Micro-puncture set. The estimated unit cost is higher than the reimbursement price of 237.4 USD charged by the National Health Insurance Fund, and the 259.4 USD and 172.9 USD charged by the hospital for private and public patients, respectively. Conclusion Image-guided PCN for cervical cancer patients costs three times the minimum monthly government wage. The study underscores the importance of conducting costing studies to inform pricing and reimbursement decisions in Tanzania.

Objective: This study aimed to summarize our experience with patients undergoing percutaneous nephrolithotomy (PNL) with a previous history of extracorporeal shock wave lithotripsy (ESWL) treatment or open nephrolithotomy and compare them with patients who underwent PNL alone. Materials and Methods: A total of 565 patients were treated with PNL from 2012 to 2022 at our center. These patients who underwent PNL were divided into three groups: Group 1 consisted of patients who had no medical history of previous ESWL or open kidney stone surgery, Group 2 consisted of those who had a history of previous ESWL, and Group 3 included patients with a history of previous open kidney stone surgery. Results: Regarding age, there were no notable differences between the three groups, body mass index, gender, laterality, and stone density in Hounsfield Units. Group 3 had a significantly higher total operation fluoroscopy time than the other two groups, and Group 2 had a significantly lower total operation time than the other two groups. Regarding the postoperative parameters of all three groups, including hospital stay, time to nephrostomy removal, urinary leakage, hemoglobin decrease, blood transfusion, and stone-free rates, no statistically significant differences were Conclusion: Our study demonstrates that PNL can be safely performed with a similar success rate and without a higher risk of problems in patients who have undergone open nephrolithomy or ESWL, as well as in primary PNL patients who have not undergone any previous interventions. [ABSTRACT FROM AUTHOR]

Objective: To analyze the parameters that are believed to impact the success rate in patients undergoing percutaneous nephrolithotomy and to determine the factors that have a significant effect. Materials and Methods: Success rates of 508 patients who underwent percutaneous nephrolithotomy were determined over a five-year period. Evaluation was performed with the medical history, non-contrast computerized tomography, and clinical research form in the first, third, and sixth months postoperatively. Patient characteristics, stone characteristics, and operation details were analyzed, and their effects on success were investigated. In the evaluation of the success rate, the results of the first month, were considered. Results: No significant difference was shown between the successful and unsuccessful groups in terms of demographic features. Morbidities such as body mass index, hypertension, diabetes mellitus, hyperlipidemia, and heart disease had no effect on success. Solitary kidney or congenital renal anomaly, degree of hydronephrosis, and high preoperative serum urea creatinine levels did not have a significant impact on the success rate. Significant effects of parameters such as stone volume greater than 15 cm², complex stones, infection and cystine stones, intraoperative complication rate, and operation time on success were investigated (p<0.001, p=0.038, p=0.014, p=0.010, p=0.022, p=0.030, respectively). Success rates decreased statistically in cases with accompanying macroscopic hematuria (p=0.032). Previous surgery, extracorporeal shock wave lithotripsy history, and multifocal access had no effect however surgical experience increased the success rate (p=0.036). Conclusion: The success rates in percutaneous nephrolithotomy can be enhanced by examining the factors that may have an impact and taking necessary precautions relevant to these factors. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to evaluate the safety profile and efficacy of "flank-free modified supine position (FFMS)" approach for percutaneous nephrolithotomy (PCNL). Materials and methods: This study was conducted in the Department of General Surgery over 4-year period from August 2016 to August 2020 on 50 patients after institutional ethical clearance. Results: The patients in our study were in the range of 21-65 years with mean age of 35.9 SD 9.85 years. Approximately, 62% of patients were males and right kidney was involved in 54%. The mean stone size of our study group was 17.3 SD 1.81 mm with a range of 14.2-21 mm. Pelvic stones were found in 28 (56%) of patients and majority of our patients, i.e., 88% were symptomatic of their disease. The mean operative time in our study was 83.62 SD 16.95 with range of 60-115 minutes. Nephrostomy was placed in situ in 84% patients. There was no operation related mortality in our study. The mean hospital stay of our patients was 3.7 SD 1.15 days. Out of total 50 patients, success was achieved in 45 (90%) patients as 6% required auxiliary treatment and 4% was converted to prone position. Conclusion: Thus, in our study we found that FFMS PCNL surgery is a safe and an effective means of intrarenal access with high success rate and with acceptable morbidity and complications. [ABSTRACT FROM AUTHOR]

The article presents the discussion on French super-mini PCNL (14 Fr-SMP) is a key development in percutaneous nephrolithotomy (PCNL) surgery. Topics include solitary stones within a diverticulum or patients with refractory stent symptoms who prefer to avoid a multistaged ureterorenoscopy; and reducing the risks of renal injury and sepsis, as well as achieving clear intraoperative vision.

The article presents the case study of 49-year-old female with nephrolithiasis in right renal pelvis. Topics include rigid and flexible nephroscopy (with ultrasonic-lithotripsy and endo-basketing) being used to remove stones prior to placing a 5 Fr nephro-ureteral catheter; and patient appeared well, with a CT demonstrating a resolving hematoma.

