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Monopolar Transurethral resection of bladder tumor (TURBT) has been a gold standard for bladder tumor. Initial studies of bipolar TURBT were promising, however, no high level evidence exists and its exact role remains undefined. We compared the safety and efficacy of bipolar and monopolar TURBT. Primary objective was to compare the incidence of obturator jerk. The secondary objectives included the comparison of decrease in hemoglobin, recoagulation and transfusion requirements, bladder perforation, decrease in sodium, resection syndrome and resection time, hospital stay, detrusor muscle identification and severe cautery artifact in resected specimen in two groups. A randomized control trial was conducted for one year. All patients undergoing TURBT for suspected bladder tumors were eligible. Patient’s refusal to participate, unfitness for spinal anesthesia and lack of tumor in lateral wall were excluded. Of the 118 TURBT done during study period, 48 were excluded and 70 patients, 36 in monopolar and 34 in bipolar arms, were analyzed. The incidence of obturator jerk was less in bipolar arm but not significantly different (26.4% vs. 47.2%, p=0.073). There was no significance difference in most of the secondary outcomes except lesser hemoglobin drop (0.49gm/dl vs. 0.98gm/dl, p=0.016) and lesser resection time in bipolar arm (33.0 mins vs. 46.8mins, p=0.008). Bipolar was not different to monopolar TURBT with respect obturator jerk and most of the secondary outcomes. However, with bipolar TURBT, there was significantly less resection time and although hemoglobin drop was less as well, it was not clinically significant.

Renal metastasis from osteosarcoma is a rare entity, and tumour thrombus is even rarer. To date, only 15 cases of osteosarcoma with tumour thrombus have been reported in the literature. We present a case of an 18-year-old female diagnosed as having right distal femur osteosarcoma, later presenting with renal osteosarcoma with IVC thrombus.

Highlights • Myxoid liposarcoma is a rare mesenchymal tumor of the bladder with only a few cases reported in the literature. • It is difficult to diagnose and carries a poor prognosis. • The primary treatment is complete surgical resection which is usually followed by adjuvant chemotherapy. • We report a case of 26 year female with mesenchymal tumor of the bladder presenting as a large abdominal mass., Introduction Myxoid liposarcoma of the bladder is a rare mesenchymal tumor which is difficult to diagnose and carries a poor prognosis. The primary treatment is complete surgical resection which is usually followed by adjuvant chemotherapy. Presentation of case We report a case of 26 years female who presented with a large abdominal mass and was initially misdiagnosed to be arising from ovaries and subsequently discovered to be a mesenchymal tumor arising from the bladder. Discussion Myxoid liposarcoma is an exceedingly rare but aggressive mesenchymal tumor of the bladder often with misleading imaging appearances. Conclusion Surgical resection, when feasible, plays the leading role in its management, and should be attempted in all potential patients.

IntroductionSince the beginning of renal transplant, the objective has been to increase the patient and graft survival, bothshort term and long term. Data relating to donor factors affecting short term survival at 6 months in live donorkidney transplantation has been scarce. This single center study tries to examine the predictors of short termgraft outcome at six months in recipients of live donor kidney transplants and explore which donor characteristicsare the most useful in predicting the post-transplant graft function in Nepalese population.MethodsAll patients who underwent kidney transplantation between May 2015 to July 2016 were included in the study.The patients who expired during follow were excluded. The clinical and laboratory parameters of the donors wererecorded. The recipients were followed up for six months post transplantation. The eGFR of the recipients and theoccurrence of rejection were recorded at the end of six months post transplantation.ResultsA total of 82 donor-recipient pairs underwent living donor renal transplantation at our hospital during the studyperiod. One recipient who expired during follow up was excluded. The mean age of donor was 45.20 ± 11.226years of which 55 (67.9%) were female and 26 (32.1 %) were male. The mean eGFR of the donor calculatedfrom Cockcroft Gault equation was 81.98 ± 18.11. The eGFR of the recipient at the end of six months posttransplantation calculated form the MDRD equation was 67.76 ± 20.94. A total of 7 patients (8.6%) had rejectionthat were biopsy proven. Only donor eGFR was found to be significantly associated with eGFR of the recipientat six months post transplantation (p=0.034). Body mass index of the donor was significantly associated withrejection in the recipient at six months post transplantation (p=0.011).ConclusionOur study demonstrates that the donor eGFR and body mass index are independent and important factorsaffecting the short term graft outcome at six months post transplantation.KeywordsBody mass index, donor eGFR, graft outcome, renal transplantation

