An Observational Pilot Study on Supine Percutaneous Nephrolithotomy: Initial Experience at a Single-Centre.

Objective To assess the surgical outcome of supine percutaneous nephrolithotomy (PCNL) in patients with co-morbidities. Materials and methods We retrospectively reviewed the data of 15 patients who underwent supine PCNL at our centre from September 2019 to May 2021. Preoperatively, a complete examination of the patients, along with biochemical and radiological investigations, was done. The data, which included patient demographics, comorbidities, complexity of renal calculi, complications, and stone clearance rate, were collected from the patients' medical records. Results Patients aged between 31 and 70 years were included in the study. The mean (SD) BMI was 26.01 (2.31). Twelve patients (80%) were overweight with a BMI of 25.3 to 29.3 kg/m2. The most common comorbidities were diabetes (33.3%) and hypertension (26.7%). In our study, six patients were American Society of Anesthesiologists (ASA) grade 3 (40%), followed by grade 2 in five patients (33.3%), grade 4, and grade 1 in two patients (13.3%) each. The Guy's Stone score was one in nine patients (60%) and two in six patients (40%). Complete clearance was achieved in 13 (86.7%) patients. Two patients (13.3%) had a stone clearance of more than 80%. Data analysis showed that 14 patients (93.3%) had no perioperative complications. Postoperative abdominal distension was noted in one patient (6.7%), which was managed conservatively (Clavien-Dindo grade 1). We did not encounter any cases of organ injury following supine PCNL. Postoperatively, none of our patients received blood transfusions. Conclusion Our study shows that supine PCNL is a good surgical option, especially for high-risk patients with good stone clearance and low complication rates.

Conservative Management of a Biliary Tract Injury During Percutaneous Nephrolithotomy.

Percutaneous nephrolithotomy (PCNL) is a well-established treatment option for the management of kidney stones. It has evolved over time with advances in surgical technique and technology. Even for the most experienced urologists, both major and minor complications may be encountered during PCNL. Timely diagnosis and appropriate management are the keys to a favourable outcome. Here, we discuss the case of a woman aged 34 years, who underwent PCNL for a right renal staghorn stone and had an accidental puncture of the gall bladder. Post-operatively, the patient recovered well with conservative management.

Underactive urinary bladder - Masquerading as abdominal ascites.

An impaired ability to evacuate the urinary bladder is commonly seen in both men and women with aging. Usually, patients present with a range of storage, voiding, and post-micturition urinary symptoms. It may eventually lead to urinary retention. These symptoms may have a considerable effect on the patient's quality of life. Despite its common prevalence with advancing age, the etiopathogenesis of the underactive urinary bladder is incompletely understood. There are no widely agreed diagnostic criteria. The urodynamic study (UDS), an invasive investigation is the only accepted modality to diagnose underactive detrusor. There is a lack of effective treatments to improve bladder emptying. The goals of treatment are to improve symptoms and reduce the risk for the complications of impaired bladder emptying. We report a case of a 73 year male who came to us with a history of urinary symptoms and a distended abdomen.

Testicular Torsion: Successful Management of a Late-Diagnosed Case.

Testicular torsion is an emergency. It usually occurs spontaneously, without an apparent cause but has been associated with anatomical, traumatic, and environmental factors. In the case of the acute scrotum, a high degree of clinical suspicion is the most important factor in early diagnosis. Scrotal Doppler helps to confirm the diagnosis of testicular torsion. Prompt recognition and treatment are critical for testicular viability. Surgical intervention, even in late-diagnosed selected cases may yield desirable results. We report a case of a 16-year-old boy who came to the urology outpatient department (OPD) with a history of scrotal pain for approximately 12 hours.

Noninfectious glans gangrene in a diabetic male.

Limited glans penis gangrene is a rare subset of penile gangrene and is associated with favorable prognosis as compared to more aggressive course of the similar entity in moribund diabetic end-stage renal disease patients. A 64-year-old diabetic, hypertensive male with a history of tobacco consumption, bilateral great toe amputations, and normal renal function, presented with gangrene of glans penis and lower urinary tract symptoms. Early surgical debridement, glycemic control, and alpha-blocker treatment were successful in controlling the disease. There was no further progress of the gangrene requiring further amputation and no voiding difficulties after 6 months of follow-up.

Penile Fracture during masturbation - a case report.

Penile fracture is a well-recognized but uncommon urological emergency. It is a tear in the tunica albuginea with rupture of corpus cavernosum. It may be associated with injury to corpus spongiosum and urethra. Diagnosis is usually clinical and Urethral injury should be suspected in penile fracture, especially in those cases with urethral bleeding and bilateral cavernosal rupture. Penile fracture is most commonly caused by injury during sexual intercourse. It has also been described with masturbation, rolling over or falling onto the erect penis, and other scenarios. A cracking or popping sound followed by pain, rapid detumescence, discoloration and swelling of penile shaft and urethral bleeding are common presenting symptoms. Prompt surgical intervention with closure of tunica albuginea is the treatment of choice with satisfactory cosmetic and functional results. We report a case of fracture penis in a 25-year-old male who came to emergency department of our hospital.

Comparing Outcomes of Robotic and Open Inguinal Lymph Node Dissection in Patients with Carcinoma of the Penis.

PURPOSE: We compared outcomes between robot-assisted video endoscopic inguinal lymphadenectomy and open inguinal lymph node dissection in patients without bulky nodal metastasis in a tandem contemporary cohort. MATERIALS AND METHODS: We retrospectively analyzed a prospectively maintained hospital registry of 51 patients who underwent robot-assisted video endoscopic inguinal lymphadenectomy and 100 treated with open inguinal lymph node dissection from 2012 to 2016 for groins without bulky nodal metastasis and who had a minimum 9-month followup. Complications were graded by the Clavien-Dindo classification, and nodal yield and disease recurrence during followup were assessed. Elastic net regression was used to select variables associated with major complications (Clavien 3a or greater) for multivariable analysis of plausible factors, including patient age, diabetes, body mass index, smoking, nodal stage, surgery type, sartorius transposition, saphenous vein transection and adjuvant radiotherapy. Penalized likelihood logistic regression methods were used for multivariate analysis to ascertain final effect sizes while accounting for sparse data bias. RESULTS: Robot-assisted video endoscopic inguinal lymphadenectomy and open inguinal lymph node dissection had comparable median lymph node yields (13 vs 12.5). No patient experienced recurrence during the median followup of 40 months. Robot-assisted video endoscopic inguinal lymphadenectomy was associated with significantly lower hospital stay, days needing a drain in situ, incidence of major complications, edge necrosis, flap necrosis and severe limb edema. On multivariable analysis pathological nodal stage (OR 2.8, 95% CI 1.1-6.8, p = 0.027) and open inguinal lymph node dissection (OR 7.5, 95% CI 1.3-43, p = 0.024) emerged as independent risk factors associated with an increased risk of major complications. CONCLUSIONS: Robot-assisted video endoscopic inguinal lymphadenectomy is a feasible technique which allows for a similar nodal yield while being associated with lower morbidity than open inguinal lymph node dissection in patients without bulky groin adenopathy.