Purpose: Contemporary predictive tools for miniaturized percutaneous nephrolithotomy (mPCNL) mainly focus on stone clearance but not perioperative complications, especially infection and hemorrhage. This study aimed to evaluate whether the Mayo adhesive probability (MAP) score, an index of the perinephric fat characteristics, can predict postoperative fever and intraoperative hemorrhage in mPCNL. Methods: This is a retrospective study recruiting 159 mPCNL patients from July 2018 to January 2022. MAP scores were recorded using preoperative computed tomography. Postoperative complications included postoperative fever and intraoperative bleeding, defined as hemoglobin drop. Results: Over half patients had the MAP score ≧ 3. Men, elderly, chronic kidney disease, and diabetes were associated with a higher MAP score. The patients with a higher MAP score were more likely to have postoperative fever after mPCNL. On multivariate analysis, preoperative positive urine culture (OR 2.68) and a higher MAP score (OR 2.28) were both significantly associated with postoperative fever. ROC curves analysis of the combination of these two factors on predicting postoperative fever showed AUC values were 0.731 (0.652–0.810). Moreover, a higher MAP score (OR 2.30) and longer operative time (OR 2.16) were significantly associated with higher hemoglobin drop on multivariate analysis. Conclusion: A high MAP score was associated with postoperative fever and intraoperative hemorrhage in patients undergoing mPCNL. The MAP score can be a novel and easy predictive tool to help endourologists improve the awareness of mPCNL safety. [ABSTRACT FROM AUTHOR]

Advances in laser technology and surgical telescopic systems have propelled retrograde intrarenal surgery (RIRS) to the forefront as a viable alternative to percutaneous nephrolithotomy (PCNL). Currently, RIRS is being increasingly utilized as a treatment option, even for kidney stones larger than 2 cm. In this narrative review, we aimed to take a snapshot of current practice in renal stone treatment and the latest technological and technical developments and to evaluate the efficacy of RIRS in larger renal stones. With low complication rates and acceptable stone-free rates, RIRS offers patients a less invasive option with favorable outcomes. There are insufficient data comparing PCNL with RIRS using a new-generation high-power laser and suctioning ureteral access sheath (UAS). Further studies with novel lasers and UAS could provide superiority in terms of RIRS. It is crucial to take into account various patient-specific considerations, such as stone location and burden, when deciding on the appropriate treatment approach. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to evaluate the efficacy of bipolar cauterization for tract site bleeding during standard percutaneous nephrolithotomy (PCNL). Methods and Materials: We defined tract site bleeding as when the visual field across the parenchymal tract starts to bleed while the sheath of a balloon dilator is being withdrawn just before the operation is completed. Among 181 patients, 90 patients showed no significant bleeding, and 91 patients required further procedures to resolve tract site bleeding. In cases of unresolved tract site bleeding, either nephrostomy placement (n = 60) or cauterization (n = 31) was performed. The outcomes of three groups (no procedure group, nephrostomy group and cauterization group) were compared. Results: The median decrease in hemoglobin at 2-hour intervals postoperatively was −1.75, −1.0, and −0.2 in the nephrostomy, cauterization, and no procedure groups, respectively (P < .001). There were 25 patients (41.7%) who received transfusions in the nephrostomy group, whereas only 1 patient (3.2%) received a transfusion in the cauterization group (P < .001). Conclusion: The bipolar cauterization of bleeding points at the end of PCNL could efficiently decrease tract site bleeding and reduce the need for transfusion. Clinical Research Information Service (https://cris.nih.go.kr/cris; No. KCT0008303). [ABSTRACT FROM AUTHOR]

Objectives: Ketamine uropathy causes inflammatory changes to the urothelium, manifesting as significant lower urinary tract symptoms, small bladder capacity, and pelvic pain. Upper tract involvement and hydronephrosis can occur. Data from UK centers are limited, and no formal treatment guidelines exist. Patients and Methods: All patients with ketamine uropathy presenting to our unit over an 11‐year period were identified through operative and clinic lists, emergency presentations, and a prospectively collected local database. Demographic data, biochemical findings, imaging techniques, and both medical and surgical management were recorded. Results: A total of 81 patients with ketamine uropathy were identified from 2011 to 2022; however, a large proportion presented from 2018 onwards. The average age at presentation was 26 years (interquartile range [IQR]: 27–34), 72.8% were male, and average follow‐up time was 34 months (IQR: 8–46). Therapeutic interventions included anticholinergic medication, cystodistension, and intravesical sodium hyaluronate. Hydronephrosis was present in 20 (24.7%) patients and nephrostomy insertion was required in six. One patient underwent bladder augmentation surgery. Serum gamma‐glutamyl transferase and length of follow‐up were significantly higher in patients with hydronephrosis. Adherence to follow‐up was poor. Conclusions: We present a large cohort of patients with ketamine uropathy from a small town in the UK which is unusual. The incidence appears to be rising, in‐keeping with increasing recreational ketamine use and should be of concern to urologists. Abstinence is a key aspect of management, and a multi‐disciplinary approach works best particularly as many patients are lost to follow‐up. The development of formal guidance would be helpful. [ABSTRACT FROM AUTHOR]

