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There have been major advances in the last few decades in our understanding of heavy rainfall during monsoon season due to substantial progress in both observation and numerical modelling of monsoon. All these resulted in more accurate forecast of heavy rainfall in short to medium range, (upto five days) with 40% improvement in accuracy of heavy rainfall forecast in recent five years (2018-2022) as compared to previous five years. However, improvement of forecast and warning skill is not sufficient to minimize damage to lives and property. It is essential to extend to hazard forecast systems (hazard models) and then to impact and risk assessment with stakeholder interaction for risk based warning (RBW) and response action to protect lives and livelihoods Considering all these, India Meteorological Department (IMD) has introduced impact based forecast (IBF) for heavy rainfall at meteorological sub-division level since July 2013 and at district and city scale in August, 2019 in its short to medium range forecasts and nowcasts indicating the likely impact of the heavy rainfall in different sectors and required response actions. Thereafter the IBF of heavy rainfall has undergone several changes over the years. Currently, the IBF being implemented by IMD includes all the four components, viz., (i) meteorological hazards, (ii) geophysical hazards, (iii) geospatial applications and (iv) socio-economic conditions and it utilises a web-GIS based decision support system (DSS). In this study we have reviewed various approaches and stages of development of IBF of heavy rainfall in India. The success of IBF of heavy rainfall will enhance the management of critical resources like agriculture, water & power and support urban and disaster management sectors among others while reducing loss of life and property.

Objective To present our technique and experience of robot-assisted ureterocalycostomy (RAUC) in managing secondary pelvi-ureteric junction obstruction (PUJO) in adults. Patients and methods We retrospectively reviewed all patients from our centre who underwent RAUC, between 2011 and 2015, for secondary PUJO resulting from previous surgical intervention. Six procedures in five patients, including a bilateral RAUC were performed. The median (range) patient age was 33.7 (18–41) years. The outcome variables included operative time, duration of hospital stay, and objective evidence of unimpeded drainage on urography. Results The mean (range) operating time was 172 (144–260) min and estimated blood loss was 100 (50–250) mL. There were no conversions to open or laparoscopic surgery, and no intraoperative complications. Two patients had Clavien–Dindo Grade I complications that were managed conservatively and one patient had a Grade IIIb complication, which required balloon dilatation and re-stenting. After a median (range) follow-up of 11 (7–48) months, five of the six renal units had successful outcomes. Conclusion The robot-assisted approach appears to be ideally suited for redo cases demanding fine dissection with meticulous suturing. In our present series of adult patients, we could safely and successfully perform RAUC with minimal morbidity. However, a larger multi-institutional outcome analysis is required to substantiate the role of the robot-assisted approach in performing UC.

Background/Aims/Objectives: The study aims to review our experience with balloon dilatation of urethral strictures and retrospectively analyze predictors of improved success rates. Methods: One hundred and forty-four cases were analyzed from January 2011 to December 2012. Patients underwent balloon dilatation using 6-Fr Balloon dilator set (Cook Urological, Spencer, Ind., USA). Patients analyzed with respect to demography, uroflowmetry (Qmax) and need for auxiliary procedures in the immediate postoperative period, at 6 months and at 1 year. Comparisons were made between those who performed self-calibration against those who did not. Results: Overall success rate of balloon dilatation in our study was 84.4%. Procedural failure was observed with 3 patients (2.1%). Auxiliary procedure was required in 21 cases (15.6%) during follow-up. The mean Qmax (ml/s) in those who regularly performed self-calibration (n = 73) and in those who did not perform self-calibration (n = 39) in the immediate postoperative period, at 6 months and at 1 year were 24.2 ± 10.5, 16.5 ± 7.5, 14.4 ± 6.3 and 21.2 ± 10.6, 14.5 ± 7, 10.8 ± 5.6, respectively. Statistical significance was noted at 1 year (p = 0.003). Lesser re-treatments were required in those who performed self-calibration (12.3 vs. 20.5%). Improved success rates were noted with focal and bulbar strictures. Iatrogenic strictures and pan-anterior urethral strictures had poor outcomes despite self-calibration. Conclusions: Balloon dilation with self-calibration significantly improves flow rates at 1 year and lessens auxiliary procedures required. It is simple, easy to perform under local anesthesia and repeatable in case of re-strictures.

Transitional-cell carcinoma (TCC) of the upper tract in a case of circumcaval ureter (CCU) is a rare entity. Laparoscopic transperitoneal nephroureterectomy in such case represents a unique challenge in the era of minimally invasive surgery. We report a case of complete transperitoneal laparoscopic nephroureterectomy with bladder cuff excision done for TCC in a case of CCU. This case report describes the first point of technique of the procedure done for this rare entity. A 38-year-old male patient underwent the procedure for high-grade TCC of right lower calix. The essential tenets of the procedure included performance of the technique in a manner contrary to the conventional nephroureterectomy. The case report describes the procedure in the following steps: management of lower ureter and bladder cuff followed upper tract procedure after transposition of bladder cuff posterior to inferior vena cava. The procedure was accomplished utilizing four ports and a 6 cm Pfannenstiel incision with operative time of 220 minutes and blood loss of 50 mL.

