Randomized Controlled Trial to Assess the Efficacy of the Combination Therapy of Alfuzosin and Tadalafil in Patients with Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia.

OBJECTIVE: The purpose of our study was to evaluate the effect of alfuzosin and tadalafil as combination therapy compared with each monotherapy, in patients with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). METHODS: Men over the age of 50 years with LUTS secondary to BPH and an International Prostate Symptom Score (IPSS) 8 or higher, were randomized to receive 10 mg alfuzosin (n = 25), 10 mg tadalafil (n = 25) or the combination of both the drugs (n = 25) once daily for 3 months. Symptoms were assessed at baseline, 6 weeks and 3 months. The primary endpoint was the change in IPSS from the baseline. Secondary endpoints were changes in IPSS storage and voiding subscores, peak urinary flow rate, residual urine volume, IPSS quality of life score and erectile domain score. RESULTS: There were significant improvements in all IPSS scores, peak urinary flow rate and IPSS quality of life score from baseline at both 6 weeks and 3 months in all the three groups (P < 0.003). Combination therapy was better than monotherapy in improving IPSS scores and reducing post-void residual urine volume (P < 0.005). Combination therapy was similar to alfuzosin regarding improvement in maximum urine flow rate (P = 0.22), similar to tadalafil in improvement on erectile function (P = 0.22) and better than each monotherapy in improving the IPSS quality of life (P ≤ 0.015). CONCLUSION: Alfuzosin and tadalafil combination therapy provides greater symptomatic improvement as compared to either monotherapy in men with LUTS due to BPH.

Unusual causes of Hematuria in dialysis patients: Diagnostic dilemma, risks and management.

Two male patients with end-stage renal disease (ESRD) developed a spontaneous hemorrhage of one of their native kidneys and were referred to our institution. Symptoms included sudden onset abdominal pain, hematuria and shock. Symptoms were associated with a hemoglobin decrease. Computerized tomography (CT) was done and nephrectomy undertaken in both the cases. Histologic findings confirmed bleeding and there was no abnormality other than those related to renal insufficiency (cysts and atrophy). In chronic hemodialysis (HD) patients with hematuria, if other common causes are not identified spontaneous subcapsular or renal cyst rupture should be kept in mind. Surgery is our preferred treatment because of the diagnostic dilemma of tumors and the potential mortality of massive hematomas in morbid patients.

Prospective randomized controlled trial comparing laser lithotripsy with pneumatic lithotripsy in miniperc for renal calculi.

BACKGROUND AND PURPOSE: The energy source used for stone fragmentation is important in miniperc. In this study, we compared the stone fragmentation characteristics and outcomes of laser lithotripsy and pneumatic lithotripsy in miniperc for renal calculi. PATIENTS AND METHODS: After Institutional Review Board approval, 60 patients undergoing miniperc for renal calculi of 15 to 30 mm were equally randomized to laser and pneumatic lithotripsy groups. Miniperc was performed using 16.5F Karl Storz miniperc sheath and a 12F nephroscope. Laser lithotripsy was performed using a 550-µm laser fiber and 30 W laser with variable settings according to the need. Pneumatic lithotripsy was performed using the EMS Swiss lithoclast. Patient demographics, stone characteristics, intraoperative parameters, and postoperative outcomes were analyzed. RESULTS: The baseline patient demographics and stone characteristics were similar in both groups. The total operative time (P = 0.433) and fragmentation time (P=0.101) were similar between the groups. The surgeon assessed that the Likert score (1 to 5) for fragmentation was similar in both groups (2.1 ± 0.8 vs 1.9 ± 0.9, P=0.313). Stone migration was lower with the laser (1.3 ± 0.5 vs 1.7 ± 0.8, P=0.043), and fragment removal was easier with the laser (1.1 ± 0.3 vs 1.7 ± 1.1, P=0.011). The need for fragment retrieval using a basket was significantly more in the pneumatic lithotripsy group (10% vs 37%, P=0.002). The hemoglobin drop, complication rates, auxiliary procedures, postoperative pain, and stone clearance rates were similar between the groups (P>0.2). CONCLUSION: Both laser lithotripsy and pneumatic lithotripsy are equally safe and efficient stone fragmentation modalities in miniperc. Laser lithotripsy is associated with lower stone migration and easier retrieval of the smaller fragments it produces.

Current role of microperc in the management of small renal calculi.