Background: Robot-assisted pyeloplasty is widely used in pediatric surgery because of its well-known advantages over open or laparoscopic surgery. The aim is to explore our experience and evaluate the achievements we have made. Methods: We evaluated patients undergoing robotic pyeloplasty from January 2016 to November 2021, including those who presented with a ureteropelvic junction obstruction associated with other anomalies of the kidney. The parameters examined were: age, weight, associated renal malformations, conversion rate, operative time, and intra- and postoperative complications. Results: Of 39 patients, 7 (20%) were included, of whom 5 (71%) were male and 2 (29%) were female. The mean age at surgery was 84 months (range 36–180 months), and the mean weight at surgery was 24.4 kg (range 11–40 kg). In five (71%) patients the ureteropelvic junction obstruction (UPJO) was left-sided and in two (29%) it was right-sided. In four (57%) cases, UPJO was associated with a horseshoe kidney, right-sided in one (25%) patient, and left-sided in the other three (75%). A 180° rotation of the kidney was present in one (14%) patient. Nephrolithiasis was present in two (29%) patients. The mean operative time was 160 min (range 140–240 min). The average bladder catheter dwell time was 1 day (range 2–3 days), while the average abdominal drainage dwell time was 2 days (range 2–4 days). The mean hospitalization time was 4 days (range 3–9 days). On average, after 45 days (range 30–65) the JJ ureteral stent was removed cystoscopically. No intraoperative complications were reported, while one case of persistent macrohematuria with anemia requiring blood transfusion occurred postoperatively. Conclusions: Ureteropelvic junction obstruction might be associated with other congenital urinary tract anomalies such as a duplicated collecting system, horseshoe kidney, or pelvic kidney. These kinds of malformations can complicate surgery and require more attention and accuracy from the surgeon. Our experience shows that, with regards to the robotic learning curve required for pyeloplasty, the treatment of the ureteropelvic junction in these situations does not present insurmountable difficulties nor is burdened by complications. The application of robot-assisted surgery in pediatric urology makes difficult pyeloplasties easier. [ABSTRACT FROM AUTHOR]

Endourological procedures are the mainstay of treatment for stone disease in the upper urinary system. Infection is a common complication, and urine cultures (UC) are often obtained preoperatively. In this study, we sought to investigate the role of positive UC in the 90 days prior to surgery (90PreOp) in predicting postoperative infectious complications in comparison to a single positive preoperative UC (PreOP). We compared the correlation between positive PreOp UCs and positive 90PreOp UCs with postoperative urosepsis, and a positive UC obtain proximal to obstruction (Prox UC) during percutaneous nephrolithotomy, ureteroscopy and a placement of nephrostomy tube or ureteral stent. Data from 140 consecutive patients were collected. PreOp UCs were positive in 15 (11%) of patients versus 31 of 140 (22%) positive 90PreOp UCs. All six sepsis events had a positive 90PreOp UC, and five had a positive PreOp UC. Fourteen (93.3%) out of 15 positive Prox UC had a positive 90PreOp UC, whereas only 7 (38.9%) had a positive 90PreOp UC. Positive 90PreOp UC outperformed PreOp UC in predicting positive Prox UC, OR = 12.8 (95% CI 3.70–44.30, p < 0.001), versus OR of 88.9 (95% CI 11.0–720.7, p < 0.001); sensitivity 93%(95% CI 68–100%) versus 47%(95% CI 21–73%); as well as area under the ROC curve(AUC), 0.90 (CI 0.80–0.95) for 90PreOp versus 0.70 (CI 0.56–0.82) for positive Prox UC. Uropathogen persistence was better identified when using 90PreOp UC (27%) than using PreOp UC (12%). We suggest reviewing UCs taken within 90 days preoperatively as this was found superior to a single preoperative midstream UCs in predicting postoperative infectious sequela after stone procedure. [ABSTRACT FROM AUTHOR]

Drainage catheters are used almost routinely to provide urinary drainage, prevent extravasation of urine, and create tamponade against bleeding after percutaneous nephrolithotomy (PNL). In the literature, there is no standardized approach to determining which type of catheter is superior. In this context, we aimed to comparatively analyze two different types of catheters (re-entry malecot catheter and nelaton catheter) in terms of success and complications, which we use for drainage after a PNL operation and which have very different costs. Patients who underwent PNL for kidney stones between January 2018 and October 2022 were included in the study. The data of a total of 148 patients who had a 16-F reentry malecot nephrostomy catheter or a 16-F nelaton catheter were analyzed. In addition to the demographic characteristics of the patients, stone characteristics, operative data, hospitalization time, analgesia requirement, hemoglobin exchange, amount of blood transfusion, and postoperative data (success and complications) were comparatively evaluated. The current unit price for a reentry malecot and a nelaton catheter is 4.7 United States dollars (USD) and 0.11 USD, respectively. There were a total of 148 patients in the study, 63 of whom were nelaton catheters and 85 were reentry malecots, and the mean age was 39.95 ± 13.28 years. There was no statistically significant difference between preoperative stone sizes and residual stone rates according to the groups. In addition, there was no statistically significant difference between the groups in terms of access site and stone localization. There was no significant difference between the groups in terms of complication rates according to the Clavien–Dindo classification, Hb levels, blood transfusion rates, operation times, or hospitalization times. In conclusion, if a second procedure is planned, a reentry malecot catheter may be preferred. Apart from this situation, nelaton catheters should be preferred because they are similar to reentry catheters in terms of effectiveness, and side effects and are more economical than reentry catheters in terms of cost. [ABSTRACT FROM AUTHOR]

We are reporting the 39 patients' outcomes who underwent percutaneous nephrolithotomy and purulent urine encountered at the initial steps of surgery. Of 873 patients who underwent PCNL, 48 had purulent fluid during the initial puncture. After excluding those at risk for infection, we studied 39 patients' preoperative and postoperative variables-including postoperative day (POD) 1, 3, 5 fevers. In group 1, 21 patients had a nephrostomy tube placed, and PCNL was postponed. In group 2, 18 patients had successful stone removal in the first session. All surgeries were successful, with no septic events during follow-up. No significant differences in preoperative variables were found. 14% and 22% of patients in groups 1 and 2 had infected fluid (p = 0.470). Four patients in group 1 (19%) and seven patients in group 2 (38.9%) had a high fever (≥ 38 C) on POD1 (p = 0.171), and 1 (5%) in group 1 and 3 (17%) in group 2 had high fever on POD 3 (p = 0.22). No patients remained with high fever on POD5. Mild sepsis was diagnosed in 9.5% of group 1 and 16% of group 2 (p = 0.820), and hospitalization time differed significantly (p < 0.001). Stone size and operation time were correlated with postoperative fever, and prolonged hospital stays were associated with positive blood cultures and postponed procedures. PCNL with proper technique and antibiotics can lead to quicker recovery and reduced hospitalization time in selected patients with pus in their pelvicalyceal system. [ABSTRACT FROM AUTHOR]