PURPOSE This study was aimed to compare lymphatic complications of bipolar vessel sealing system with silk ligation of lymphatic vessels among renal transplant recipients. METHODS This was a prospective randomized controlled trial done among 68 patients undergoing renal transplantation in Tribhuvan University Teaching Hospital. They were randomly assigned to either silk ligation or Enseal bipolar vessel sealing lymphatic dissection. Postoperative drain volume and duration of drain placement were measured in all patients. Ultrasound was used to find lymphocele formation in six and 12 weeks. RESULTS Total of 30 patients in silk ligation group and 28 patients in bipolar vessel sealing group were analyzed. The baseline characteristics of the patients in each group were similar. Overall, lymphatic complications (either lymphorrhea or lymphocele formation) were in 16 cases (27.58%), 7 (25%) in the bipolar group, and 9 (30%) in the silk ligation group (p = 0.67). A total of 13 patients (22.41%) had lymphorrhea, 6 (21.4%) patients in the bipolar group, and 7 (23.3%) patients in the silk ligation group. Median drain volume was 415 ml (Q1 275 ml, Q3 675 ml) in the bipolar group and 542 ml (Q1 290, Q3 775) in silk group (p = 0.72). Median drain removal day was 5 in each bipolar and silk group with Q1 and Q3 being 5 days in each arm (p = 0.95). A total of five patients (8.62%) developed symptomatic lymphocele, two (7.1%) in the bipolar group, and three (10%) in the silk ligation group, but the difference was not statistically significant. In univariate analysis, double renal arteries in the donor's kidney (p = 0.03) and graft rejection (p = 0.04) were risk factors for the development of lymphatic complications. However, in multivariable analysis, these factors were not statistically significant. CONCLUSIONS This study did not find any significant differences in lymphatic complications between bipolar vessel sealing system and silk ligation. However, large sample multi-centric studies should be done to add evidences on lymphatic complications differences between these two techniques. TRIAL REGISTRATION NUMBER UMIN000039354, Date of registration-2020, Feb 01.

To define the clinical and pathological patterns of urinary bladder carcinoma from the University Hospital of Nepal. This is a retrospective analytical study. Patients with bladder mass who underwent surgery over 1 year and who had data record were included in the study. Demographic profile, type of surgery, findings on clinical examination, cystoscopy findings, histopathological report, tumor stage, and post-surgery adjuvant therapy were analyzed. Out of 86 patients who underwent transurethral resection of bladder tumor, 77 patients had biopsy-proven malignant bladder tumor. Urothelial cancer was present in 96.1%. Male were 78.6%. The mean age of diagnosis was 65.5 ± 11.8 years. Non-muscle-invasive bladder cancer (NMIBC) was 3.7 times more common than muscle-invasive bladder cancer (MIBC). High-grade tumors (58.6%) were more common than low grade (41.4%). The detrusor muscle was present inthe biopsy specimen of 48 patients (64%). Re-TURBT within 2–6 weeks was considered based on histopathology reports for about half of the patients (45.3%). Upstaging and upgrading of the tumor was present in 5.8 and 5.8% of the patients, respectively. Residual tumor without upstaging and upgrading was present in 23.5%. One patient (1.3%) had Clavien–Dindo grade 1, three (4%) patients had grade 2 and two patients (2.7%) had grade 3b. In the present study, patients with bladder cancer are younger than reported in other studies. Smokers are strongly predisposed. The histological pattern is similar to the Western and Asian populations. NMIBC and MIBC occur in proportion to that described as in other studies. We had a lower rate of recurrence, upstaging and upgrading. We had a lesser rate of acceptance for radical cystectomy in our patients.

Hydatid disease in developing countries like Nepal is not uncommon but isolated renal involvement without liver and lung hydatid is rarely described in literature. It may create diagnostic dilemma at times. We describe a 22-year-old female with isolated renal hydatid disease managed with nephron sparing surgery (NSS).

Gestational choriocarcinoma with kidney and lung metastases with delayed presentation after term pregnancy is rare event and not described frequently in literature. We describe a rare case of 24-year-old female with hematuria after 3 years of term delivery. Management includes chemotherapy and even renal embolization in case of life threatening hematuria.

