Mini percutaneous nephrolithotomy versus retrograde flexible ureterorenoscopy in the treatment of renal calculi in anomalous kidneys.

OBJECTIVES: To report our single center experience in comparing mini-percutaneous nephrolithotomy versus flexible ureterorenoscopy for management of renal stones up to 2 cm in anomalous kidneys. MATERIALS AND METHODS: Records of the last 30 patients with stones less than 2 cm in anomalous kidney treated by mini-percutaneous nephrolithotomy were reviewed and compared to last 30 patients treated by flexible ureterorenoscopy. RESULTS: Mean stone size was significantly higher in the minipercutaneous nephrolithotomy group (17.90 mm) than in flexible ureterorenoscopy group (14.97mm) (p < 0.001). Mean operative time (80.33 min vs 56.43 min) and fluoroscopy exposure time (4.49 min vs 0.84 min) were significantly higher in the mini-percutaneous nephrolithotomy group than in the flexible ureterorenoscopy group (p < 0.001). The mean post-operative drop in hemoglobin concentration was significantly higher in the mini-percutaneous nephrolithotomy group (0.47 gm versus 0.2 gm) (p < 0.001). Stone free rate after 12 weeks follow up was not statistically significant between the 2 groups (90% in minipercutaneous nephrolithotomy vs 80% in flexible ureterorenoscopy) (FEp = 0.472). CONCLUSIONS: Both modalities were found to be safe and effective for treatment of stones less than 2 cm in anomalous kidneys.

Bipolar vs monopolar resection of bladder tumours of >3 cm in patients maintained on low-dose aspirin: A randomised clinical trial.

OBJECTIVE: To compare the safety and efficacy of bipolar vs monopolar transurethral resection of bladder tumour (TURBT) in patients maintained on low-dose aspirin with tumours >3 cm. PATIENTS AND METHODS: A prospective randomised single-centre study was performed including 200 patients with bladder tumours of >3 cm, as measured by ultrasonography. All patients were using low-dose aspirin (81 mg/day), which was not stopped in the perioperative period. Patients were randomised into two groups: Group A, monopolar TURBT (M-TURBT); Group B, bipolar TURBT (B-TURBT). The primary endpoint of the study was the decrease in postoperative haemoglobin (Hb) concentration measured using an automated cell counter. The secondary endpoints of the study were intraoperative blood transfusion or the occurrence of urethral trauma during cystoscopy and the need for re-coagulation. RESULTS: The postoperative reduction in Hb concentration, was significantly lower in the B-TURBT group [mean (SD) 0.55 (0.26) g/dL] compared with the M-TURBT group [mean (SD) 1.24 (0.61) g/dL] (P < 0.001). There was also a significant difference (in favour of B-TURBT) between the groups in the mean postoperative reduction in haematocrit and the mean postoperative hospital stay. There was no significant difference between the groups for the occurrence of obturator jerk, bladder perforation, and the need for blood transfusion. CONCLUSION: B-TURBT in patients maintained on low-dose aspirin is better than M-TURBT for minimising postoperative drop in Hb concentration.

Prospective randomized comparison between cold and warm ischemia in patients with renal insufficiency undergoing partial nephrectomy.

OBJECTIVE: To compare between the effects of cold and warm ischemia on the risk of deterioration of renal insufficiency in patients with T1 renal tumor managed by partial nephrectomy. METHODS: This prospective randomized study was performed on 120 patients with chronic kidney disease, all having T1 renal tumors. Renal function was estimated by estimated glomerular filtration rate (eGFR), using the Modification of Diet in Renal Disease formula. Patients were randomly divided into 2 groups: in group A, warm ischemia was used, and in group B, cold ischemia was used. All patients were treated by open partial nephrectomy. Patients were followed up for 2 years. The primary outcome of the study was eGFR at 2 years. Secondary outcomes were tumor recurrence, loss of follow-up, or patient death. RESULTS: Mean age of patients was 60.7 ± 5.3 years. Associated chronic disease (diabetes and/or hypertension) was present in 93 patients. Worsening of renal insufficiency occurred within 1 month of surgery in 38 patients (27 in group A and 11 in group B). At 3 months follow-up, 21 of these 38 patients returned to their baseline eGFR. Warm ischemia rendered patients more prone to a decrease in eGFR after partial nephrectomy, with relative risk of 1.34 and 2 times at 3 months and 2 years of follow-up, respectively. CONCLUSION: Warm ischemia increases the risk of deterioration of renal functions in patients with renal insufficiency undergoing open partial nephrectomy for renal tumors.