'Microperc' is a recently described technique in which percutaneous renal access and lithotripsy are performed in a single step using a 16 G micropuncture needle. 'Mini-microperc' is a further technical modification in which an 8 Fr sheath is used to allow insertion of ultrasonic or pneumatic lithoclast probe with suction. The available evidence indicates that microperc is safe and efficient in the management of small renal calculi in adult and pediatric population. It can also be used for renal calculi in ectopic kidneys and bladder calculi. The high stone clearance rate and lower complication rate associated with microperc make it a viable alternative to retrograde intrarenal surgery.

Microperc for the management of renal calculi in pelvic ectopic kidneys.

Management of stone disease in an ectopic kidney is challenging. Laparoscopy or ultrasound guided percutaneous nephrolithotomy and retrograde intra-renal surgery are the preferred techniques for these stones. We performed ultrasound guided microperc using a 16 G needle for the management of renal calculi in pelvic ectopic kidneys in two patients. There was no intraoperative or post-operative complication. Both patients had complete stone clearance and were discharged on the first post-operative day. Ultrasound guided microperc is a safe and effective option for the management of small renal calculi in pelvic ectopic kidneys.

Micropercutaneous nephrolithotomy (microperc) vs retrograde intrarenal surgery for the management of small renal calculi: a randomized controlled trial.

OBJECTIVE: To compare micropercutaneous nephrolithotomy (microperc) and retrograde intrarenal surgery (RIRS) for the management of renal calculi <1.5 cm with regard to stone clearance rates and surgical characteristics, complications and postoperative recovery. PATIENTS AND METHODS: Seventy patients presenting with renal calculi <1.5 cm were equally randomized to a microperc or a RIRS group between February 2011 and August 2012 in this randomized controlled trial. Randomization was based on centralized computer-generated numbers. Patients and authors assessing the outcomes were not blinded to the procedure. Microperc was performed using a 4.85-F (16-gauge) needle with a 272-µm laser fibre. RIRS was performed using a uretero-renoscope. Variables studied were stone clearance rates, operating time, need for JJ stenting, intra-operative and postoperative complications (according to the Clavien-Dindo classification system), surgeon discomfort score, postoperative pain score, analgesic requirement and hospital stay. Stone clearance was assessed using ultrasonography and X-ray plain abdominal film of kidney, ureter and bladder at 3 months. RESULTS: There were 35 patients in each group. All the patients were included in the final analysis. The stone clearance rates in the microperc and RIRS groups were similar (97.1 vs 94.1%, P = 1.0). The mean [sd] operating time was similar between the groups (51.6 [18.5] vs 47.1 [17.5], P = 0.295). JJ stenting was required in a lower proportion of patients in the microperc group (20 vs 62.8%, P < 0.001). Intra-operative complications were a minor pelvic perforation in one patient and transient haematuria in two patients, all in the microperc group. One patient in each group required conversion to miniperc. One patient in the microperc group needed RIRS for small residual calculi 1 day after surgery. The decrease in haemoglobin was greater in the microperc group (0.96 vs 0.56 g/dL, P < 0.001). The incidence of postoperative fever (Clavien I) was similar in the two groups (8.6 vs 11.4%, P = 1.0). None of the patients in the study required blood transfusion. The mean [sd] postoperative pain score at 24 h was slightly higher in the microperc group (1.9 [1.2] vs 1.6 [0.8], P = 0.045). The mean [sd] analgesic requirement was higher in the microperc group (90 [72] vs 40 [41] mg tramadol, P < 0.001). The mean [sd] hospital stay was similar in the two groups (57 [22] vs 48 [18] h, P = 0.08). CONCLUSIONS: Microperc is a safe and effective alternative to RIRS for the management of small renal calculi and has similar stone clearance and complication rates when compared to RIRS. Microperc is associated with higher haemoglobin loss, increased pain and higher analgesic requirements, while RIRS is associated with a higher requirement for JJ stenting.

Randomized controlled trial to compare the safety and efficacy of naftopidil and tamsulosin as medical expulsive therapy in combination with prednisolone for distal ureteral stones.

