Challenges on percutaneous nephrolithotomy in pregnancy: supine position approach through ultrasound guidance

Urolithiasis in pregnancy represents a major diagnostic and therapeutic challenge to the obstetrician, urologist, radiologist and anesthetist. It is a cause of major concern, considering the potential adverse effects of radiation exposure and of any invasive surgical procedure and anesthesia on the mother and fetus. Fortunately, with conservative management, 70-80% of symptomatic calculi pass spontaneously with no sequel. However, fever, infection, uncontrolled pain and progressive hydronephrosis are indications for surgical intervention when retrograde placements of a ureteral stent or a percutaneous nephrostomy tube are the most traditional options. The recent technological advances in stone fragmentation devices and the administration of safe anesthesia have forced clinicians to embark on more definitive stone management techniques in pregnancy. Ureteroscopy is considered the first definitive treatment of obstructive ureteral calculi during all trimesters of pregnancy, but also has limitations. Although generally avoided during pregnancy, percutaneous nephrolithotomy can be a good treatment choice in selected patients.

Vesicostomy as a protector of upper urinary tract in long-term follow-up

The aim of this study was to analyze the result of vasicostomy in children as a protector of the upper urinary tract and assess the adjustments taken by the caregivers. Twenty-one children who had undergone vesicostomy with the Blocksom technique were evaluated. Their mean age was 3.7 years [range, <1 to10 years]. The evaluation consisted of kidney function tests, cystography, and analysis of complications. Twenty parents or caregivers were interviewed about their attitudes towards vesicostomy and its outcomes. The main causes of the vesical dystfunction were posterior urethral valve in 7 [33.3%] and myelomeningocele in 5 patients [23%]. Then children [58.8%] showed improvement and 7 [41.2%] showed cure. Hydronephrosis observed in 17 children was alleviated or cured following the procedure. Kidney function, tested by creatinine clearance calculation, remained stable or improved in 20 patients [95.2%]. Episodes of urinary tract infection and vesicoureteral reflux lowered in 8 of 21 [38.1%] and 10 of 14 patients [71.4%], respectively. Subjective evaluation of 20 cases showed that 18 children [90.0%] remained dry during the day and 14 caregivers/parents [70.0%] felt they had acquired the skills necessary to handle a patient with vesicostomy. The mean global rate of satisfaction of the results of the surgery ranging from 0 [worst result] to 10 [best result] was 8.7. Vesicostomy is a simple surgery that protects the upper urinary tract, decreases hydronephrosis, and improves kidney function. There was adequate adjustment to vesicostomy and a positive global evaluation as reported by the parents and caregivers