We present an extremely rare case of renal ptosis from the normal orthotopic position into the cavity of inguinal hernia in a 93-year-old male patient. The following clinical case was accompanied by renal insufficiency, which was associated with the obstruction of the right ureter in the hernial sac and the stenosis of the left renal artery. The differential diagnosis between nephroptosis and dystopic kidney was based on MDCT scan images, which demonstrated the length of the right renal artery to be more than 20 cm. The patient underwent percutaneous nephrostomy through the right inguinal area and was successfully followed up for two years. We also analyzed six similar clinical cases described in the literature. This disease has, thus far, been observed exclusively in elderly men with long-standing and large inguinal hernias. The most frequent complications in these patients include ureteral strangulation in the area of the hernial gate and renal failure. [ABSTRACT FROM AUTHOR]

To describe a concept of ideal 'puncture zone' as against any single ideal 'puncture tract' for percutaneous nephro-lithotomy (PCNL) and present our results. Through this narrative, we aim to reduce the gaps in inter-understanding of an erstwhile description of ideal tract and real-life puncture making. The puncture zone principle was applied for our novel puncture making technique during PCNL. The largest imaginary cone that can fit into a respective calyx, with its tip in the pelvis defines the 'puncture zone' for that calyx. This concept allows fine-tuning of the ideal puncture tract based upon the desired corresponding manipulation zone and also shifts the focus of puncture making to infundibulum anatomy from the tip of calyx. The surgical technique and retrospective review of 136 cases done between 2015 and 2021 using this concept are presented. Primary outcome included stone-free rate, pseudo-aneurysm and blood transfusion at 3 months of follow-up. 33 cases had multiple (> 3) stones, 21 only calyceal/infundibular stones, eight partial staghorn and 12 were complete staghorn stones. Mean stone size was 29 ± 15 (Range: 5–53) mm. Complete clearance was achieved in 127 cases, four of which required two tracts. Blood transfusion was required in one case. No pseudo-aneurysms were encountered. The puncture zone concept has provided good results in our hands. It may help easier understanding of PCN puncture making and provides a background for reconciliation between description of an ideal tract and practical puncturing techniques used by different surgeons. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of radical nephroureterectomy on postoperative renal function in patients with upper tract urothelial carcinoma (UTUC). Methods: We retrospectively evaluated 645 patients with UTUC treated with radical nephroureterectomy between January 2000 and May 2022. The primary outcome was the rate of postoperative estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2. Secondary outcomes included the rate of eGFR decline, identification of factors related to eGFR decline, and the impact of comorbidities (diabetes or cardiovascular disease) on postoperative eGFR at 1 year. Results: The median preoperative and postoperative eGFR levels were 55.6 and 43.3 mL/min/1.73 m2, respectively. The rate of patients with preoperative and postoperative eGFR ≥60 mL/min/1.73 m2 was 40.9% and 9.0%, respectively. The median decline in eGFR after surgery was 25.1%. The presence of preoperative unilateral hydronephrosis and eGFR <60 mL/min/1.73 m2 was significantly associated with a low decline of postoperative eGFR and poor survival. The impact of the presence of comorbidities on postoperative eGFR at 1 year was significant (p < 0.001). Conclusion: Impaired renal function is prevalent in patients with UTUC. The rate of patients with postoperative eGFR ≥60 mL/min/1.73 m2 was 9.0%. The presence of preoperative renal impairment was significantly related to a low decline in postoperative eGFR and poor survival. The presence of comorbidities had a significant effect on eGFR decline 1 year after radical nephroureterectomy. [ABSTRACT FROM AUTHOR]

A 66-year-old woman underwent a total hysterectomy and pelvic lymph node dissection on June 19, 201X, and postoperative chemoradiation (50.4 Gy external radiation, 24.0 Gy intracavitary radiation, three courses of cisplatin) from July 19 to September 6 for cervical cancer. Bilateral ureteral stents were placed intraoperatively, and both were removed on August 14. Bilateral hydronephrosis was observed on January 24, 201X+1, and bilateral ureteral stents were reinserted. On April 5, 201X+4, intense hematuria occurred when the left ureteral stent was removed for routine ureteral stent replacement. However, the hematuria resolved spontaneously after the stent was reinserted. The same phenomenon was observed during the left ureteral stent replacement, with the patient requiring a blood transfusion after the replacement due to progressive anemia. Retrograde urography showed contrast leakage into the left common iliac artery and pulsatile bleeding from the ureteral catheter, leading to a left arterio-ureteral fistula diagnosis. An attempt was made to close the fistula by laparotomy but this was discontinued due to strong adhesion and dissection difficulty. The patient was moved to the fluoroscopy room for stent graft placement in the left common iliac artery. The left ureteral stent was removed, and the left nephrostomy was managed without hematuria recurrence. [ABSTRACT FROM AUTHOR]