PURPOSE: To compare the safety and efficacy of naftopidil and tamsulosin with prednisolone as medical expulsive therapy for distal ureteric stones. MATERIALS AND METHODS: Between July 2010 and March 2012, 120 adult patients presenting with distal ureteric stones of size 5 to 10 mm were randomized equally to tamsulosin (group A), naftopidil (group B) or watchful waiting (group C). Tamsulosin or naftopidil was given for a maximum of four weeks. In addition patients in group A and B were given 5 mg prednisolone once daily (maximum one week). Stone expulsion rate, time to stone expulsion, analgesic use, number of hospital visits for pain, follow-up and endoscopic treatment and adverse effects of drugs were noted. Statistical analyses were done using chi-square test, Mann-Whitney test and analysis of variance. RESULTS: There was a statistically higher expulsion rate in groups A (70%) and B (87.5%) as compared to group C (32.5%) (p<0.001). The expulsion rates were not statistically different between groups A and B (p=0.056). The mean time to expulsion was comparable between groups A and B but longer in group C. Analgesic use was significantly lower in groups A and B. Average number of hospital visits for pain, follow-up and endoscopic treatment was similar in all groups. There was no serious adverse event. CONCLUSIONS: Medical expulsive therapy for the distal ureteric stones using either naftopidil or tamsulosin in combination with prednisolone is safe and efficacious.

Eosinophilic cystitis mimicking tuberculosis: An analysis of five cases with review of literature.

Eosinophilic cystitis (EC) is a rare disease. It is a transmural inflammation of the bladder, predominantly with eosinophils. High index of suspicion is needed for timely intervention. EC should be kept as a differential diagnosis in patients presenting with lower urinary tract symptoms due to small capacity bladder with a negative workup for urinary tuberculosis and in patients having hematuria and negative cytology, or incidentally found bladder lesions with known risk factors. Initial treatment is conservative with removal of risk factor, anti-histaminics and steroids. Augmentation cystoplasty should be considered in patients with a small capacity bladder. These patients need a strict and long term follow-up.

Prospective randomized placebo-controlled study to assess the safety and efficacy of silodosin in the management of acute urinary retention.

OBJECTIVE: To determine the safety and efficacy of silodosin in the management of acute urinary retention (AUR) related to benign prostatic hyperplasia (BPH). METHODS: From January 2011 to May 2012, 60 men over 50 years of age with AUR were equally randomized to either silodosin 8 mg once daily or placebo for 3 days followed by trial without catheter (TWOC). If the patient re-experienced urinary retention or if postvoid residual urine volume was >150 mL, he was re-catheterized and considered to have a failed TWOC. All patients with a successful TWOC on day 3 were started on silodosin regardless of which arm they had belonged initially. Uroflowmetry, postvoid residual volume and International Prostate Symptom Score (IPSS) were noted at TWOC and after 2 weeks. RESULTS: Baseline patient demographics and clinical characteristics were similar in both groups (P >.1). The success rate of TWOC was 76.7% in the silodosin group and 36.7% in the placebo group (P = .002). On multivariate analysis, patients in silodosin group had lesser odds of having a failure (0.13) when compared to those not given treatment (P = .008). Among the clinical parameters, a retention volume more than 800 mL (P = .038) and an IPSS score more than 25 (P = .042) had significantly greater odds of failure. There were no adverse effects related to the use of silodosin. CONCLUSION: Silodosin significantly increases the chances of successful TWOC after AUR.

Renal deterioration index: preoperative prognostic model for renal functional outcome after treatment of bilateral obstructive urolithiasis in patients with chronic kidney disease.

BACKGROUND AND PURPOSE: Patients who present with varying severity of obstructive urolithiasis behave differently after the treatment. Some patients recover with improved renal function while others progress to renal failure. Our objective was to objectively quantify which patients would progress to renal failure after treatment for obstructive urolithiasis. PATIENTS AND METHODS: A prospective analysis of 167 patients with renal failure from bilateral obstructive urolithiasis who were treated and subsequently followed for at least 1 year was performed. Failure was defined as glomerular filtration rate (GFR) values less than 15 mL/min at 1 year follow-up. All patients had preoperative placement of a percutaneous nephrostomy tube for at least 5 days before treatment with either ureteroscopy or percutaneous nephrolithotomy. Multiple logistic regression analysis of affecting parameters was performed. A renal deterioration index (RDI) was constructed based on scores assigned to varying severity of multivariate significant factors and the receiver operating characteristic (ROC) curve was analyzed. RESULTS: There were 48(28.7%) patients who progressed to CKD stage V at 1-year follow-up. Combined cortical width (≤ 0.001), proteinuria (0.01), positive urine culture (0.004), and nadir preoperative GFR postbilateral percutaneous nephrostomy (0.016) were statistically significant factors affecting renal deterioration on multivariate analysis. RDI has a high ROC curve (AUC=0.90) for predicting renal functional outcome. Combining these parameters in a prediction table yielded a RDI score ≥ 12 being associated with high odds risk (odds ratio=11.2) of treatment failure. CONCLUSION: RDI ≥ 12 is associated with renal deterioration after appropriate treatment of bilateral obstructive urolithiasis.

