Large calculi within malpositioned and malformed kidneys, is percutaneous nephrolithotomy [PCNL] feasible? a single center's experience over 10 years

Percutaneous nephrolithotomy [PCNL] for large calculi within malpositioned and malformed kidneys is a challenging problem for urologist because of the abnormal anatomy. The aim of this study was to evaluate and to review our experience with PCNL in malpositioned and malformed kidneys with large calculi. Between January 2000 and December 2009, we performed PCNL in 36 patients with large calculi in malpositioned and malformed kidneys, including 16 patients with horseshoe kidneys, 11 patients with rotational anomalous, three patients with transplanted kidney and six patients with ectopic pelvic kidneys. After appropriate preoperative evaluation, the procedure was performed by choosing anterior, posterior or laparoscopic assisted approaches under fluoroscopic and ultrasound guidance. PCNL access was made in the upper pole of the kidney in 21 [58.3%] patients, in the midpole in 14 [38.9%] patients, and in the lower pole in one patient [2.8%]. The mean age of the patients was 37.5 years [range 21-57] with male: female ratio 2.7: 1, the mean stone size was 2.9 cm [range 2.1-4.9]. Complete stone removal was achieved in 26 [72.2%] patients. A second-look procedure for residual stone removal was required in nine patients [25%], five of them via the same tract and three patients required another access, four of them became stone free, four patients required adjuvant ESWL sessions for the residual stones, and one patient converted to open surgery due to difficulty in creating an access. The mean operating time for PCNL was 95 minutes [range 45-120], and the mean hospital stay was 3.7 days [range 3-8 days]. Blood transfusion was required for three [8.3%] patients, transient postoperative pyrexia encountered in six [16.7%] patients and one patient had persistent urine leak [2.8%]. Serious complications were encountered, small bowel perforation was occurred in two [5.6%] patients, and both were treated by laparatomy with primary repair of injury with uneventful outcome. Patients with malposition and malformed kidneys and large calculi can be managed safely and effectively with PCNL when they are properly selected and appropriately assessed before operation. Stone management in malformed and malposition kidneys is challenging, and establishing percutaneous renal access is the most crucial step in the procedure

Urinary bladder stone: ways of management at Prince Hussein Urology Center

To describe our experience in the management of primary and secondary urinary bladder stone, we use different options of surgical intervention for clearance of the stones. Between January 2005 and May 2009, we treated 242 patients with urinary bladder stones in our center, 208 males and 34 females. Transurethral cystolitholapaxy was the first option for single stone less than 4cm and multiple stones each less than 2cm. Open cystolithotomy was performed in presence of hard stone more than 4cm and in presence of concomitant huge obstructing prostate > 100gm or bladder surgery. Percutaneous suprapubic cystolithotripsy was performed among pediatric age group and patients with permenant cystostomy. Extracorporeal shockwave lithotripsy was a reserved for high risk patients. Out of 242 patients, 190 patients underwent transurethral cystolitholapaxy; Transurethral Resection of Prostate and optical urethrotomy were performed among 105 patients [55.3%]. Presence of foreign bodies as in retained ureteral stents, eroded tension free vaginal tape mesh, suture materials were main causes of the rest of the patients. The duration of urethral catheterization was 24-48 hours, complete clearance was achieved in 185 patients [97.4%], complications were detected in 24 patients [12.6%], hematurea and transient pyrexia were the main complications. Cystolithotomy was performed in 35 patients, concomitant open prostatectomy in 15 cases, bladder diverticulectomy in two cases and 18 cases excluded from cystolitholapaxy criteria. The mean duration of urethral catheterization was 9 days [average 5-14 days] and wound infection was the commonest complication. Percutaneous suprapubic cystolithotripsy was done in 11 cases, failure occurred in one patient [9%], the average duration of catheterization was 3 days and transient pyrexia was detected in two [18%]. Extracorporeal shockwave lithotripsy was a first option in 6 high risk patients with stone clearance rate 83% and significant hematurea occurred in one patient. Transurethral cystolitholapaxy offers the first choice of management for single urinary bladder stones less than 4cm, and multiple small bladder stones. Percutaneous suprapubic cystolithotripsy is a safe procedure and it is an option of management in pediatric age group and in patients with permenant cystostomy. Extracorporeal shockwave lithotripsy can be used in high risk patients. In concomitant prostate or bladder surgery and in hard stones or stones that are more than 4cm, Open surgery is the first treatment of choice

Percutaneous nephrolithotomy for management of large renal stones. Experience at Prince Hussein Bin Ab dull ah Urology Center

The aim of this study was to evaluate and to review our experience with percutaneous nephrolithotomy [PCNL] in management of large renal stones. Between January 2005 and December 2009, 786 patients underwent PCNL for treatment of renal stones at our center, 108 renal units were with big stone burden. All procedures were performed in prone position after retrograde insertion of ureteral catheter under fluoroscopic guidance for creating the PCNL tract. 27F rigid nephroscope was used to identify the stones, fragmentation was done using electrohydrulic or pneumatic lithoclast. Stones fragments were removed by forceps and suction. 20F foley catheter inserted in all cases as nephrostomy, and postoperative stone clearance was documented by plain abdominal X-ray KUB. 108 renal units of 92 patients were treated [67 men and 25 women] with mean age of 41 years [range 17- 74 years]; the average stone size was 4.9cm [range 3.0-6.8cm]. 83 renal units were treated with PCNL monotherapy [76.9%], with mean operative time of 75 minutes [range 55-100 minutes]. 18 renal units required a second look for significant residual stones through the same tract after 72 hours [16.7%], 7 renal units required a second look through a different calyx [6.5%]. Complete stone removal achieved by PCNL alone in 89 renal units [82.4%], with ESWL for the residual small stones we achieved 91.7% stone clearance rate. The mean hospital stay was 3.7 days [mean 3-8 days]. No Serious complications were encountered, 9 patients required blood transfusion [8.3%], 18 patients developed transient post operative pyrexia [16.7%] and three patient had persistent urine leak [2.8%]. PCNL is the first line treatment option for management of large renal stones. Selection of the patient, establishing percutaneous renal access, a well standardized technique and post-operative follow up are mandatory for early detection of complication and achieving a high stone free clearance rate. With significant residual stones in PCNL procedure, a second look at 48-72 hours interval is preferable in centers where flexible instruments and laser therapy are not available

Ureteroscopy as a day case procedure

To evaluate the efficacy and safety of ureteroscopy as a day case procedure. A retrospective analysis was performed of 256 patients who underwent ureteroscopy as an outpatient procedure at the Queen Rania Urology Center during the period between June 2003 and September 2004. The value of performing ureteroscopy as a day case procedure was assessed. Of the 256 patients involved, 181 were males and 75 were females, with a mean age of 32 years. The patients underwent ureteroscopy as a day case procedure for different ureteic pathologies. Most patients had uneventful ureteroscopy and were discharged on the same day. Only 18 patients were admitted post ureteroscopy because of intolerance of pain, fever, social factors, or for further management. Day case ureteroscopy should be considered in low risk patients scheduled for short and uncomplicated procedures. It is cost effective and safe

Bullet injury to the penis: Abnormal presentation

This is a case report of a 24-year-old male patient who presented with an unusual bullet injury to the penis. He had no urethral injury and normal voiding. The bullet was surgically extracted from the corpora with no difficulty. He left the hospital 2 days after surgery and regained full sexual function after one month