Laparoscopically guided transperitoneal percutaneous nephrolithotomy for calculi in pelvic ectopic kidneys.

Although percutaneous nephrolithotomy is a well-established endourological modality for the management of calculi in the normally placed kidney, it is not easy to apply in the management of calculi in pelvic ectopic kidneys. We report the cases of three patients who were found to have large calculi in pelvic ectopic kidneys and subsequently underwent laparoscopically guided transperitoneal percutaneous nephrolithotomy, all with successful outcome. In all patients, complete stone clearance was achieved in a single operation with no intraoperative or postoperative morbidity. They remain asymptomatic and recurrence-free at a follow-up ranging from 2 to 38 months. Laparoscopic guidance allows the transperitoneal route to be used safely for percutaneous nephrolithotomy in patients with calculi in pelvic ectopic kidneys. We believe it to be a feasible, safe, and valid minimally invasive management option for this uncommon but challenging urological condition.

Percutaneous calyceal irrigation calculi during percutaneoius nephrolithotomy

Objectives: Percutaneous nephrolithotomy performed for the management of complex renal calculi is a challenging endourological procedure. In complex situations multiple tracks and Y tracks may be needed to achieve complete stone clearance. These maneuvers carry a risk of complications especially bleeding. This study was carried out to evaluate the efficacy of the use of percutaneous calyceal irrigation (PCI) for small calyceal calculi during percutaneous nephrolithotomy. Patients and Methods: Fifty patients; in whom percutaneous calyceal irrigation (PCI) was attempted; were retrospectively evaluated. Results: Complete stone clearance was achieved with the help of PCI in 62renal units. There were no complications attributable to PCI. Conclusion: Our results encourage the use of PCI as a simple technique for clearance of small calyceal calculi thus preventing the need for a second track or Y track

Symptomatic small non-obstructing lower ureteric calculi: comparison of ureteroscopy and extra corporeal shock wave lithotripsy.

OBJECTIVE: To compare the success, efficacy and complications of ureteroscopy (URS) and extra corporeal shock wave lithotripsy (ESWL) for the treatment of symptomatic small non obstructing lower ureteric calculi. SUBJECTS AND METHODS: This prospective non-randomised study was conducted simultaneously at two urological referral centres, included 280 patients with symptomatic small (4-10 mm) lower ureteric calculi (situated below the sacroiliac joint), with good renal function on intravenous urography. Patients were offered both the treatment options. One hundred and sixty patients chose ureteroscopy, whereas 120 patients were treated by ESWL. Standard techniques of ureteroscopy and ESWL were employed. Patients were followed-up to assess the success rates and complications of the two procedures. RESULTS: Ureteroscopy achieved complete stone clearance in one session in 95% of patients. In six patients ureteroscopy had failed initially and was later accomplished in second session improving the success rate to 98.7%. Two patients had a proximal migration of calculus that needed ESWL. Of the 120 patients treated by ESWL, 90% achieved stone free status at three months. Ureteroscopy was needed for twelve patients (10%) where ESWL failed to achieve stone clearance. There were no significant ESWL related complications. ESWL was administered on outpatient basis, while patients needed hospitalisation and anaesthesia for ureteroscopy. CONCLUSION: ESWL can be the primary mode of treatment for symptomatic small non-obstructing lower ureteric calculi as it is minimally invasive and safe. Ureteroscopy can be offered to patients who demand immediate relief or when ESWL fails.

Nephrostomy tube after percutaneous nephrolithotomy: large-bore or pigtail catheter?

BACKGROUND AND PURPOSE: A nephrostomy tube is an integral part of any percutaneous renal surgery. Commonly, a nephrostomy tube that is 2F to 3F smaller than the percutaneous tract is used after percutaneous nephrolithotomy (PCNL). In our experience, quite a few patients have pain at the nephrostomy tube site, and many patients complain of a prolonged urinary leak after tube removal when a large nephrostomy tube is used. This prospective study was planned to document whether these symptoms could be attributed to the size of the nephrostomy tube and whether a small pigtail catheter could reduce these problems without increasing complications. PATIENTS AND METHODS: Forty well-matched patients in whom a one-stage PCNL was done for calculus disease were studied prospectively. Alternate patients had a 28F nephrostomy tube or a 9F pigtail catheter placed at the end of the procedure. Patients were observed for the duration of hematuria, number of analgesic injections needed, and the duration of urinary leak after tube removal. RESULTS: The groups were comparable in the amount and duration of hematuria after PCNL. There was a statistically significant difference in the analgesic need and the duration of urinary leak after tube removal, both of which were less in patients having a pigtail catheter. CONCLUSIONS: A pigtail catheter nephrostomy tube after PCNL reduces the hospital stay by reducing the duration of the urinary leak. The postoperative course is smooth, as patient has less pain and needs less analgesic support. There is no statistically significant increase in the postoperative bleeding secondary to use of a pigtail catheter. Second-look nephroscopy was easy in the one patient with a pigtail nephrostomy catheter who needed the procedure.

Endoscopy-assisted Freyer prostatectomy: a safer technique.