Background: Percutaneous Nephrolithotomy (PCNL) represents the gold standard treatment method for cases with large kidney stones. As a critical step in performing PCNL, the procedure of establishing a safe and accurate nephrostomy tract will dramatically impact the treatment quality of patients with large-sized kidney stones. Objective: This work attempts to describe a new and improved process of establishing an accurate nephrostomy tract and clinically evaluate the effectiveness and safeness of this proposed methodology. Methods: This work represents a retrospective single-center study carried out between August 2013 and November 2019. The collected samples consist of 937 patients who were operated on using PCNL coupled with our proposed procedure. Briefly, a preoperative B-ultrasonography was firstly performed to decide the puncture point in a simulated surgical position where was marked with ureteral catheter segments (2–3 cm). A computed tomography (CT) scan was followed to correct the anchor points in the simulated surgical position. After this, an accurate puncture operation was performed under the real-time guidance of intraoperative B ultrasound. Results: Examining this study, 851 subjects with renal stones and 86 subjects with ureteropelvic junction stones were included for the PCNL operation project. All samples were grouped with Guy's grading system: grade I, II, III, and IV patients there were 0.00%, 42.69%, 51.01%, and 6.30%, respectively. Among these patients, the average age was 48.49 ± 10.80 years old, with a male to female ratio of around 1.73:1. Conclusions: This study showed that our developed method warrants an accurate and safe PCNL operation that involves the process of establishing the nephrostomy tract. Other advantageous attributes of this new PCNL process include negligible radiation exposure, lesser complications, and low failure rates. More importantly, this new localization approach is particularly attractive for hospitals that are new to the field of adopting PCNL considering its safeness, effectiveness, and learnability. [ABSTRACT FROM AUTHOR]

Objectives: Management of postoperative pain following percutaneous nephrolithotripsy (PCNL) is a significant goal. We sought to identify risk factors and clinical correlates of postoperative pain in order to improve perioperative management and patient satisfaction. Materials and methods: A single-center, retrospective analysis, from a prospectively maintained database, of all consecutive patients who underwent PCNL for renal calculi between January 2011 and August 2018. Postoperative pain was assessed using the visual analog scale (VAS) and analgesic use. We considered VAS score above 4 as meaningful. Pain management was standardized according to patirnt reported VAS scores. Multivariable logistic regression was performed to identify risk factors and clinical correlates. Results: A total of 496 patients were analyzed. Younger age was associated with VAS above 4 on the operative day and the first postoperative following PCNL (p = 0.003 and p < 0.001, respectively). Female gender was associated with VAS above 4 in the first 2 days following the operation (p < 0.001). Conclusions: Younger age and female gender would most likely benefit from pre-emptive improved pain management protocols following PCNL. [ABSTRACT FROM AUTHOR]

Horseshoe kidney is a rare congenital anomaly resulting from the fusion of the lower pole leading to medial and caudal deviation of kidneys that pose challenges to successful stone clearance. We evaluated the various patient- and treatment-related factors that can impact successful stone clearance. A total of 34 patients with 36 renal moieties with urolithiasis in horseshoe kidneys from 2015 to 2021 were included with a median age of 38 years (11–56 years). The mean calculus size was 39.27 mm (21–70 mm). Twenty-two patients had left, 10 had right, and 2 had bilateral disease. Twelve patients (33%) had previous interventions done. As per Guy stone score (GSS), 14 patients had grade IV, 16 patients had grade III, and 4 patients had grade II disease. Of these patients, 22 underwent unilateral percutaneous nephrolithotomy (PCNL), 2 underwent bilateral PCNL, 6 had pyelolithotomy, 2 had right nephrectomy, and 2 patients underwent shockwave lithotripsy (SWL). Six patients undergoing pyelolithotomy had complete clearance. In PCNL, infra-costal puncture was done uniformly. Complete clearance was seen in 12 out of 16 with superior calyceal access (75% stone-free rates, SFR), 2 out of 8 with middle calyceal puncture (25% SFR), and both the cases with inferior calyceal puncture (100% SFR). Factors affecting stone clearance are as follows: GSS, i.e., grade < IV vs ≥ IV (71.4 vs 50%, P = 0.42), STONE score < 12 vs ≥ 12 (83.3 vs 28.5%, P = 0.048), stone size < 40 vs ≥ 40 mm (50 vs 71.4%, P = 0.42). Our analysis showed that stone clearance was independent of mode of access, GSS, or stone size, although STONE score was a predictor of successful outcomes in PCNL. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effectiveness and safety of ureteroscopy (URS) for urinary stones treatment in patients ≥ 80 years of age. Methods: From 2012 to 2021, 96 patients ≥ 80 years underwent URS for urinary stone disease. Patients' demographics and surgical outcomes were examined. Results: The median length of follow-up was 25 months. Median age was 84 years. Half of the patients (53%) were ASA score 3 and 16% ASA 4. Mean stone diameter (SD) was 10.6 mm, and mean procedure time was 78 min. Eighty-three patients underwent follow-up imaging (ultrasonography or computed tomography) with a median time of 31 days. Stone-free rate was 73.9%. Twenty patients (20.7%) experienced a minor complication [Clavien-Dindo (CD) I–II] whereas five (5.7%) experienced a major complication (CD III–V). SD ≥ 10 mm predicted CD III–V complications (OR 1.25, 95% CI 1.01–1.55, p = 0.03). Urinary drainage prior the procedure with double J stent, nephroureteral stent or percutaneous nephrostomy tube had no impact on patients' SFR [74.6% in the drained group versus 64.0% in the undrained group (p = 0.44)] nor on major complications (OR 4.68, 95% CI 0.25–87.77, p = 0.30). Conclusion: In elderly patients, URS for treatment of renal and ureteral stones is a relatively efficient and safe procedure. The risk of major complications is low, and the only associated risk factor found was SD ≥ 10 mm. Urinary drainage prior the procedure did not affect patients' outcomes. [ABSTRACT FROM AUTHOR]