INTRODUCTION AND OBJECTIVE:Retrograde intrarenal surgery (RIRS) has changed the paradigm of treatment of renal stone. Ureteral access sheath used during RIRS though has definite advantage but canno...

Highlights • Atrial fibrillation is associated with peripheral embolism. • Renal artery embolism is reported in rare instances. • Clinical suspicion in high risk patient and urgent treatment is key to success., Introduction Renal artery embolism is uncommon cause of flank or back pain. Of all embolic episodes in patients with atrial fibrillation, 2–4% are renal artery embolism. Early thrombolysis within 90 min has favorable renal outcome. Long term anticoagulation can prevent recurrent embolic episodes. Two different embolic phenomenon within short span in same patient is not described in literature. Presentation of case We describe fifty-year-old female with rheumatic heart disease with atrial fibrillation presented as renal segmental artery emboli with popliteal artery emboli within seven-day interval. Discussion Embolic phenomenon is well known in atrial fibrillation. High index of suspicion in patient with risk factors of thromboembolism with appropriate use of contrast enhanced computed tomography can help early diagnosis. Renal artery embolism is managed with anticoagulation or thrombolysis based on duration of presentation. Peripheral artery embolism can be diagnosed with Doppler ultrasonography. Thrombus can be removed with endovascular procedure or open surgical technique. Holistic patient management includes cardiac workup and treatment of factors predisposing to embolization. Conclusion Early identification and urgent treatment is key to the management of embolic episode in patient with atrial fibrillation. Long term prophylaxis can prevent further episodes.

Introduction: Nephron-sparing surgery (NSS) is the standard of care for clinical T1 (cT1), renal mass less than 7 cm, whenever intervention is indicated. It has ontological outcome equivalent to radical nephrectomy in small renal masses and it also minimizes the progression to chronic kidney disease. However, there is paucity of data on outcomes of NSS in Nepalese population. Methods: A six years retrospective review of medical records of patients undergoing partial nephrectomy from Jan 2012 to Dec 2017 in Department of Urology and Kidney Transplant Surgery at Tribhuvan University Teaching Hospital was done to determine its demographics and outcomes. Results: Twenty eight patients underwent nephron sparing surgery for clinical T1 renal masses in the past six years. Complications occurred in three cases. Five of the lesions were benign and 23 malignant on final histology. Clear cell carcinoma was the commonest variant of renal cell cancer. Margin was positive in two cases and both were kept in close surveillance. There was no local recurrence and renal impairment during five to 60 months follow up. Conclusion: Nephron sparing surgery is a safe procedure with good oncological outcome for clinical T1 renal mass. It prevents unnecessary nephrectomy in benign lesions as well as chronic renal impairment at the same time.

IntroductionAdrenal gland surgery is a challenging art as it encompasses diverse physiological derangements which are evenlife-threatening. Also, it remains a medical finesse to rightly identify the correct patient who will benefit fromsurgery which include strong biochemical and radiological resource. Soundly performed surgery will lead tooncologic and homeostatic correction leading to near normal course.MethodsThis is a retrospective analysis of adrenalectomy cohort over three years in a tertiary center in Nepal identifyingdiagnosis, perioperative management and postoperative course. The objective of this study is to review thepresentation, histopathology and clinical outcomes of patients operated for adrenal mass in our center.ResultsThere were 42 surgeries performed via open approach. The number of adenoma, phaeochromocytoma, carcinomaand non-functioning tumor were 13, 16, 12 and one respectively. In most of the hypertensive patients, controlwas achieved with minimal drug and recurrences were observed in 25% of carcinoma in postoperative follow up.ConclusionA large proportion of operative adrenal mass are observed clinically in our setup. The surgical outcome issatisfactory but judicious perioperative management is essential.KeywordsAdrenalectomy, adrenocortical carcinoma, phaeochromocytoma