The goal of this randomized controlled trial was to compare the outcomes of robot-assisted laparoscopic donor nephrectomy (RDN) with standard laparoscopic donor nephrectomy (LDN).Forty-five voluntary kidney donors (27 for right subgroup and 18 for left subgroup) who met inclusion and exclusion criteria were randomized into 2 groups, RDN and LDN in 1:2 ratio. Primary endpoints were visual analogue scale (VAS) pain scores, analgesic requirement, and hospital stay of donors. Secondary endpoints were donor's intraoperative and postoperative parameters, graft outcomes, and donor surgeon's difficulty scores.All procedures were completed without any intraoperative complications. VAS pain scores at 6, 24, and 48 hours (p = 0.00), analgesic requirement (p = 0.00), and hospital stay (p = 0.00) were less in RDN than in LDN. Longer graft arterial length could be preserved with robotic approach on right side (p = 0.03) but not on left side (p = 0.77). The RDN group required more number of ports (p = 0.00), longer retrieval time (p = 0.00), and warm ischemia time (WIT) (p = 0.01). Total operative time (p = 0.14), hemoglobin drop (p = 0.97), postoperative donor complications (p = 0.97), and the recipient estimated glomerular filtration rate at 9 months (p = 0.64) were similar in both groups. Difficulty scores of console surgeon were less in most steps on right side but not on left side. Patient-side surgeon in RDN had higher difficulty scores for retrieval.RDN is safe and is associated with better morbidity profile than LDN. Robotic approach provides technical ease and facilitates preservation of longer length of renal artery on right side. Left RDN is associated with longer WIT; however, this does not translate into poor graft outcome.

Laparoscopic pyeloplasty was first described as a minimally invasive treatment option by Schuessler and colleagues in 1993,1 and there are now several large published series with extended follow-up confirming long-term patency rates of 96–100%.2–4 These results parallel the outcomes of the open pyeloplasty. As demonstrated with other minimally invasive operations, patients undergoing laparoscopic pyeloplasty have reduced analgesic requirements, hospital stays, and time until return of full activities compared with their open surgery counterparts. Although technically challenging, the low incidence of failure combined with reduced postoperative morbidity has made this an increasingly popular treatment option at various centers across the globe. This chapter discusses the possible difficulties a surgeon may encounter and also details the possible solutions to these problems.

Objectives To present our single-centre experience of the micropercutaneous nephrolithotomy (microperc) technique and define its role in the management of renal calculi as well as to analyse the factors predicting outcome. Patients and Methods We retrospectively analysed data from 139 patients who underwent microperc for renal calculi between June 2010 and November 2014 at our institution. The factors analysed were demographic variables, which included age, sex, stone volume, stone density (Hounsfield units [HU]) and stone location, and intra- and peri-operative variables, such as operating time, drop in haemoglobin level, stone clearance and complications. Results The mean ± sd (range) patient age was 38.99 ± 17 years (9 months to 73 years), stone volume was 1 095 ± 1 035 (105–6 650) mm3 and stone density was 1 298 ± 263 HU. The mean ± sd (range) operation duration was 50.15 ± 9.8 (35–85) min, hospital stay was 2.36 ± 0.85 (2–5) days and drop in haemoglobin level was 0.63 ± 0.84 (0–3.7) mg/dl. Eight patients had renal colic that was managed by antispasmodic medication, four patients had renal colic severe enough to warrant JJ stenting and three patients had urinary tract infections which were managed with appropriate antibiotics. We were able to complete microperc in 130 patients, with 119 (91.53%) patients being rendered completely stone-free, while in 11 patients (8.46%) there were some residual fragments seen on imaging. On multivariate analysis, stone number, volume and density were found to be significant predictors of clearance. Conversion to mini- or standard percutaneous nephrolithotomy was required in nine patients (6.47%), with intra-operative complications and stone number being the significant factors warranting conversion on a multivariate basis. Conclusion The outcomes in the present study suggest that microperc is a promising treatment method for solitary renal stones with volumes

Objective To devise a management protocol for chylous ascites after laparoscopic nephrectomy. Patients and Methods We retrospectively reviewed the data of the patients that underwent laparoscopic nephrectomy between January 2010 and January 2014 in our institution for different indications and were diagnosed with chylous ascites. We also analyzed a different management protocol that was used. Results The overall incident rate of chylous ascites was 0.77%. It was more commonly seen on left side and with simple nephrectomy rather than radical. Three out of 9 patients were managed by surgical intervention, rest were successfully managed on conservative treatment in the form of dietary modification, total parenteral nutrition, or octreotide. Conclusion Chylous ascites is a rare but morbid condition following laparoscopic nephrectomy. To manage this complication, we propose preventive and treatment strategies based on symptoms and amount of chylous ascites using our experience and review of the literature.