Objective: Proximal ureteric stricture is one of the many challenging problems urologists face. We aim to evaluate the results of buccal mucosal graft ureteroplasty at our institution. Methodology: All buccal mucosal graft ureteroplasties performed at the Princess Margaret Hospital, Hong Kong, between December 2020 and July 2022 were reviewed. This review included patients with ureteric strictures of different aetiologies and various stricture lengths. Collected data consisted of patients' demographics, previous interventions, surgical approach, early and intermediate outcomes. Results: Six patients (median age 59.5 years) were included in this case series. Four had previously failed ureteral interventions. Pre‐operatively four had ureteral stents and two were on nephrostomy tubes. Five had a robotic‐assisted laparoscopic repair while one had an open repair. Onlay graft was performed in five patients and augmented anastomotic repair in one patient. The median stricture length was 2 cm. Median operative time was 268 min, estimated blood loss was 200 mL, and length of stay was 7.5 days. Four patients with adequate follow‐up were considered successful at a median follow‐up of 13.7 months. There were no intra‐operative complications. Anastomotic leakage and donor site bleeding were observed in one patient (Clavien‐Dindo III). Conclusion: Buccal mucosal graft ureteroplasty is suitable in appropriately selected patients with proximal ureteral strictures. Robotic surgical approaches have made this technique promising. Long‐term outcomes are eagerly awaited. [ABSTRACT FROM AUTHOR]

This article discusses a 69-year-old male patient diagnosed with a right kidney stone and repeated right lower abdomen pain. The patient was admitted from September 30 to October 3, 2019, and underwent a single-stage minimally invasive percutaneous nephrolithotomy. During the nursing care the author collected data using Watson's care theory which indicated the patient had anxiety before the operation, potentially dangerous surgical injuries during the operation, and acute pain and lack of healthcare knowledge after the operation. Preoperative visits were made to encourage the patient to express feelings, and operation-related information was provided at the same time. During the operation, standard procedures were employed to ensure safety. After the operation, a pain assessment scale was used to evaluate level of pain, while pain relief skills were taught to improve comfort. Also a care plan was drawn up to strengthen dietary awareness; help prevent the recurrence of stones; and enhance positive health behavior to promote a good quality of life after discharge from the hospital. It is hoped the sharing of this nursing experience will serve as a reference for nursing such patients in the future. (Tzu Chi Nursing Journal, 2023; 22:4, 95-104) [ABSTRACT FROM AUTHOR]

Delayed surgical reconstruction of iatrogenic ureteral injuries is often a challenging procedure because spreading scar tissue impedes accurate identification and dissection of the injured ureter. We report a novel real‐time navigation system using a ureteral near‐infrared ray catheter (NIRC) and indocyanine green (ICG) via nephrostomy in delayed robot‐assisted ureteral reconstruction. A female patient presented with complete obstruction of the right upper ureter after gynecological surgery with extensive lymphadenectomy. A nephrostomy tube was urgently placed, and surgical repair was performed. A straight NIRC was placed in the right ureter up to the obstruction point. ICG was administered via nephrostomy. Near‐infrared light could clearly visualize the ureter and renal pelvis encased in scar tissue. The ureter and renal pelvis were dissected and successfully anastomosed. We found that near‐infrared navigation using ureteral NIRC and ICG via nephrostomy was valuable for delayed laparoscopic reconstruction of the injured ureter. [ABSTRACT FROM AUTHOR]

Purpose: To report the result of percutaneous nephrolithotripsy (PCNL) via standard nephrostomy tract in a single training institution. The perioperative complications in relation to the comorbid state are particularly assessed. Patients and methods: A prospective interventional study between January 2019 to November 2022, included 210 patients scheduled for PCNL. The average age was 40.3 ± 11.8 years (range 18- 67 years). Patients were categorized into two groups. The first group comprised 146 cases (69 .5%) with no associated co-morbidities while the second group 64 (30.5%) had co-morbidities such as obesity in 4 cases (1.9%), hypertension (HTN) in 24 cases (11.4%) cases, diabetes mellitus (DM) in 17 (8.1%) cases, history of recurrent stone surgery in 11 (5.2%) cases and more than one in 8 cases (3.8%). Co-morbidities, stone burden, location of stone, time of surgery, stay in the hospital, further operations, and negative events were among the reported data. Complications and the stone-free rate were the main outcome indicators. Results: Intraoperative complications were reported in 40 (18.8%) patients (18 group 1 and 22 group 2) during PCNL. Bleeding occurred in 22 (10.5%) patients (9 group 1 and 13 group 2), blood transfusions were needed in 4 (1.9%) (2 group 1 and 2 group 2), extravasation was observed in 11 patients (5.2%) (6 group 1 and 5 group 2) and cardiac arrhythmia in 3 (1.4%) (1 group 1 and 2 group 2) patients. Postoperative complications occurred in 61 patients (29%) (24 group 1 and 37 group 2) in the form of fever in 10 patients (4.8 %) (3 group 1 and 7 group 2) and prolonged leakage in 50 patients (23.8%) (21 group 1 and 29 group 2). One patient of group 2 died from postoperative sepsis. Extravasation and postoperative leakage were higher in diabetic patients than in non-diabetics. Stonefree rate was 60.5% (127 of 210). Clinically significant residual fragments (CSRFs) found in 70 cases (33.3%) (33 group 1 and 37 group 2). In 13 cases (6.2%) (5 group 1 and 8 group 2), clinically insignificant residual fragments (CIRFs) were found. In 8 (3 group 1 and 5 group 2) of the 13 cases, spontaneous stone passage was observed within 4-6 weeks of surgery. Residual stones in three cases (1 group 1 and 2 group 2) were asymptomatic and 4 mm or less, whereas stones increased in two cases of group 2. Among all factors studied, stone burden was significantly correlated to both intraoperative and postoperative complications. The occurrence of postoperative fever increased with large stone burden. Conclusions: PCNL is a therapeutic modality that is effective, feasible, and safe for a wide range of patients with concurrent medical issues. A steep curve is required to reduce intraoperative and postoperative complications. [ABSTRACT FROM AUTHOR]