Supine percutaneous nephrolithotomy for bilateral complete staghorn calculi in an L-shaped cross-fused renal ectopic anomaly.

A 68-year-old woman was diagnosed to have a left-to-right L-shaped crossed-fused kidney with staghorn calculi in both renal moieties on evaluation for abdominal pain. She underwent supine percutaneous nephrolithotomy using 3 tracts in 3 stages. By using 3-dimensional reconstructed computed tomography urogram, proper preoperative planning, appropriate patient positioning, ultrasound-guided access, intraoperative traction, and flexible nephroscopy, complete stone clearance can be achieved in seemingly difficult stones in anomalous kidneys.

Concept and design engineering: endourology operating room.

PURPOSE OF REVIEW: A dedicated operating room with fluoroscopic imaging capability and adequate data connectivity is important to the success of any endourology program. Proper understanding of the recent developments in technology in relation to operating room is necessary before planning an endourology operating room. RECENT FINDINGS: An endourology operating room is a fluorocompatible operating room with enough space to accommodate equipment like multiple flat monitors to display video, C-arm with its monitor, ultrasonography machine, laser machine, intracorporeal lithotripsy unit, irrigation pumps and two large trolleys with instruments. This operating room is integrated with devices to continuously record and archive data from endovision and surface cameras, ultrasound and fluoroscopy. Moreover, advances made in data relay systems have created seamless two-way communication between the operating room and electronic medical records, radiological picture archiving and communication system, classroom, auditorium and literally anywhere in the world. SUMMARY: A dedicated endourology operating room is required for any hospital, which has a significant amount of endourology procedures. A custom-made integrated endourology operating room will facilitate endourology procedures, smoothen the workflow in operating room and improve patient outcomes. Meticulous planning and involving experts in the field are critical for the success of the project.

Tranexamic acid reduces blood loss during percutaneous nephrolithotomy: a prospective randomized controlled study.

PURPOSE: Bleeding is a significant morbidity associated with percutaneous nephrolithotomy. This study was conducted to evaluate the safety and efficacy of the antifibrinolytic agent tranexamic acid in reducing blood loss in patients undergoing percutaneous nephrolithotomy. MATERIALS AND METHODS: A total of 200 patients undergoing percutaneous nephrolithotomy were randomized into 2 equal groups. Patients in the tranexamic acid group received 1 gm tranexamic acid at induction followed by 3 oral doses of 500 mg during 24 hours, while those in the control group did not receive tranexamic acid. The patient demographics and clinical data of the 2 groups were compared. RESULTS: Baseline patient demographics were similar in both groups. Mean hemoglobin decrease in the tranexamic acid group was significantly lower than that of the control group (1.39 vs 2.31 gm/dl, p <0.0001). Mean operative time in the tranexamic acid group was significantly lower than that in the control group (48.3 vs 70.8 minutes, p <0.0001). The stone clearance rate was similar in both groups (91% vs 82%, p = 0.06). The blood transfusion rate was lower in the tranexamic acid group (2% vs 11%, p = 0.018), as was the complication rate (33% vs 59%, p <0.0001). Two patients with a solitary functioning kidney in the tranexamic acid group required ureteral stenting to relieve anuria due to clot obstruction. CONCLUSIONS: The use of tranexamic acid in percutaneous nephrolithotomy is safe, and is associated with reduced blood loss and a lower complication rate.

Efficacy of holmium laser urethrotomy in combination with intralesional triamcinolone in the treatment of anterior urethral stricture.