In this paper, we report the dielectric and structural behavior of Sr2+ modified PZT–PMN ceramic. X-ray diffraction patterns have been recorded at room temperature, which reveal that PSZT–PMN ceramics are single phase in nature. Rietveld analysis of the powder diffraction data shows the presence of the morphotropic phase boundary in PSZT–PMN ceramic near the composition x ≥ 0.050. The structural changes take place from tetragonal with P4mm space group to rhombohedral with R3c space group at 0.050 ≤ x ≤ 0.075. The relative dielectric constant and dielectric loss have been calculated as a function of temperature. It has been shown that the transition temperature decreases significantly with increasing Sr2+ substitution in PZT–PMN ceramics. It is also shown that the material obeys modified Curie-Weiss law.

Background: We summarise our experience with RPN emphasising on learning curve, techniques and outcomes. Patients and Methods: A retrospective chart review of 57 patients was done. The preoperative workup included a triple phase CT angiography. The parameters analyzed were demographics, tumor characteristics, operative details, postoperative outcome, histopathology and follow-up. The data were compared with historical cohort of the laparoscopic partial nephrectomy (LPN). Results: 58 renal units in 57 patients (45 males and 12 females) underwent RPN. The mean age was 53.08 ± 13.6 (30-71) years. The mean tumor size was 4.96 ± 2.33 (2-15.5) cm. Average operative time was 129.4 ± 29.9 (70-200) min.; mean warm ischemia time was 20.9 ± 7.34 (9-39) min. 8 renal units in 7 patients were operated with the zero ischemia technique. The average follow-up was 5.15 months (1-18). There was no recurrence. 15 patients underwent LPN. The mean tumor size was 4.3 ± 1.6 (1.6-8) cm. operative time was 230.7 ± 114.8 (150-300) min.; mean warm ischemia time was 31.8 ± 9 min. The nephromerty score in the LPN group was 7.1 ± 0.89, in the RPN group was 8.75 ± 1.21. Conclusion: Our results suggest that prior experience of LPN shortens the learning curve for RPN as seen by shorter warm ischemia time and operative time in our series. The nephrometry score in RPN were higher suggesting that complex tumour can be managed with robotic approach.

In percutaneous nephrolithotomy (PCNL), placement of the access tract into the kidney is an important aspect of the procedure and is responsible for the steep learning curve associated with the operation. The aim of the current prospective randomized trial was to assess the duration of radiation exposure along with the safety and efficacy of PCNL done by a trainee, utilizing either ultrasonography (US) or fluoroscopic guidance to obtain access.Sixty-four patients with ≤3 cm renal calculi undergoing single-tract PCNL by trainee urologists (experience of25 PCNL's) were randomized into US- and fluoroscopic-guided access groups (32 in each). In Group 1 (US guided), puncture was done using a 3.5/5 MHz US probe with a puncture attachment, whereas the triangulation technique with biplanar C-arm fluoroscopy was utilized in group 2 (fluoroscopic guided). Patient demographics, stone parameters, intraoperative characteristics, fluoroscopy durations, and postoperative outcomes were analyzed.Both groups were comparable as far as patient and stone characteristics were concerned. The fluoroscopy exposure during the puncture phase (T2) and overall (T) was significantly lower in the US group at 9.0±20.8 vs 43.8±34.8, (p0.0001) and 204.3±84 vs 239.9±77.5, (p=0.04). Six patients in group1 required fluoroscopic adjustment (p=0.03). All other intra- and postoperative parameters were similar in both the groups.Both ultrasound and fluoroscopic guidance for renal access are equally safe and feasible in the hands of a trainee urologist. Total fluoroscopy duration and exposure time during puncture were both significantly less in the ultrasound group. Expertise in fluoroscopic-guided access is essential for a novice to effectively achieve access in all possible situations.

Specimens of Pb1−1.5x La x (Zr0.53Ti0.47)1−y−z Fe y Nb z O3 (x = 0, 0.004, 0.008, 0.012, and 0.016, y = z = 0.01) (PZTFN) ceramics were synthesized by a semi-wet route. In the present study, the effect of La doping was investigated on the structural, microstructural, dielectric, piezoelectric, and ferroelectric properties of the ceramics. The results show that, the tetragonal (space group P4mm) and rhombohedral (space group R3c) phases are observed to coexist in the sample at x = 0.012. Microstructural investigations of all the samples reveal that La doping inhibits grain growth. Doping of La into PZTFN improves the dielectric, ferroelectric, and piezoelectric properties of the ceramics. The hysteresis loops of all specimens exhibit nonlinear behavior. The dielectric, piezoelectric and ferroelectric properties show a maximum response at x ≥ 0.012, which corresponds to the morphotropic phase boundary (MPB).