Purpose: Myriad operative factors and characteristics of patients may influence the risk of infection in a patient undergoing stone surgery. We prospectively determined the risk factors for systemic inflammatory response syndrome (SIRS) and quick sequential organ failure assessment (qSOFA) in patients undergoing percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). Materials and Methods: Patients who underwent PCNL and RIRS from March 2018 to January 2020 satisfying our selection criteria were enrolled. Samples of urine from the renal pelvis, bladder, and retrieved stones were sent for culture testing. Postoperatively patients were keenly supervised for any indications of SIRS and qSOFA. The association between stone and urine cultures across various sites was examined. Regression analysis was performed to ascertain clinical variables affiliated with SIRS and qSOFA. Results: The study included a total of 150 patients including both PCNL and RIRS, of which 23% post-PCNL and 20% post-RIRS met the criteria of SIRS and qSOFA. On univariate analysis in PCNL-Dilated pelvicalyceal system (PCS), renal pelvic urine culture (RPUC), stone culture (SC), and operative time >124 min among others were identified as risk factors whereas, in RIRS-residual calculus, RPUC, SC and operative time >62 min were risk factors. Multivariate analysis identified dilated PCS and SC for PCNL and only intraoperative RPUC for RIRS as independent risk factors. Only a significantly strong correlation among culture analysis was found between RPUC and SC in both the procedures. Conclusion: Intraoperative RPUC and SCs are better predictors of post-PCNL SIRS while Intraoperative RPUC and duration of surgery are better predictors of post-RIRS sepsis. We, therefore, recommend that both these cultures must routinely be obtained in the above procedures to identify the offending organisms and amend antibiotic therapy during treatment and surgical duration should be kept <62 min in RIRS. SIRS serves as a sensitive review tool which is specifically useful for initial care and on the contrary qSOFA is well suited for patients at greater risk of demise, thereby guiding clinicians to decide future care and course of treatment of patients. [ABSTRACT FROM AUTHOR]

Purpose: To investigate rates of adverse pregnancy events associated with the use of percutaneous nephrostomy tubes (PCN) versus ureteral stents in the treatment of nephrolithiasis during pregnancy. Methods: We queried the TriNetX Diamond Network database to evaluate pregnant women (ICD-10 Z34, O09) with a history of nephrolithiasis (N20-23) who underwent a PCN (CPT 50432) or ureteral stent (52332) placement up to 6 months before delivery (O80-82). We controlled for the following potentially confounding variables through propensity score matching: age, race, ethnicity, acute pyelonephritis (N10), infections of the genitourinary tract in pregnancy (O23.0), and other sepsis (A41) at the time of stent or PCN placement. Results: We identified 2,999 pregnant women who underwent ureteral stent placement and 321 who underwent PCN. Following propensity score matching, we found there to be no significant difference in the rate of premature labor or delivery (aOR 1.08, 95% CI 0.735–1.588), premature rupture of membranes (0.889, 0.453–1.743), intrauterine infection (0.906, 0.379–2.165), or c-Sect. (0.825, 0.408–1.667). Within 6 months of their initial procedure, women with a ureteral stent experienced a significantly decreased rate of subsequent urinary tract infection (UTI) or pyelonephritis (0.52, 0.38–0.71), inpatient hospital stay (0.40, 0.26–0.64), emergency department visit (0.65, 0.48–0.89), and repeat exchange procedure (0.70, 0.51–0.96). Conclusion: In the treatment of nephrolithiasis during pregnancy, PCN versus ureteral stent placement does not confer a significant difference in rates of adverse pregnancy events. However, ureteral stent placement was associated with a lower incidence of hospital admissions, emergency department visits, exchange procedures, and new UTIs or pyelonephritis. [ABSTRACT FROM AUTHOR]

Purpose: The da Vinci SP® robotic system enables three double-jointed wristed instruments and a fully wristed three-dimensional camera to be placed through a single port. This study presents our experience with robot-assisted ureteral reconstruction using the SP system and reports its outcomes. Materials and Methods: Between December 2018 and April 2022, a single surgeon performed robotic ureteral reconstruction using the SP system in 39 patients: 18 underwent pyeloplasty and 21 received ureteral reimplantation. Demographic and perioperative patient data were collected and analyzed. Radiographic and symptomatic improvements were assessed 3 months after surgery. Results: In pyeloplasty group, 12 patients (66.7%) were female and two patients (11.1%) had undergone previous surgery for ureteral obstruction. The median operative time was 152 minutes, the median blood loss was 8 mL, and the median length of stay in hospital was 3 days. There was one case of a complication involving postoperative percutaneous nephrostomy (PCN). In ureteral reimplantation group, 19 patients (90.5%) were female and ten patients (47.6%) had undergone gynecological surgery that caused ureteral obstruction. The median operative time was 152 minutes, the median blood loss was 10 mL, and the median length of stay in hospital was 4 days. We observed one case of open conversion and two cases of complications (colonic serosal tearing and postoperative PCN after ileal ureter replacement). The radiographic results and symptoms successfully improved following both surgeries. Conclusions: Despite adhesion-related complications, the SP system appears to be safe and effective for use in robot-assisted ureteral reconstruction. [ABSTRACT FROM AUTHOR]

