Safety and Efficacy of Ureteroscopic Laser Lithotripsy in the Management of Ureteric Calculi in Pregnancy-Experience of a Tertiary Care Center.

Introduction: Ureteric colic in pregnancy is one of the common non-obstetric reasons for emergency department visits. Ureteric calculi present a significant threat to maternal and fetal health and definitive management often becomes necessary. Our aim is to assess the safety and efficacy of ureteroscopic laser lithotripsy in the management of ureteric stones in pregnancy. Material and methods: This is a prospective observational study of 3 years carried at a tertiary referral center. It includes all pregnant patients who underwent ureteroscopic laser lithotripsy for ureteric stones. Results: A total of 29 pregnant patients underwent ureteroscopic laser lithotripsy at our center in 3 years. The mean age of patients was 33.5 ± 6.2 years, and the mean gestation age at the time of ureteroscopy was 23.34 ± 5.9 weeks. The average stone size was 8.3 ± 3.6 mm and was predominantly found in upper ureter (62%). The mean operative time was 31 ± 8.9 min, and the average laser energy spent was 4.3 ± 1.1 kJ/case. There was no major Intraoperative complication, and the average hospital stay was 2.5 ± 1.5 days. Complete stone clearance was achieved in 93.1% of cases. Conclusion: Ureteroscopic laser lithotripsy is safe and effective treatment of ureteric stones in terms of obstetric outcome and stone clearance in pregnancy.

Mini-PCNL - a boon for CKD patients with nephrolithiasis.

Purpose: The prevalence of urinary stone disease in ESRD is 3.2%, leading to renal damage due to obstructive uropathy, infection, and frequent surgical intervention. PCNL, the gold standard for complex renal stone disease, has evolved with smaller access sheaths (14-20 F), improved optics, and fluoroscopic equipments. This study aims to assess the safety and feasibility of mini- PCNL in CKD patients with respect to postoperative outcome and its effect on stage of CKD. Patients and methods: This prospective study was conducted in the Department of Urology, Sher-I-Kashmir Institute of Medical Sciences, from January 2022 to October 2022. This study included adult patients with nephrolithiasis at CKD stage 3 or higher. The primary objective of this research was to assess the impact of mini-PCNL on renal function, specifically measuring changes in estimated glomerular filtration rate (eGFR) from baseline to a 6-month follow-up. The secondary objective was to evaluate the feasibility of mini-PCNL in CKD patients in terms of complications, stone clearance rate, and duration of hospital stay. Four variable Modification of Diet in Renal Diseases(MDRD) equation was used to calculate the estimated GFR(eGFR) of each patient and NKF/KDOQI classification system to classify the stage of CKD. Results: A total of 46 patients were included in the study. We found that for management of nephrolithiasis in CKD patients, mini-PCNL leads to significant improvement in eGFR at 6 months follow-up (mean difference = 14.25 ml/min/1.73 m2; p-value <0.01) with high stone-free rates (89.5%). The complication rates were comparable to standard PCNL. Conclusions: mini-PCNL is a bonanza for management of CKD patients with nephrolithiasis.

Zinner's syndrome: Masquerading as pyonephrotic ectopic kidney.

Zinner's syndrome is a rare developmental anomaly of Wolffian duct, comprising a triad of seminal vesicle cyst, ipsilateral renal agenesis and ejaculatory duct obstruction, first described by Zinner in 1914. Several aberrations have been reported like renal dysplasia, ectopic ureteric orifice in one of the derivatives of Wolffian duct. Usually it presents in second to fourth decade of life with symptoms of urinary bladder irritation/obstruction, cyst distension, ejaculatory duct obstruction. The diagnosis is principally based on imaging studies, usually confirmed by MRI. Treatment is based upon the persistent symptoms or complications related to it. Excision of cyst is gold standard.

Massive perinephric hematoma - A rare complication of extracorporeal shock wave lithotripsy.

Extracorporeal shock wave lithotripsy is commonly used to fragment renal calculi. This treatment modality is considered safe with minimal complications. We report a case of massive retroperitoneal hematoma following extracorporeal shock wave lithotripsy in a patient with no comorbidity and normal coagulation parameters. Patient was managed conservatively and had excellent recovery with normal renal function.

Stripping of glidewire - A rare intraoperative complication of Percutaneous Nephrolithotomy.

Percutaneous nephrolithotomy is the standard procedure used to treat nephrolithiasis. Glidewires play a pivotal role in the smooth conduction of the procedure. Rough handling of glidewires and other accessories can lead to their fragmentation or stripping thus complicating the procedure. These foreign bodies can get easily lost in the retroperitoneum and are difficult to retrieve. We present a case of stripping of glidewire during percutaneous nephrolithotomy and the procedure to retrieve it percutaneously under fluoroscopic guidance.

A childhood blast victim presenting with bladder stone in adulthood-A rare case report of retained blast fragment with secondary stone.

Secondary bladder stones in young adults are usually a result of bladder outlet obstruction secondary to urethral stricture disease or neurogenic bladder. Foreign body inside bladder is a perfect nidus for the development of secondary bladder stone. We report a rare case of bladder stone in a young adult developing on the retained blast fragment inside bladder.

Management of accidental penile incarceration due to unusual masturbation practices.

OBJECTIVE: We aimed to discuss the unusual masturbation practices performed by methods such as penile devices causing incarceration and its emergency management. MATERIAL AND METHODS: It is a retrospective study of cases who presented to the emergency department with penile incarceration by metallic and nonmetallic encircling objects from September 2015 to October 2020. The cases were analyzed for age, marital status, motive, type of object used, duration of incarceration, associated urinary retention, type of anesthesia used, methods of removal, complications of incarceration, and secondary procedures required to treat complications. RESULTS: A total of nine cases had paid emergency visit to our hospital for the past 4 years. The average age of the patients was 36.78 years. Unusual masturbation practices that underwent wrong were the common cause in most cases (77.7%). Most of cases presented after 24 hours of incident. All foreign bodies were removed under spinal anesthesia except one that was removed under penile block. Two cases (22.9%) required skin grafting and one (11.1%) underwent partial penectomy following the removal of encircling objects. CONCLUSION: This study emphasizes that the penile incarceration because of unusual masturbation practices is rare as it is sparsely reported as only a few case reports in the literature. Most of the patients presented late because of the embarrassment associated with it. This emergency requires urgent intervention, and the method used to remove the foreign body depends on the resources available, duration of incarceration, grade of injury, and the type of foreign body.

Giant hydronephrotic kidney in adolescence- A rare case report and a review of the literature.

Giant hydronephrotic kidney is a rare form of obstructive uropathy in adolescents. We report a 19 year old girl with huge abdominal distention secondary to hydronephrotic kidney. The cystic swelling occupied whole of the abdominal cavity with other structures being compressed. She presented with progressive distention of abdomen with early satiety. Subsequently ultrasonological and CT scan evaluation revealed a giant hydronephrosis of right kidney occupying almost whole abdomen. Such presentation of PUJ obstruction is rare. We present this case in which percutaneous nephrostomy with slow decompression was done as initial treatment to relieve symptoms and prevent complications.