Objective To assess the impact of various treatment optimisation strategies in shockwave lithotripsy (SWL) used at a single centre over the last 25 years. Patients and Methods In all, 5017 patients treated between 1989 and 2013 were reviewed and divided into groups A, B, C and D for the treatment periods of 1989–1994 (1561 patients), 1995–2000 (1741), 2001–2006 (1039) and 2007–2013 (676), respectively. The Sonolith 3000 (A and B) and Dornier compact delta lithotripters (C and D) were used. Refinements included frequent re-localisation, limiting maximum shocks and booster therapy in group B and Hounsfield unit estimation, power ramping and improved coupling in group D. Parameters reviewed were annual SWL utilisation, stone and treatment data, retreatment, auxiliary procedures, complications and stone-free rate (SFR). Results The SFR with Dornier compact delta was significantly higher than that of the Sonolith 3000 (P < 0.001). The SFR improved significantly from 77.58%, 81.28%, 82.58% to 88.02% in groups A, B, C, and D, respectively (P < 0.001). There was a concomitant decrease in repeat SWL (re-treatment rate: A, 48.7%; B, 33.4%; C, 15.8%; and D, 10.1%; P < 0.001) and complication rates (A, 8%; B, 6.4%; C, 4.9%; and D, 1.6%; P < 0.001). This led to a rise in the efficiency quotient (EQ) in groups A–D from 50.41, 58.94, 68.78 to 77.06 (P < 0.001).The auxiliary procedure rates were similar in all groups (P = 0.62). Conclusion In conclusion, improvement in the EQ together with a concomitant decrease in complication rate can be achieved with optimum patient selection and use of various treatment optimising strategies.

In the present work, detailed investigation of dielectric, piezoelectric and ferroelectric properties of Nb and Fe co-doped PZT ceramic near the MPB composition has been carried out. Pb1-3x/2 Fex(Zr0.52Ti0.48)1-5y/4 NbyO3 (PFZTN) ceramics for x = 1- 6 mol% and y = 5.50 mol% have been prepared by a semi-wet route. X-ray diffraction studies confirm the formation of single phase perovskite structure. It is shown that Fe doping in PZNT improves the dielectric, ferroelectric and piezoelectric properties of ceramics. It has been found that at room temperature, dielectric constant and d33 start to increase up to the composition x = 0.05 and thereafter decrease. The maximum value of dielectric constant and d33 has been found for the composition x = 0.05. It has been shown that doping of Fe does not affect over the transition temperature uptown x = 0.04. The value of remnant polarization is of the order of 11.62 µC/cm 2 at x= 0.04. The investigated material seems to be promising candidate for multilayer capacitor applications. Copyright © 2014 VBRI press.

Introduction: The majority of staghorn classifications do not incorporate volumetric stone burden assessment. Accurate volumetric data can easily be acquired with the ever-increasingly available computerized tomography (CT) scan. This manuscript reviews the available staghorn stone classifications and rationalizes the morphometry-based classification. Materials and Methods: A Pubmed search was performed for articles concerning staghorn classification and morphometry. Twenty abstracts were shortlisted from a total of 43 published abstracts. In view of the paucity of manuscripts on staghorn morphometry (4), older staghorn classifications were analyzed with the aim to determine the most optimum one having relevance to the percutaneous nephrolithotomy (PCNL) monotherapy outcome. Results: All available staghorn classifications are limited with non-widespread applicability. The traditional partial and complete staghorn are limited due to non-descript stone volumetric data and considerable overlap of the intermediate ones in either group. A lack of standardized definition limits intergroup comparison as well. Staghorn morphometry is a recent addition to the clinical classification profiling of a staghorn calculus. It comprises extensive CT volumetric stone distribution assessment of a staghorn in a given pelvi-calyceal anatomy. It allowsmeaningful clinical classification of staghorn stones from a contemporary PCNL monotherapy perspective. Conclusions: Morphometry-based classification affords clinically relevant nomenclature in predicting the outcome of PCNL for staghorn stones. Further research is required to reduce the complexity associated with measuring the volumetric stone distribution in a given calyceal system.

The energy source used for stone fragmentation is important in miniperc. In this study, we compared the stone fragmentation characteristics and outcomes of laser lithotripsy and pneumatic lithotripsy in miniperc for renal calculi.After Institutional Review Board approval, 60 patients undergoing miniperc for renal calculi of 15 to 30 mm were equally randomized to laser and pneumatic lithotripsy groups. Miniperc was performed using 16.5F Karl Storz miniperc sheath and a 12F nephroscope. Laser lithotripsy was performed using a 550-μm laser fiber and 30 W laser with variable settings according to the need. Pneumatic lithotripsy was performed using the EMS Swiss lithoclast. Patient demographics, stone characteristics, intraoperative parameters, and postoperative outcomes were analyzed.The baseline patient demographics and stone characteristics were similar in both groups. The total operative time (P = 0.433) and fragmentation time (P=0.101) were similar between the groups. The surgeon assessed that the Likert score (1 to 5) for fragmentation was similar in both groups (2.1 ± 0.8 vs 1.9 ± 0.9, P=0.313). Stone migration was lower with the laser (1.3 ± 0.5 vs 1.7 ± 0.8, P=0.043), and fragment removal was easier with the laser (1.1 ± 0.3 vs 1.7 ± 1.1, P=0.011). The need for fragment retrieval using a basket was significantly more in the pneumatic lithotripsy group (10% vs 37%, P=0.002). The hemoglobin drop, complication rates, auxiliary procedures, postoperative pain, and stone clearance rates were similar between the groups (P0.2).Both laser lithotripsy and pneumatic lithotripsy are equally safe and efficient stone fragmentation modalities in miniperc. Laser lithotripsy is associated with lower stone migration and easier retrieval of the smaller fragments it produces.

