The use of minimally-invasive cortical sparing adrenalectomy as an approach to bilateral adrenal masses in a patient with von Hippel Lindau Syndrome: Learnings from a lower middle-income country setting

@#von Hippel Lindau syndrome is a rare genetic disease which may present with bilateral adrenal masses requiring surgical intervention. Previous practice at UP-PGH was to perform outright total adrenalectomy on pathologic adrenal glands and rely on lifelong steroid replacement for patients who had both adrenals removed. Presented here is a case of a patient diagnosed with von Hippel Lindau syndrome with bilateral adrenal masses, surgically managed initially with open adrenalectomy on the right side, followed by the first ever performed minimally invasive cortical sparing adrenalectomy at UP-PGH on the left side.

Determination of factors affecting stone free rates of Primary Percutaneous Nephrolithotripsy (PCNL) in a tertiary government hospital

INTRODUCTION AND OBJECTIVES@#Percutaneous nephrolithotripsy (PCNL) is the first-line treatment for stone burden >2 cm. The aim of this study was to determine factors that would affect stone free rates after PCNL. Preoperative and intra-operative variables were correlated to the patient’s post-operative outcomes to find a link, or lack thereof, to stone-free outcomes.@*METHODS@#A retrospective study of patients who underwent primary PCNL was done over a 1-year period. The association of the stone characteristics (based on Guy stone score), stone burden, operative time, lithotripsy time, number of access tracts, and location of access tracts to the stone-free status were analyzed.@*RESULTS@#One hundred thirty patients who underwent PCNL were included in this study. Stone free rate was 77.69% (101/130) while 23 of the 29 patients with residual stones (22%) (29/130) required further treatment. The 30-day overall morbidity rate was 8.46% (11/130). Guy stone score (GSS) and stone burden were found to be significantly associated with stone-free status. Patients with GSS grade I had the highest stone-free rate of 95.45% while patients with GSS Grade IV had the lowest stone-free rate at 30.00%. After multivariate analysis, stone burden (OR 1.176; 95% CI 1.084- 1.275; p 0.00) and GSS 4 (OR 15.374; 95% CI 1.164- 202.980; p 0.04) were significant independent risk factors for stone-free status.@*CONCLUSION@#Stone clearance and complication rate after PCNL of the present study were 78% and 8.5%, respectively, comparable with published data. A higher Guy’s stone score and a higher stone burden were significantly associated with retained stones post-PCNL.