Background: Percutaneous nephrolithotomy (PCNL) is considered to be the standard procedure in patients with large renal calculus. The purpose of this study is to analyze the evidence-based literature regarding the "nephrostomy-free" or "tubeless" PCNL and to assess the safety, efficacy, possibility, and benefits of tubeless PCNL over standard PCNL. Aims and Objectives: The aim of the study was to review and compare tubeless PCNL with standard PCNL. Materials and Methods: It is a retrospective study done between August 2021 and December 2022. 100 cases of stone disease with stone size more than 2 cm who underwent PCNL in the Department of Urology, Govt hospital, Salem. Patients are divided into two groups (Group A and Group B) of 50 each depending on date of surgery. Results: In our study, we compared tubeless PCNL versus standard PCNL in patients with stone disease. Tubeless PCNL was performed with success in patients of age 13 years-65 years. 36 were female patients, whereas 64 were male patients in this study. All the results were presented in a tabulated form in our study. Conclusion: Tubeless PCNL is a safe and effective technique and is associated with decreased pain, low analgesic requirement, less operating time, and faster recovery. However, it has its own limitation that precludes secondary procedure for the treatment, removal of internal stent, dysuria, and need to visit hospital for subsequent removal of internal stent. [ABSTRACT FROM AUTHOR]

Percutaneous nephrolithotomy (PCNL) is a classic operation for the presence of large calculi in the kidneys. A channel size of 24-30 Fr is a standard surgical access incision. The smaller surgical access incisions (<18 Fr) were originally introduced in pediatrics, but are now increasingly used in the treatment of adults. Access to the renal cavity system in most clinics is performed under X-ray control, but the combination of this method with ultrasound control demonstrates a number of advantages over the mono-control method. The objective: to analyze the results of treatment of patients with kidney stones by the method of mini-percutaneous nephrolithotomy (mini-PCNL) under fluoroscopic and combined (ultrasound and fluoroscopic) control, to determine the optimal control method during puncture, dilatation and intraoperative assessment of Stone-free status. Materials and methods. For a realization of the research aim, a retrospective analysis of medical documentation was conducted on the basis of the "Institute of Urology named after Academician O. F. Vozianov of the National Academy of Medical Sciences of Ukraine". The study included 178 medical cards of patients from 18 to 72 years old with kidney stones, in which mini PCNL was performed under combined control in 95 cases (Group 1), and under fluoroscopic control (Group 2) in 83 cases. Clinically relevant parameters were studied, including the dynamics of postoperative serum creatinine and hemoglobin, blood loss, total operative time, duration of ionizing radiation, and duration of hospital stay. Postoperative complications that occurred in patients during their stay in the hospital were classified according to the Clavien-Dindo system. To assess the Stone-free state at the stage of discharge from the hospital, the patients were performed kidney ultrasound and general urography. The Student's t-test and the chi-square test were used to compare anthropometric indicators and clinical results associated with both methods of control in mini-PCNL. Statistical data analysis was performed using program STATISTICA 10 (StatSoft.Inc). Data were calculated as mean ± standard deviation or percentage with a significance level of p<0.05. Results. Groups of patients were identical by age, sex, anthropometric parameters, and characteristics of calculi. However, the average operation time for mini-PCNL under combined control was significantly shorter (96.2±23.0 vs. 127.4±33.1 min; p<0.05). The average duration of ionizing radiation was significantly shorter in the group with combined control (10.6±4.8 vs. 284.0±86.0 sec; p<0.05). Conclusions. Combined control offers a wider range of incision access to the renal cavity system and the creation of a safe percutaneous working channel in real-time mode. Mini-PCNL under combined control has comparable clinical results to intervention under fluoroscopic control with significantly lower indicators of the duration of the operation time and a reduction in the radiation time of the patient and the operating team. [ABSTRACT FROM AUTHOR]

Purple urine bag syndrome (PUBS) is a complication and a rare phenomenon associated with bacterial colonisation in bladder catheters in which urine turns purple in the tubing and the catheter bag. This condition can be distressing and panicking for the patients and their families as well as the medical staff caring for them. It is an interesting and unusual presentation that affects people with long-term indwelling catheters and chronic constipation. We report one such case in our hospital, a 73-year-old woman with stage 4 cancer of the vaginal vault, post-bilateral percutaneous nephrostomy (PCN) 4 months ago, currently on best supportive care, presented to the emergency room with symptoms of urosepsis, while a purple urine bag may appear innocuous and not need any particular care beyond replacing the catheter and giving the patient the proper antibiotics, it may indicate an occult urinary tract infection (UTI), which can have catastrophic effects in a patient using a urinary catheter for an extended period of time. Only a few examples of PUBS with an underlying nephrostomy have been documented in the literature. This is a case of a palliative care patient who had a poor prognosis despite receiving the right antibiotic treatment for an upper UTI that caused purple staining of the PCN catheter bag. Using this case report as a guide, we could manage a complex UTI in a palliative care context. [ABSTRACT FROM AUTHOR]