PURPOSE: We report our experience with laparoendoscopic single-site (LESS) urological procedures in children less than 5 years of age. MATERIALS AND METHODS: Ten patients (11 procedures) underwent LESS through the umbilicus. Seven patients underwent nephrectomy and three patients underwent pyeloplasty (one simultaneous bilateral). R-port port (Advanced Surgical Concepts, Ireland) was used in nine cases, in one case, the Gelpoint access port (Applied Medical, Rancho Santa Margarita, CA, USA) was used. The Olympus Endoeye camera with coaxial light cable was used. The hilum was secured in all cases with Hem-o-Lok clips (Teleflex Medical, Research Triangle Park, NC, USA) except in one case in which an Endo GIA stapler (Covidien Surgical, Norwalk, CT, USA) was used. RESULTS: All procedures were technically successful. Accessory port (3 mm) was used in 3 patients. Mean age in nephrectomized patients was 3.14±1.7 years, the mean operative room time (ORT) was 97.5±12.54 minutes. In the pyeloplasty group, mean ORT was 192±47.16 minutes and mean age was 2.43±2.3 years. Bilateral pyeloplasty was done in a 4-month-old infant. The ORT in this case was 180 minutes. A follow-up renogram done in the pyeloplasty patients (n=2) showed good drainage. Mean length of stay was 3.6 days (range, 3 to 6 days).The analgesic requirement was 23.86 mg (range, 12.5 to 50 mg) of diclofenac sodium. CONCLUSIONS: LESS is technically feasible in patients as young as 4 months of age. It has the potential to offer better cosmesis. This needs to be proved in further comparative studies. Development of miniature instruments will further the growth of LESS in this age group.

Purpose of review A dedicated operating room with fluoroscopic imaging capability and adequate data connectivity is important to the success of any endourology program. Proper understanding of the recent developments in technology in relation to operating room is necessary before planning an endourology operating room. Recent findings An endourology operating room is a fluorocompatible operating room with enough space to accommodate equipment like multiple flat monitors to display video, C-arm with its monitor, ultrasonography machine, laser machine, intracorporeal lithotripsy unit, irrigation pumps and two large trolleys with instruments. This operating room is integrated with devices to continuously record and archive data from endovision and surface cameras, ultrasound and fluoroscopy. Moreover, advances made in data relay systems have created seamless two-way communication between the operating room and electronic medical records, radiological picture archiving and communication system, classroom, auditorium and literally anywhere in the world. Summary A dedicated endourology operating room is required for any hospital, which has a significant amount of endourology procedures. A custom-made integrated endourology operating room will facilitate endourology procedures, smoothen the workflow in operating room and improve patient outcomes. Meticulous planning and involving experts in the field are critical for the success of the project.

Purpose of review Training in percutaneous nephrolithotomy (PCNL) necessitates the trainee to climb the steep learning curve of this procedure sequentially. The initial steps of the process should be the acquisition of the necessary skills in a nonintimidating skills lab. We review the current scenario of the training in PCNL and advocate the means that may improve the overall patient care. Recent findings The training involves a comprehensive development of the trainee. Initial process starts with the cognitive skills update through conferences and observing peers do the procedure. Rapid prototyping could be useful for resident education. The benefits of three-dimensional stereolithographic biomodeling produced from computed tomography data may aid in achieving optimal access. Skills lab involving wet and dry lab reinforce the cognitive skills. The advantage of live anesthetized porcine model is it being a more realistic model and assessment tool. The specific advantage of the dry lab simulator is of repetitive tasking and easier setup feasibility. There is a lack of guideline for the lab setup and training. Funding, location, number of models installed, curriculum, a trained mentor, and instructor are the critical components that need to be planned in advance. Summary Training in PCNL starts with cognitive knowledge, reinforcement through repetitive nonpatient basic skills acquisition in wet and dry skills lab, prototyping the technique before the actual procedure, and finally supervised training under an able mentor.