Introduction. Urolithiasis is one of the common disorder with which about 1/5th is found in the ureter, of which 2/3rd is seen in the lower ureter. Medical expulsive therapy is one of the routine modalities of treatment which uses various drugs acting on the ureter smooth muscle by different mechanism. We aim to compare the efficacy of combination vs. single drug. Methods. This randomized controlled trial was done in 176 consecutive patients over a period of six months (March 2019 to August 2019) in Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching. Participants were divided into two groups (Group A, tamsulosin plus tadalafil, and Group B, tamsulosin) from computer-generated random numbers. Therapy was continued for a maximum of 3 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of colic and emergency room visits for pain, early intervention, and adverse effects of drugs were recorded. Results. Among 176 patients who were enrolled in study, 7 were lost to follow-up, and 5 people required immediate intervention. There was a significant higher stone passage rate in group A than group B (64 vs. 50; P=0.025) and shorter expulsion time (1.66 vs. 2.32 weeks P=0.001) and less number of emergency room visits and colic episodes. No significant side effects were noted during study. Conclusion. Tamsulosin plus Tadalafil is more effective than tamsulosin with early passage of stone and decreased number of colic episodes and emergency visits without significant side effects for lower ureteric calculi of 5 mm to 10 mm.

Introduction : Patients with enlarged prostate generally rate their storage symptoms (frequency, urgency and nocturia) as the most bothersome as these symptoms interfere more with daily activities and have huge impact on quality of life. Effect of transurethral resection of prostate (TURP) on storage symptoms is unknown. Objective of the study is to assess the change in storage symptoms in patients undergoing TURP. Methods : A prospective observational study was conducted at the author’s institute from August 2011 to July 2012. Patients undergoing TURP for moderate to severe lower urinary tract symptoms (LUTS) secondary to benign enlargement of prostate were included. Patients were evaluated by International prostate symptom score (IPSS) questionnaires . The question number 2, 4 and 7 of the IPSS questionnaire gave the storage symptom subscore (0-15). After initial evaluations, the patients underwent TURP. After 3 months, the IPSS was reevaluated and the change in storage symptom was analyzed. Results : A total of 57 patients who had undergone TURP were eligible for final data analysis. Majority of the patients had severe bothersome LUTS with mean IPSS score of 24.6±6. The baseline storage symptom subscore was 11.1±3. After 3 months of follow-up, there was significant decrease in total IPSS score and both of its subscores. On comparing the mean change in storage and voiding subscore, there was less decrement in storage subscore which was statistically significant (p=0.001). Conclusions: This study showed that after TURP change in voiding subscore occurs more than storage subscore and storage symptoms may not revert to normal.

Cryptorchidism is one of the most common congenital anomaly affecting new born males. Early identification and management at 6–12 months is recommended. Occasionally adult male can present for the first time with intra-abdominal mass with empty ipsilateral scrotum. These tumors may present at advanced stage and management may be challenging at times.

Introduction: Exit strategy at the end of percutaneous nephrolithotomy (PCNL) differs from center to center and patient to patient. Standard PCNL has been practiced so far with minor postoperative morbidities. Tubeless PCNL, which obviates most of the nephrostomy related morbidities, has been challenged for its safety. So this study was conducted to compare the safety and morbidity of tubeless PCNL with standard PCNL. Methods: Patients who had undergone PCNL, were randomized into group 1 (standard) and group 2 (tubeless) using computer generated random table. In group 1, nephrostomy tube was placed at the end of the procedure and tubes were omitted in group 2 patients. All preoperative, intraoperative and postoperative parameters were recorded and compared in between the groups. Results: Ninety six PCNLs were randomized into group 1 (47 patients) and group 2 (49 patients). Patients’ characteristics including age, sex, comorbidities, preoperative parameters, size and number of stones and mean operation time were comparable in between the groups. The incidence of postoperative fever, pain and analgesic requirement and urinary leak were found more in group 1 patients. The incidence of postoperative complications and events were comparable in both the groups except for blood transfusion. The mean length of postoperative hospital stay for patients in group 2 was significantly low as compared to group 1. Conclusion: Tubeless PCNL is safe and has less morbidity as compared to standard PCNL in selected cases.