PURPOSE: To evaluate the outcome of visual internal urethrotomy with a holmium:yttrium-aluminum-garnet laser along with intralesional triamcinolone injection. MATERIALS AND METHODS: Patients with an anterior urethral stricture less than 3 cm in length were evaluated by clinical history, physical examination, uroflowmetry, and retrograde urethrogram preoperatively. All patients were treated with holmium laser urethrotomy and intralesional triamcinolone (80 mg) injection under general or regional anesthesia. An 18 F urethral catheter was placed for 5 days. All patients were followed up for 12 months postoperatively by history, uroflowmetry, and if required, retrograde urethrogram or urethroscopy every 3 months. RESULTS: The mean age of the patients was 42.9 years (range, 14 to 70 years). The overall recurrence rate was 24%. The success rate in patients with strictures less than 1 cm in length was 95.8%, whereas that in patients with strictures of 1 to 3 cm in length was 57.7% (p=0.002). The outcome did not depend on age, duration of symptoms, etiology, or location of stricture. CONCLUSIONS: Holmium laser urethrotomy with intralesional triamcinolone is a safe and effective minimally invasive therapeutic modality for urethral strictures. This procedure has an encouraging success rate, especially in those with stricture segments of less than 1 cm in length.

Fragmented pigtail percutaneous nephrostomy tubes: etiology and management.

PURPOSE: To review our experience with the management of fragmented and retained pigtail percutaneous nephrostomy (PCN) tubes and to explore the reasons for the fragmentation. MATERIALS AND METHODS: We retrospectively reviewed our institute database from January 2006 to December 2011 for patients who had undergone retrieval of fragmented PCN tubes. We assessed the preoperative factors, operative technique, and post-operative outcomes. RESULTS: A total of seven patients (4 males and 3 females) had been diagnosed with fragmented PCN tubes. The mean age of the patients was 41.5 years. Of the seven patients, five required antegrade instrumentation by way of a percutaneous tract to remove the foreign body, mostly along with stone retrieval. One patient underwent ureterorenoscopy and pneumolithotripsy for a ureteric stone along with ureteroscopic removal of the PCN fragment. Another patient underwent nephrectomy of the kidney containing the PCN fragment because it had become nonfunctioning. All patients were free of stones and symptoms on follow-up. CONCLUSIONS: A prolonged waiting period for definitive surgery, urinary infection, and associated stone disease are significant factors causing fragmentation of PCN tubes. Proper insertion techniques, regular timed changes of the PCN tube, appropriate care of the PCN tube, and early surgery for underlying stone disease are required to avoid this complication. Patients with retained PCN tubes can be managed effectively with antegrade or retrograde endoscopic techniques while definitive management of the primary pathology is carried out, without any additional morbidity.

Role of active mentoring during flexible ureteroscopy training.

PURPOSE: To evaluate the outcome of flexible ureteroscopy training with or without an active mentor. MATERIALS AND METHODS: Thirty-six flexible ureteroscopy naive practicing urologists and urology residents, after an initial introductory refreshment course, underwent training under a mentor for 15 minutes each in a high-fidelity nonvirtual reality Endo-Urologie-Modell (Karl Storz). The trainees were then randomized into two equal groups for training: One under a mentor and the other without. These two groups completed the training for 2 hours. Global rating scale (GRS) for the performance of flexible ureteroscopy was measured by a blinded expert at the beginning and end of the training. A specific task completion time (TCT) was noted at the end of the training. The trainees noted their own global rating scale at the end of the training. RESULTS: The GRS by the expert at the end of the training was significantly higher in the mentor group. TCT was significantly lower in the mentor group. TCT correlated well with the GRS as measured by the expert rather than the trainee. CONCLUSION: Mentorship during flexible ureteroscopy training results in higher GRS and lower TCT at the end of the training. Self-assessment GRS by trainee does not correlate well with the skills acquired.

Large pelvic masses of obscure origin: urologist's perspective.

BACKGROUND: Large pelvic masses pose unique diagnostic and therapeutic challenges due to varied aetiology, paucity of characteristic imaging features, lack of therapeutic algorithms and surgical difficulties in resection inside the narrow confines of the pelvis with close proximity of vital structures. METHODS: Records of 22 patients with large pelvic masses in the last six years were analysed. Their demographic and clinical features were noted, along with imaging features, preoperative biopsy, surgical procedure, intraoperative difficulties, complications, adjuvant therapy and outcome. RESULTS: There were 14 men and 8 women with a median age of 45 years. Presenting symptoms were abdominal mass, pain, lower urinary tract symptoms, urinary retention and constipation. Imaging was mostly unable to determine the organ of origin of the tumour. Histopathology revealed pelvic fibromatosis (2), chondrosarcoma (1), liposarcoma (1), haemangioendothelioma (1), lymphangioma (2), fibroleiomyoma (1), leiomyosarcoma (3), schwannoma (4), malignant nerve sheath tumour (1), rectal gastrointestinal stromal tumour (1), retrovesical hydatid cysts (3), sacral chordoma (1) and Ewing's sarcoma (1). In 5 patients complete excision was not possible because of extension into vital structures. Fifteen patients were alive at 1-5 years of follow-up. CONCLUSIONS: Urologists, being the 'gatekeepers of the pelvis', are usually involved in the management of large pelvic masses. Good outcome can be achieved with careful surgical planning.