To analyze our experience in management of urolithiasis in renal donors.The stones were treated either pretransplant or posttransplant. The Amsterdam forum criteria for acceptance of living donors were used for donor selection. The donors underwent the following procedures: pretransplant extracorporeal shock wave lithotripsy (ESWL) (n=5), pretransplant retrograde intrarenal surgery (RIRS) (n=1), ex-vivo ureteroscopy (ex-vivo URS) (n=1), and ex-vivo pyelolithotomy (ex-vivo Pyl) (n=2); intraoperative Double-J stent; and observation (n=3). Data were analyzed for technical feasibility, intraoperative and postoperative complications, and stone clearance.The male and female ratio was 4:8 and average age was 52.3 years (38-71). In the pretransplant ESWL group, average of 740 shocks (600-1500) was given; the power was not ramped up beyond 12 kV. Ex-vivo URS was performed on bench with 6F pediatric cystoscope, while in the ex-vivo Pyl, a 12F nephroscope was introduced via a pyelotomy and stones were retrieved intact with a dormia basket. A postoperative ultrasound at one month revealed complete clearance of stones in all except one donor. At a mean follow-up of 36 months (10-58), there was no stone recurrence in donor or recipient.This report shows the feasibility and safety of ex-vivo URS and ex-vivo Pyl in living donors, in select cases with subcentimeter calculi, an option of conservative management with Double-J stent is safe. ESWL/RIRS can be performed safely in the pretransplant setting. Proper donor selection and follow-up are crucial to success. We propose a treatment selection algorithm for management of these donors.

To evaluate the outcome of flexible ureteroscopy training with or without an active mentor.Thirty-six flexible ureteroscopy naive practicing urologists and urology residents, after an initial introductory refreshment course, underwent training under a mentor for 15 minutes each in a high-fidelity nonvirtual reality Endo-Urologie-Modell (Karl Storz). The trainees were then randomized into two equal groups for training: One under a mentor and the other without. These two groups completed the training for 2 hours. Global rating scale (GRS) for the performance of flexible ureteroscopy was measured by a blinded expert at the beginning and end of the training. A specific task completion time (TCT) was noted at the end of the training. The trainees noted their own global rating scale at the end of the training.The GRS by the expert at the end of the training was significantly higher in the mentor group. TCT was significantly lower in the mentor group. TCT correlated well with the GRS as measured by the expert rather than the trainee.Mentorship during flexible ureteroscopy training results in higher GRS and lower TCT at the end of the training. Self-assessment GRS by trainee does not correlate well with the skills acquired.

To evaluate effect of intraperitoneal bupivacaine on postoperative pain in patients undergoing laparoscopic live donor nephrectomy. Hundred patients undergoing laparoscopic live donor nephrectomy were included in the study and were divided randomly into two groups based on computer-generated randomization chart of fifty each. Patients were made familiar with VAS chart preoperatively. Group A received 20 mL of 0.5 % bupivacaine, while group B patients received 20 mL of 0.9 % normal saline intraperitoneally Postoperatively, patients were assessed based on VAS and requirement of rescue analgesic, hemodynamic parameters and presence of any adverse effects. Student’s t test was used for statistical analysis. At all-time interval, mean pain scores were higher in group B than group A. The difference between the mean pain scores was statistically significant (p

achieved 30% reduction in symptoms. Qmax increased 68% (6.2 ml/ s) at 3 months vs. no change in controls (p

Study Type – Therapy (pattern of practice survey) Level of Evidence 2b What's known on the subject? and What does the study add? Miniperc and RIRS are commonly used modality for treating non-bulky renal urolithiasis. Both the treatment options are invasive and are associated with inherent complications. There are only a few studies that compare these two treatment modalities. Both the modalities are effective to render patient stone free with minimal complications. Immediate stone free rate is higher with miniperc but comparable in both the modalities at 1 month. RIRS is associated with favourable pain scores and lower hemoglobin drop. OBJECTIVE • To plan a prospective comparative case–control designed study aiming to compare minipercutaneous (miniperc) and retrograde intrarenal surgery (RIRS) for a renal calculus of size 1–2 cm. PATIENTS AND METHODS • A total of 64 cases (32 in each arm) underwent miniperc and RIRS during the study period from March 2009 to April 2011. • The primary and secondary outcome objective was stone-free rate and retreatment rate, complications, operation duration, patient visual pain scores, analgesic requirement, haemoglobin drop and hospital stay, respectively. RESULTS • Miniperc and RIRS had stone clearance rates of 100% and 96.88%, respectively. • In the RIRS group, one patient required retreatment at 1 month. • Hospital stay (0.24) and intra-operative (0.99) and postoperative complications (0.60) were similar in both groups. • Operation duration (P= 0.003) was lower in the miniperc group. • Haemoglobin drop (P < 0.001), patient pain and visual analogue scale score (each P < 0.001) at 6, 24 and 48 h, as well as analgesic requirement (P < 0.003), were all lower in the RIRS group. CONCLUSIONS • The stone clearances in both modalities are high and complications are low. • RIRS requires a larger operation duration, although it is associated with favourable pain scores and a lower haemoglobin drop.