Freyer prostatectomy is infrequently indicated today. One of the blind steps in this procedure is when the urethra is disconnected at the prostatic apex. There is risk of stress urinary incontinence and damage to the sphincter. We describe a safe and a simple endoscopic technique to overcome this difficulty.

Re-establishment of dislodged percutaneous nephrostomy tube using a ureteroscope.

A simple and safe technique for the replacement of a dislodged nephrostomy tube using a ureteroscope is presented.

Bilateral single-session percutaneous nephrolithotomy: a feasible and safe treatment.

BACKGROUND AND PURPOSE: The treatment of bilateral urinary calculus disease is often staged, irrespective of the modality of the treatment. Bilateral simultaneous percutaneous nephrolithotomy (PCNL) is still considered by many to be adventurous and risky. We carried out this prospective study of bilateral PCNL under a single anesthesia to study the feasibility, success rate, and complications if any. PATIENTS AND METHOD: From September 1996 to May 1999, 25 consecutive medically fit patients with bilateral renal calculi needing PCNL were subjected to bilateral PCNL under a single anesthesia. RESULTS: The PCNL could be accomplished bilaterally in 24 patients (96%). In one patient, the second-side PCNL was abandoned because of excessive bleeding on the first side. A total of 58 tracts and 27 sessions were required for complete treatment of the 48 renal units in the 24 successfully treated patients. The average operating time required for the procedure was 122 minutes. Nineteen patients were rendered stone free in one session, and two more patients were made stone free in a second session. Four renal units in three patients with residual calculi were cleared with double-J stenting and SWL. CONCLUSION: Bilateral PCNL in a single session is feasible and safe and can be carried out without increased morbidity. We advocate that an endourologist be prepared for bilateral PCNL in the patients in whom it is indicated. The opposite-side PCNL can be done if the first-side treatment is accomplished smoothly and in a reasonable time.

Inline tug on a through-and-through glidewire to reposition open-ended catheter during percutaneous nephrolithotomy.

We present a simple technique to reposition an open-ended ureteric catheter in the pelvicalyceal system during percutaneous nephrolithotomy. A through-and-through glidewire is straightened using a stone-grasping forceps. The open-ended catheter is advanced in the pelvicalyceal system over this taut glidewire.

Is antegrade ureteroscopy better than retrograde ureteroscopy for impacted large upper ureteral calculi?

OBJECTIVE: This study was planned to compare the risks and advantages of antegrade and retrograde ureteroscopy for impacted large upper ureteral calculi. PATIENTS AND METHODS: From September 1996 to February 1998, ureteroscopy was offered to 43 patients. Of these, retrograde ureteroscopy was done in 20 patients, while antegrade ureteroscopy was performed in 23 patients. All these patients were followed up to evaluate the immediate and long-term success of the procedure. The incidence and nature of complications were also noted. RESULTS: During retrograde ureteroscopy, complete stone clearance was achieved in 11 patients (55%), while pushback of the whole or fragmented calculus was seen in the rest. These patients with residual calculi were later treated by extracorporeal shockwave lithotripsy (SWL). The stone-free rate at the end of 3 months was 85%. Three patients developed minor ureteroscopy-related complications. Complete stone clearance was achieved in all patients with antegrade ureteroscopy. No intraoperative or postoperative complications were encountered. CONCLUSION: In this series, antegrade ureteroscopy was found to be a safe and effective option for impacted upper ureteral calculi and assured better results than retrograde ureteroscopy.

Percutaneous cystolithotomy for vesical calculi: a better approach.

Vesical calculus is a common problem that is treated traditionally with open cystolithotomy or cystolithalopaxy. Open surgery has the inherent problems of a long scar, prolonged catheterization, extended hospitalization, and risk of infection. Transurethral cystolithalopaxy also requires special instruments that carry a risk of trauma, which could lead to urethral strictures. Thirty-eight patients (15 children and 23 adults) were treated for vesical calculi by percutaneous cystolithotomy (PCCL), a minimally invasive procedure. A fluoroscopic-guided tract was made to the bladder through a small suprapubic puncture (9-10 mm) and a nephroscope was inserted via an Amplatz sheath placed suprapubically. The calculus was fragmented with ultrasound or pneumatic energy before being flushed out. A suprapubic catheter was kept in place for 48 hours postsurgery; no urethral catheter was needed. Urethral instrumentation was kept to a minimum. After 48 hours, the suprapubic catheter was clamped and removed after the patient had two or three normal voids. No significant intraoperative or postoperative complication was encountered. Given that the urethra is spared, percutaneous cystolithotomy is a preferred approach in patients with vesical calculi.

Detoxification of Rapeseed Products.

The full potential of rapeseed products has not yet been realized because of the presence of certain toxic compounds. This paper reviews development of low erucic acid rapeseed, and the extensive experimental scrutiny to which this oil has been subjected. The significance of the presence of gluocosinolates as well as their decomposition products (isothiocyanates and oxazolidinethiones) in rapeseed meal is also discussed. Various methods for removing these toxic constitutents from the meal are reviewed.