Introduction: Presence of residual tumors is not an uncommon event after transurethral resection of bladder tumor, and no studies from Nepal so far has addressed this issue. We conducted this study to determine the rate of residual tumors after first transurethral resection of nonmuscle-invasive bladder cancer, and to determine the factors associated with the presence of residual tumors and upstaging of nonmuscle-invasive bladder cancer. Methods: This was a prospective observational study of 43 patients of bladder cancer who had a diagnosis of nonmuscle-invasive bladder cancer following an initial transurethral resection. Demographic data and data on tumor characteristics were obtained. Patients underwent a second transurethral resection within 2 to 8 weeks. Histopathological findings at first and second resection were compared. Results: There were 20 patients with Ta tumor and 23 patiens with T1 tumor at initial resection. Residual tumor was detected in 18 (41.86%) patients overall, 2 in patients with Ta tumor (10%) and 16 in patients with T1 tumor (69.5%). Tumors with T1 stage, high grade, size more than 3 centimeters and sessile growth pattern were seen to have significant association with the presence of residual tumors. Six patients with T1 disease upstaged to T2 disease after second resection (26%), while there were no upstaging with Ta tumors. Tumors with T1 stage, sessile configuration and size more than 3 centimeters were found to be significantly associated with upstaging. Conclusion: A second transurethral resection for nonmuscle-invasive bladder cancer should be considered if the initial tumor is T1 stage, high grade, more than 3 centimeters in size and has sessile growth pattern.

Pheochromocytoma associated with inferior vena cava (IVC) thrombosis is very rare. A 27-year-old female presented with right flank pain and hypertensive urgency. Contrast-enhanced CT abdomen and gadolinium-contrast MRI abdomen revealed right adrenal mass suspicious of malignancy with invasion and compression to the right IVC wall along with IVC thrombus extending from the level of renal veins to the level of confluence with hepatic veins. Her routine laboratory investigations including 24-hour urine fractionated metanephrines, vanillylmandelic acid, and cortisol were normal. Right adrenalectomy with IVC thrombectomy was done. Perioperative period was uneventful. Histopathology of the mass turned out to be pheochromocytoma with thrombus revealing fibroadipose tissue with fibrin. Pheochromocytoma may present with IVC thrombus as well as normal serum and urinary markers. Thus, clinical suspicion is imperative in perioperative management of adrenal mass.

Background Phaeochromocytomas are rare tumors of chromaffin cells of neural crest that classically present with symptoms of catecholamine excess such as palpitations, headache and sweating. They are diagnosed by measuring plasma or urinary levels of catecholamines or their metabolites. Anatomic localization is done by computed tomographic scan or magnetic resonance imaging, or meta-iodobenzyl guanidine scan in certain cases. Adequate preoperative catecholamine blockade prevents perioperative hemodynamic instability. Objectives To study the clinical spectrum and management of phaeochromocytomas in a tertiary care centre, Tribhuvan University Teaching Hospital, in Nepal. Methods Retrospective review of case records of histologically proven cases of phaeochromocytomas from 2008 -2011 was done, and data collected on clinical spectrum, diagnostic modalities, perioperative management and follow-up. Results Tweleve cases of phaeochromocytomas were operated. The mean age was 36.41±14.07 years. There were 2 bilateral phaeochromocytomas and 1 extra-adrenal paraganglioma. Apart from the common symptoms of catecholamine excess, patients had atypical presentations like psychiatric manifestations and blurred vision. A combination of urinary Vanillyl Mandelic Acid and computed tomographic scan was used for diagnosis, and open surgery was done in all cases. Pre-operative blood pressure control was achieved by prazocin or calcium channel blockers. Ten patients had intraoperative surge in blood pressure. There were no major morbidity or mortality. Three patients had high blood pressure post-operatively, but were effectively managed with antihypertensives. Conclusion Phaeochromocytomas can have variable presentation. Good preoperative preparation and perioperative management can result in an excellent outcome. Kathmandu University Medical Journal | VOL.10 | NO. 3 | ISSUE 39 | JUL- SEP 2012 | Page 52-55 DOI: http://dx.doi.org/10.3126/kumj.v10i3.8020

