Simultaneous bilateral percutaneous nephrolithotomy in Pakistan

Twenty three simultaneous bilateral nephrolithotomy cases performed in a remote area of the country are presented. The method was applied to the properly selected patients, considering the size, shape and position of the bilateral kidney stones. Minimum age of the patient was 4 years and maximum 70 years. In our opinion simultaneous bilateral percutaneous nephrolithotomy [SBPN] is the treatment of choice in properly selected cases with bilateral renal stones. It is even beneficial in cases who have dense and staghorn stones where Extracorporeal Shockwave Lithotripsy [ESWL] does not work. It is advantageous for the patient to be operated upon through SBPN as compared to consecutive percutaneous operations or open nephrolithotomy. This procedure is less time consuming for the urologist. Risk of operative and postoperative complications is negligible and hospital stay is short. The patient can resume his daily routine life at the earliest and it is cost effective procedure for him

Endonephropexy

Targeted endonephropexy was performed in eight patients with renal ptosis at our department in Pakistan from Jan. 1993 till Mar. 1996 with satifactory results. Seven were male and one patient was female with the complication of pain or heaviness in the ipsilateral flank. Two patients complained of palpable mobile mass in the abdomen which disappeared on pressing. On ultrasonic examination kidney of the concerned side was found to be lower than the normal position which was confirmed by standing IVU examination. IVU examination also revealed tortuous ureter on the side of disease. One patient also had an accompanying stone. Operation consisted of puncture and dilatation of channel through lower calyx and advanced as is being mentioned in the text. Control IVU examination was performed after wound healing and was repeated after two months of operation. All the patients were symptom free after the operation. Standing x-ray films after the contrast material injection showed elevation of kidney with straight ureter. The idea of endonephropexy came from the observation that scar of nephrostomy channel is quite sufficient to hold kidney at its place. It was applied to fix the kidney at required level