Retrograde intrarenal surgery monotherapy versus shock wave lithotripsy for stones 10 to 20 mm in preschool children: a prospective, randomized study.

PURPOSE: We compared the outcome of retrograde intrarenal surgery monotherapy vs shock wave lithotripsy for stones 10 to 20 mm in preschool children. MATERIALS AND METHODS: This prospective study included 60 children with a mean ± SD age of 2.4 ± 1.3 years. Patients were randomly divided into 2 groups. Group 1 underwent shock wave lithotripsy and group 2 underwent retrograde intrarenal surgery as monotherapy. Retrograde intrarenal surgery was started using a 7.5Fr semirigid ureteroscope (Storz®) and the holmium laser, and completed by the Flex X™2 flexible ureterorenoscope. A ureteral access sheath was not used and only hydrodilatation was performed. Patients were evaluated preoperatively by ultrasound and plain abdominopelvic x-ray. Followup was 3 months. RESULTS: The stone-free rate after a single session treatment was 70% and 86.6% in groups 1 and 2, respectively. Mean operative time was 27.9 ± 3.5 and 40 ± 7.8 minutes, mean fluoroscopy exposure time was 60 ± 42 and 50 ± 35 seconds, and mean hospital stay was 6 ± 2 and 12 ± 8 hours, respectively. No major complication occurred in either group and no child in either group received blood transfusion. Nine group 1 patients needed a second shock wave lithotripsy session, of whom 2 required a third session. At 3 months the overall stone-free rate was 93.3% and 96.6% in groups 1 and 2, respectively. CONCLUSIONS: Retrograde intrarenal surgery is an option for treating medium sized renal stones in preschool children with results comparable to those of shock wave lithotripsy and a safe short-term outcome.

Congenital penile curvature presenting as unconsummated marriage. Repair by 16-dot plication with subjectively reported patient and partner satisfaction.

OBJECTIVE: To evaluate self-reported patient and partner satisfaction in cases of unconsummated marriage due to congenital penile curvature that was treated by the 16-dot plication procedure. PATIENTS AND METHODS: From March 2008 to March 2012, 24 couples presented to our institute with an unconsummated marriage due to congenital penile curvature. All patients were treated using the 16-dot plication operation. Patients were followed up for 3 months and were asked, with their partners, to complete a specific questionnaire to evaluate their satisfaction with the outcome of the operation. RESULTS: The duration of unconsummated marriage was 2-12 weeks. The mean (SD, range) angle of penile curvature was 57.4 (20.3, 30-110)°. All patients were able to consummate their marriage within a mean (SD, range) of 5.3 (1.3, 4-8) weeks after surgery. The overall satisfaction rate with the outcome of the operation among patients was nearly 100% for 'moderately satisfied' or greater, and among their partners was nearly 96% for 'moderately satisfied' or greater, at 3 months. CONCLUSION: The 16-dot plication technique is an easy procedure for the emergent correction of congenital penile curvature presenting as an unconsummated marriage. Most patients and their partners were pleased with the outcome of the procedure.

Percutaneous nephrolithotomy for the management of stones in anomalous kidneys in children.