A randomized controlled trial comparing combined spongiosum block and intraurethral lignocaine with intraurethral lignocaine alone in optical internal urethrotomy for urethral stricture.

BACKGROUND AND PURPOSE: Optical internal urethrotomy is the most commonly performed procedure for the management of anterior urethral stricture. This study was performed to compare the safety and efficacy of spongiosum block along with intraurethral lignocaine with intraurethral lignocaine alone for optical internal urethrotomy. PATIENTS AND METHODS: Fifty patients with anterior urethral stricture were prospectively randomized to undergo optical internal urethrotomy under spongiosum block along with intraurethral lignocaine (group 1=25 patients) and intraurethral lignocaine only (group 2=25 patients). The procedure-related pain was noted using the visual analogue scale. Postprocedure evaluation was performed by uroflowmetry and urethral calibration. Retrograde urethrography and micturating cystourethrography were performed as needed. RESULTS: Optical internal urethrotomy was successfully completed in all patients. The mean visual analogue score for pain in group 1 (1.5 ± 1.4) was significantly lower than the score in group 2 (2.7 ± 1.8) (P=0.006). At 6 months follow-up, recurrent strictures developed in three patients in group 1 and five patients in group 2. CONCLUSIONS: Spongiosum block with intraurethral lignocaine has a better anesthetic effect than intraurethral lignocaine alone for performing optical internal urethrotomy. Spongiosum block with intraurethral lignocaine is a viable alternative for regional and general anesthesia in the management of anterior urethral stricture with optical internal urethrotomy.

Status of oxidative stress in patients with renal cell carcinoma.

PURPOSE: Although oxidative stress is implicated in renal cell carcinoma pathogenesis, to our knowledge changes in oxidative stress parameters in patients who undergo surgery for renal cell carcinoma have not been studied previously. We investigated the status of oxidative stress in patients with renal cell carcinoma. MATERIALS AND METHODS: Reactive oxygen species, nitric oxide and glutathione were measured in the blood of 68 patients with renal tumor and in 30 age matched normal controls. Levels were measured again 1 week, and 1 and 2 months postoperatively in patients who underwent surgery for renal cell carcinoma. Levels of superoxide dismutase, catalase and lipid peroxidation were measured in tumor tissue and in normal renal parenchyma in 51 patients with renal tumor. RESULTS: Significantly increased reactive oxygen species and nitric oxide, and decreased glutathione were observed in patients with renal cell carcinoma compared to normal subjects and in patients with benign tumors. Superoxide dismutase and lipid peroxidation were increased and catalase was decreased in tumor tissue compared to normal renal tissue. Oxidative stress correlated with renal cell carcinoma grade and stage but decreased after curative resection. Patients with metastatic disease had persistently increased oxidative stress parameters. Antioxidant enzyme levels in benign tumor tissue were significantly higher than in renal cell carcinoma. CONCLUSIONS: Patients with renal cell carcinoma have increased oxidative stress, which is effectively alleviated by curative resection. In patients with benign tumors antioxidant defense mechanisms maintain normal redox status.

Miniperc: what is its current status?

PURPOSE OF REVIEW: To review the recently published literature related to miniperc. RECENT FINDINGS: Miniperc has generated lot of enthusiasm in the last few years. Miniperc utilizes tract size of 20 F or less, hence the complication rates are much less. Hematocrit drop is significantly reduced and blood transfusion rates have gone down. Reduced pain and hospital stay without affecting success rate is the remarkable achievement of this procedure. Although initially it was supposed to be for small sized stones, many authors have utilized miniperc even for large and complex stones with good clearance rate. SUMMARY: Miniperc has several advantages over standard percutaneous nephrolithotomy. In comparison with retrograde intrarenal surgery and shock wave lithotripsy, it offers better clearance rate. Hemorrhagic complications of miniperc are significantly less, making it an attractive procedure for treating renal stones.