Introduction: Ageing is a continuous, universal and progressive process associated with an increasing incidence of comorbidities. Benign Enlargement of Prostate (BEP) is major cause of morbidity in the ageing men. Transurethral Resection of Prostate (TURP) is the Gold Standard for patients with BEP and delivers durable outcomes, however, is associated with morbidity and mortality.This study was conducted to analyze the correlation of these comorbidities in ageing men with the incidence of complications of TURP.Objective: To report and grade operative complications of TURP using Modified Clavien Classification System (MCCS) and analyze whether Charlson Comorbidity Index (CCI) predicts complications after TURP.Methods: This is a prospective analytical study of 77 patients diagnosed as Benign Prostatic Hyperplasia (BPH) undergoing TURP over one year at Tribhuvan University Teaching Hospital. Preoperative morbidity was classified using Charlsons Comorbidity and postoperative complications were graded according to Modified Clavien Classification System (MCCS) into five grades (Grades I, II, IIIa, IIIb, IVa, IVb and V) according to severity followed till 90 days after TURP.Results: Fourteen out of seventy seven (18.2%) patients developed postoperative complications. CCI Scores of 2 in 4 (5.2%) patients, constituting the bulk of 93%, Grade IV complications were 7% and no mortality was observed. Patients with higher CCI scores showed statistically significant increase in the grade of postoperative complication and positively correlated to MCCS (ρ of .295; p value

Introduction: Ureteral stent placement is an increasingly common procedure in urological practice.They are used for both prevention and treatment of ureteral obstruction. Despite improved design and materials, many patients still develop stent-related symptoms which commonly affect quality of life and sometimes necessitate early removal. Tamsulosin improves stent-related symptoms and quality of life, and can be applied in routine clinical practice. In the present study, the effect of Tamsulosin in improving double-J stent-related symptoms and quality of life following ureteral stent placement was studied.Methods: This RCT was carried out in the Department of Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal from February 2015 to January 2016. Forty six patients were included in the study and randomized into Tamsulosin(T) group and Control(C) group each having 23 patients. In addition to standard postoperative care, Tamsulosin group received 0.4mg Tamsulosin daily and Paraceramol on demand and control group received only Paracetamol. Stent related symptoms and quality of life was assessed by IPSS at discharge (day2) and at the time of DJ stent removal (2 weeks). Pain was evaluated by VAS and analgesic requirement was documented. Data were analysed using SPSS 20, chi-square test and Student’s t- test was used. A p-value of

Background Renal tumor is the 13th most common malignancy in the world and more than 90% of renal tumors are renal cell carcinomas. As there is no data available on renal cell carcinoma in Nepal, hence this study was undertaken to analyze the patterns of renal cell carcinoma in patients with renal mass at a tertiary level hospital in Nepal. Objectives To analyze the patterns of renal cell carcinoma in patients with renal mass at a tertiary level hospital in Nepal. Methods The case records of 50 consecutive patients with renal cell carcinoma presenting at the Tribhuvan University Teaching Hospital, Kathmandu from July 2006 to June 2011 were retrospectively evaluated for presenting symptoms, physical finding, investigation and histopathology report. Results Out of 50 patients, 64% were male and 36% were female. The age ranged between 11 to 78 years (mean ± SD: 55 ± 15 years). Fifty four percent of patients were smokers. Incidentally tumor was detected in 40% cases by ultrasonography and the typical triad was present in only 4%. The tumor was occupying upper pole in 40% of cases. The tumor size ranged from 3 to 15 cm (mean ± SD: 7.3 ± 2.9 cm). Histopathologically, 76% of the patient had organ confined renal cell carcinoma (T1-2 N0 M0). Clear cell was the most common type seen in 86%. Fuhrman’s nuclear grade 2 was found in 50%. Conclusion Many of the renal cell carcinoma are detected incidentally, at an early stage and are of clear cell subtype. DOI: http://dx.doi.org/10.3126/kumj.v9i3.6302 Kathmandu Univ Med J 2011;9(3):185-8

Histoplasmosis is an opportunistic infection caused by a dimorphic fungus Histoplasma capsulatum. Histoplasmosis causing bilateral adrenal involvement is rare and usually occurs only in immunocompromised individuals with disseminated disease. Here we report a case of bilateral adrenal histoplasmosis with disseminated disease in an immunocompetent patient.

Ureterosigmoidostomy is one of the oldest technique for continent urinary diversion. Though less common nowadays, it is still a useful form of urinary diversion; simple to perform, offers good continence with minimal interference with life style. It still has a major role in conditions like ectopia vesicae and post-radical cystectomy for bladder carcinoma. We present a case of 33 years lady who underwent ureterosigmoidostomy at the age of 10 years for ectopia vesicae and later developed left pyonephrosis due to distal ureteric calculus. Left sided PCN was done and successful antegrade endoscopic removal of calculus relieved her symptoms.