PURPOSE: We report percutaneous nephrolithotomy for the management of stones in anomalous kidneys in children. MATERIALS & METHODS: We performed PCNL on 6 children (one with bilateral stones), 3 boys and 3 girls with anomalous kidneys. Three had horseshoe kidneys, 2 malrotated kidneys, and one crossed fused ectopic kidney. Their age ranged from 5 to 12 years with a mean of 7.3 ± 3 years. Two patients had previous failed ESWL, 4 underwent PCNL for large stone burden. Mean stone burden was 324.9 ± 191.8 mm(2). Under fluoroscopic guidance we performed serial dilatation using Alken metal dilators. In 4 patients 17 Fr rigid nephroscope was used, in 2 patients 26 Fr nephroscope was utilized. Pneumatic lithotripsy was used for stone disintegration and forceps for stone extraction. RESULTS: A single stage PCNL resulted in complete stone clearance in 5 children, while one required a second look procedure. Operative time ranged from 25 to 70 min with a mean of 43.3 ± 17.8 min. None of the patients required blood transfusion. Perforation of the renal pelvis occurred in one patient and was managed by prolonged insertion of nephrostomy tube. Hospital stay ranged from 1 to 6 days with a mean of 3 ± 2 days. Postoperative fever occurred in one child and persisted for 3 days. All children were followed for 3 months and were stone free. Patient with bilateral stones performed ESWL on the contra lateral side. CONCLUSION: Children with stones in anomalous kidneys can be managed safely with PCNL when they are properly selected.

Penile advancement and lengthening for the management of post-circumcision traumatic short penis in adolescents.

OBJECTIVES: To report on the safety of combing suprapubic fat liposuction, penile suspensory ligament severing, and Z-plasty of penoscrotal webbing for penile lengthening in cases of post-circumcision traumatic short penis in adolescents. METHODS: This prospective study was conducted in 9 male patients with a mean age of 15.6 ± 1.4 years. All patients had a short penis because of traumatic amputation of the glans in 7 patients and both glanular and partial distal corporal loss in 2 patients during circumcision. All were initially treated in childhood by penile skin advancement for phallic coverage. Penile length and circumference were measured pre- and post-operatively, both in the flaccid state at maximal stretch and in the erect state. Operative technique included Z-plasty of penoscrotal web, release of suspensory ligament, and suprapubic fat liposuction. RESULTS: Average functional penile length measured 3 months post-operatively had significantly increased by 18-30 mm (mean: 23 ± 4 mm) in the provoked, erect state. All patients had normally developed penile corpora cavernosa and wide circumference (mean: 11.7 ± 0.2 cm). No post-operative complications occurred in any of the patients. No patients had sexual partners or were sexually active. CONCLUSIONS: The described technique of penile advancement and lengthening can be safely applied to patients with post-circumcision traumatic short penis.

Radiolucent renal stones in children: combined use of shock wave lithotripsy and dissolution therapy.

OBJECTIVES: To provide a noninvasive efficient modality for the treatment of radiolucent renal stones in children. Uric acid calculi comprise a significant proportion of urinary stones. METHODS: This study included 24 children (10 girls and 14 boys) with radiolucent renal stones. Of the 24 patients, 5 presented with bilateral renal stones, 8 with multiple stones, 4 with staghorn stones, and 7 with a solitary renal stone. Their age range was 2-12 years (mean 6.3 +/- 2.8). The stone size range was 12-65 mm in the largest diameter. All patients were treated with combined extracorporeal shock wave lithotripsy (ESWL) and medical therapy in the form of urinary alkalization using potassium sodium hydrogen citrate and allopurinol for the treatment of hyperuricosuria. Before ESWL, 3 patients had a percutaneous nephrostomy tube inserted and 2 patients had a ureteral stent placed to relieve obstruction. ESWL was performed with a Siemens Lithostar using either general anesthesia or intravenous sedation. The follow-up period after stone clearance was 12-36 months (mean 26 +/- 7.2). RESULTS: The stone-free rate of 100% was achieved in all 24 patients after 3 months of combined use of extracorporeal shock wave lithotripsy and dissolution therapy. CONCLUSIONS: Combined ESWL and dissolution therapy accelerated stone clearance and delayed stone recurrence. The use of ESWL and medical therapy as a combined modality is a safe and effective treatment of radiolucent renal stones in children.