PURPOSE OF REVIEW The term staghorn is plagued by an unclear morphology There is a need for clinical definition of staghorn that could classify patients in either of the two ends of the treatment spectrum for percutaneous nephrolithotomy (PCNL) monotherapy. RECENT FINDINGS Staghorn morphometry was identified as a prognostic tool to predict tract(s) and stage(s) for PCNL monotherapy for staghorn. Staghorn morphometry requires a three-dimensional computed tomography urography assessment by volume rendering software. As per the detailed stone morphometric analysis, a clinically important definition of staghorn calculi based on the high odds probability of multiple tract(s) and stage(s) is proposed. Type 1 staghorn has a total stone volume of less than 5000 mm with less than 5% unfavorable calyx stone percentile volume, whereas type 3 staghorn has a total stone volume of more than 20,000 mm with greater than 10% unfavorable calyx stone percentile volume. Type 2 staghorn is in-between type 1 and 2. Based on the prediction model for achieving clearance by PCNL monotherapy, type 1 staghorn would require single tract and stage, type 2 single tract-single/multiple stages or multiple tract-single stage and type 3 multiple tract and stage. SUMMARY Staghorn morphometry based clinical classification of staghorn is an exciting concept for PCNL monotherapy. Further prospective studies are required to validate the staghorn morphometry based clinical variate of staghorns. The prospective studies should take into account clinical presentations, operative complications, tract and stage required, postoperative complications, hospital stay, operative cost and stone-free status.

Purpose of review Miniaturization of instruments in percutaneous nephrolithotomy (PCNL) has spawned an interest in so-called 'microperc' in which the procedure is carried out through 16-gauge needle. Recent findings The greatest limitation of extracorporeal shock wave lithotripsy is its unpredictable results. The main limitation of retrograde intrarenal surgery is high sustainable cost and poor durability. The main limitation of PCNL is its invasiveness and associated morbidity. The interest in reducing the tract size was to potentially reduce the invasiveness of the procedure, and, therefore, attending complications. In a historical study, postrenal biopsy bleeding was found to be significant only after the tract of the needle was less than 16 gauge. Microperc extended the concept of 'All-seeing needle' to perform PCNL through a 4.85-Fr (16 gauge) tract. The working hypothesis of the 'All-seeing needle' is that if the initial tract is perfect, then the tract-related morbidity could be reduced. The optical needle helps to avoid any traversing viscera and confirms the visual cues of a correct papilla. The other advantage of microperc is that it is a novel single-step renal access procedure, resulting in a shorter insertion to lithotripsy time. This may provide a new standard of obtaining renal access. Summary Only a few published studies have documented efficacy and safety. Till further prospective and multicentric articles are published, it is still an experimental procedure requiring further research.

Staghorn stone volume and its distribution within the collecting system, "staghorn morphometry," predicts the requirement of tract and stage for percutaneous nephrolithotomy (PCNL) monotherapy. The purpose of the study was to develop a CT urography staghorn morphometry-based prediction algorithm to predict tract(s) and stage(s) for PCNL monotherapy and classify staghorn accordingly.A retrospective case-control design of 94 units was used. CT software calculated the total stone volume (TSV) with absolute volume and percentile volume in the pelvis, planned entry calix, favorable and unfavorable calix. Entry calix was the optimum calix chosen, keeping the relations of the ribs and adjoining viscera that could clear maximum stone volume. Unfavorable calix was defined as having an acute angle from the entry calix and infundibular width of ≤ 8 mm. A prediction model with odds ratio (OR) (95% confidence interval) was constructed on univariate and multivariate regression factors.On univariate analysis, TSV (P=0.013), unfavorable calix stone volume (0.007), and percentile distribution of stone in pelvis (0.026), pelvis and entry calix (0.001), and unfavorable calix (0.001) predicted tracts while total stone (0.001), pelvic stone (0.0046), and unfavorable calix stone (0.001) volume and percentile volume in pelvis (0.04), pelvis and entry calix (0.005) and unfavorable calix (P0.001) predicted stage. Multivariate analysis showed that unfavorable calix stone percentile volume predicted tract (area under the curve [AUC] - 0.91) while TSV and unfavorable calix stone percentile volume (AUC - 0.846) predicted stage. The OR-based prediction model suggested a need for single tract and stage PCNL vs multiple tract and stage PCNL for TSV and unfavorable calix percentile stone volume of (5,000 mm(3) and 5%) and (20,000 mm(3) and 10%), respectively.The model predicts the tract and stage for PCNL monotherapy. Staghorn morphometry differentiates staghorn into type 1 (single tract and stage); type 2 (single tract-single/multiple stage, or multiple tract-single stage), and type 3 (multiple tract and stage).

Background: There is a lack of published data on laparoscopic radical prostatectomy (LRP) in India. Although the published short-term oncologic outcomes after LRP are encouraging, intermediate and long-term data are lacking. Objective: We analyzed the oncological outcome after LRP based on 6 years of experience and compared it with the other single-center published literature. Materials and Methods: Of the 90 patients who underwent LRP for a clinical T2 localized disease, 73 patients with at least a follow up of one year were analyzed. Patients were classified as low-, intermediate-, and high-risk D′Amico groups in 22 (30%), 26 (36%), and 25 (34%) of the patient population, respectively. Progression of disease was defined as a PSA of 0.4ng/ml with a confirmatory rise. We used Kaplan-Meier product limit estimates to calculate actuarial 5-year probabilities of biochemical progression-free survival. Univariate analysis of risk factors for biochemical recurrence (BCR) was done. Results: The mean age of the patients was 63.3 ± 6.6 years. The average follow-up for patients was 22 (12-72) months. There was no prostatic cancer-specific mortality. Fourteen patients had BCR. The 5-year progression-free probability for men with low-, intermediate-, and high-risk prostate cancers was 91%, 82%, and 58%, respectively. High-risk group, Gleason sum more than 8, extracapsular extension, and positive surgical margin were significantly associated with biochemical progression. Conclusions: LRP provided a similar level of oncological success as reported by the other contemporary single-center published literature

Background: Access to urethras and ureters of infants may be hazardous and injurious through an endoscopic route. Placement and removal of stents in infants requires anaesthesia and access through these small caliber urethras. We describe our technique of placing antegrade splint during a laparoscopic pyeloplasty in these infants. Materials and Methods: An ultrasound-guided percutaneous renal access is obtained. Telescopic metal two part needle is passed into the kidney over a guide wire. A second guide wire is passed through the telescopic metal two part needle. The tract is dilated with 14 Fr screw dilator. Over one guide wire, a 5 Fr ureteric catheter is passed and coiled in the renal pelvis. Over the other wire, a 14 Fr malecot catheter is placed as nephrostomy. Laparoscopic pyeloplasty is then done. During pyelotomy, the ureteric catheter is pulled and advanced through the ureter before the pyeloplasty is completed. The ureteric catheter thus acts as a splint across the anastomosis. Ureteric catheter is removed on the 3 rd post operative day and nephrostomy is clamped. Nephrostomy is removed on 4 th post operative day if child is asymptomatic. The modified technique was successfully done in five patients aged less than one year old. All patients tolerated the procedure well. Post operative period was uneventful in all. Conclusion: Ultrasound-guided ante grade nephroureteral ureteral splint for infant laparoscopic pyeloplasty is safe. It avoids the need for urethral instrumentation for insertion and removal of stents in these small patients.

A donor would prefer a minimally invasive procedure because of lesser morbidity, this may be the reason that laparoscopic donor nephrectomy (LDN) rates have exponentially increased. The rationale dictates that a virtually scarless surgery would be most beneficial to this patient subgroup. In this article, we review the approach, instrumentation, dissection and retrieval issues and the results of laparoendoscopic single-site donor nephrectomy (LESS-DN). The existing literature on LESS-DN was reviewed in Pubmed. The various access sites described for LESS-DN include the umbilicus and Pfannenstiel incision. The steps of LESS-DN duplicate those of standard LDN. There is a paucity of studies comparing LESS-DN with LDN, particularly randomized studies. The most challenging step of LESS-DN is graft retrieval. Authors have described a variety of methods for graft retrieval which include manual methods, and those using retrieval bags. In the majority of the studies, the graft retrieval time is longer in comparison to standard LDN. However, the graft outcome in recipients is comparable. In this article, we also allude to the complications mentioned in various series. LESS-DN is currently an evolving procedure. The procedure requires a high level of skills in laparoscopic surgery. The choice of access site, access site ports and the type of instruments to be used is a matter of surgeon preference. Although the warm ischemia time in most of the series is longer in LESS-DN, this has not translated into poor recipient outcomes. Further work needs to be done to make the retrieval quick. Current literature from comparative studies with standard LDN suggests that the results in terms of graft outcome are comparable.

Objective: To prospectively study and identify, the preoperative factors which predict intraoperative difficulty in laparoscopic transperitoneal simple nephrectomy. Patients and Method: Seventy seven patients (41 males and 36 females) with mean age of 43 ± 17 years, undergoing transperitoneal laparoscopic simple nephrectomy at our institute between February 2012 to May 2013 were included in this study. Preoperative patients' characteristics recorded were: Gender of patients, history of intervention, palpable lump, BMI, urine culture, side, size of kidney, fixity of kidney on USG, perinephric fat stranding on preoperative CT scan, periureteral fat stranding, perinephric collection, enlarged hilar lymph nodes, renal vascular anomalies, differential renal function on renogram. Preoperative factors of these patients were noted and intraoperative difficulty in the surgery was scored between 1 (easiest) to 10 (most difficult or open conversion) by a single surgeon (who was a part of all studies either as operating surgeon or assistant). Using SPSS 15.0 software, multivariate and univariate analysis was done. Results: In multivariate analysis presence of pyonephrosis on preoperative evaluation and BMI < 25kg/m2 were found to be statistically significant factors predicting intraoperative difficulty during laparoscopic simple nephrectomy. On univariate analysis following factors were associated with increased surgeon's score: Lower BMI, palpable kidney, pyonephrosis, history of renal intervention, perinephric fat stranding, right side, fixity of kidney on USG with surrounding structures. Conclusion: Our findings suggest that presence of pyonephrosis as identified on preoperative imaging and a BMI of less than 25 Kg/m2 are the most significant factors predicting intraoperative difficulty during laparoscopic simple nephrectomy.