Comparative Analysis of Standard Percutaneous Nephrolithotomy (PCNL) and Mini-Percutaneous Nephrolithotomy (Mini-PCNL) for Renal Stones Larger Than 2 cm at a Rural Hospital: A Study Protocol.

Background Percutaneous nephrolithotomy (PCNL) is considered a standard treatment option for large-size renal stones but is associated with drawbacks such as bleeding and prolonged recovery. Mini-PCNL offers a less invasive alternative, but its efficacy compared to standard PCNL for renal stones larger than 2 cm remains under debate. This study aims to compare the efficacy and safety of standard PCNL versus mini-PCNL for renal stone sizes more than 2 cm. Methods This single-centre prospective interventional study will be conducted at Acharya Vinoba Bhave Rural Hospital (AVBRH). The study will include patients 18 to 70 years of age undergoing unilateral PCNL for renal calculi. Patients with renal stones larger than 2 cm will be enrolled. Data on stone-free rate (SFR), operative duration, hospital stay time, surgical site infection, haemoglobin (Hb) drop, need for blood transfusion, and post-surgery fever will be collected and compared between the two procedures. Statistical analysis of data will be performed using descriptive and analytical statistics. Results The study aims to enrol a total of 32 patients. Data analysis will be done using IBM SPSS Statistics for Windows, Version 24 (Released 2016; IBM Corp., Armonk, New York). Conclusion This study will provide valuable insights into the comparative outcome in terms of efficacy and safety of standard PCNL and mini-PCNL for kidney stones larger than 2 cm.

Surgical Management of Bilateral Single-System Ectopic Ureters (BSSEUs) in a Pediatric Patient: A Report of a Rare Case and Literature Review.

Bilateral single-system ectopic ureters (BSSEUs) are among the rarest entities encountered in pediatric urology. A BSSEU occurs when the ureteric buds originate cranially from the mesonephric ducts, causing a delay in their integration into the urogenital sinus. It presents as continuous incontinence in females, whereas symptoms like infection and discomfort are present in males. We describe a case involving a BSSEU opening into the vagina and urethra, with the patient experiencing continuous urinary incontinence, and its diagnosis and management. Here, We discuss a rare case of a four-year-old girl exhibiting continuous urinary incontinence or dribbling associated with recurrent urinary tract infections (UTIs) attributed to bilateral ectopic ureters. Imaging modalities, including contrast-enhanced computed tomography(CECT) and MRI, revealed the presence of BSSEUs accompanied by hydroureteronephrosis. The condition was managed with prompt surgical intervention involving bilateral ureteric reimplantation. Subsequent to the procedure, the patient experienced a significant improvement in continence mechanism and bladder capacity, obviating the requirement of urinary diversion procedure appendicovesicostomy or bladder neck reconstruction. Notably, while BSSEUs are an uncommon presentation, their timely and appropriate management is paramount in preventing potential renal damage. This case underscores the significance of vigilant monitoring and proactive intervention in addressing such complex urological anomalies in pediatric patients.

Ectopic Ureter Opening in Vagina: A Rare Cause of Nonfunctional Kidney and Urinary Incontinence in a Pediatric Patient.

An ectopic ureter is a condition characterized by a ureter, whether single or duplex, that fails to open in the trigone area of the urinary bladder but instead drains outside of it. This anomaly arises congenitally due to abnormal migration of the ureteric bud during its insertion into the urinary bladder. Here, we present a case involving an ectopic ureter draining into the vagina, with continuous urinary incontinence. We discuss the diagnosis, evaluation, and management of urinary incontinence in a female because of an ectopic ureter. A 9-year-old girl child presented with a continuous urinary leak or incontinence requiring the use of one to two pads per day that progressively became wetter throughout the day. Physical examination revealed a normal urethral meatus and vagina without obvious visible dribbling of urine at the introitus. CT urography showed significant dilation of the right ureter, causing hydroureter and ectopic insertion of the tortuous right ureter near the external urethral orifice at the vaginal vestibule, along with an atrophic right kidney. A DTPA (diethylenetriamine pentaacetate) scan indicated the nonfunctional status of the right kidney. The patient underwent a right nephroureterectomy, leading to a complete resolution of urinary incontinence. Ectopic ureter causing nonfunctional kidney and urinary leak or incontinence is rare. This case emphasizes the importance of a comprehensive diagnostic workup for achieving a better prognosis and initiating early treatment of ectopic ureter.

Case Report on Adrenal Schwannomas: A Rare Mimic in the Spectrum of Adrenal Masses.

Adrenal schwannomas are exceptionally rare tumors affecting about 0.2%, originating from the adrenal gland, presenting diagnostic challenges due to their nonspecific clinical features and overlapping radiological characteristics with other adrenal masses. Here, we report the case of a 49-year-old female with no significant medical history presenting with diffuse abdominal pain. Imaging studies, including contrast-enhanced computerized tomography (CECT), revealed a well-defined mass within the right adrenal gland. Given inconclusive radiological findings and persistent symptoms, surgical exploration was performed, leading to the identification and resection of the mass. Microscopic examination, including immunohistochemistry, confirmed the schwannomatous origin of the tumor. The final diagnosis of an adrenal schwannoma was established after a histopathological examination. Postoperatively, the patient was treated with antibiotics and discharged on oral antibiotics after suture removal on advised follow-up after 15 days. This case highlights the diagnostic complexities associated with adrenal schwannomas and emphasizes the necessity of surgical intervention for conclusive diagnosis. The report aims to contribute to the limited literature on adrenal schwannomas, enhancing our understanding of their clinical presentation and reinforcing the importance of a multidisciplinary approach in their diagnosis and management.

Diagnostic accuracy of the postoperative C - reactive protein to albumin ratio in prediction of complications after major abdominal surgery.

INTRODUCTION: postoperative complications are common after surgery for both benign and malignant disease, and results in infections, extended hospital stay, delayed return to normal status, increased financial burden and long-term morbidity hence early recognition of surgical complications and management is of utmost importance. AIM: To assess the predictive value of C-reactive protein to albumin ratio (CAR) and C-reactive protein (CRP) in determining the post-operative complications following major abdominal surgeries. METHODS: this two-year prospective observational study was carried out at acharya vinoba bhave hospital and risk factors for post-operative complications in 100 eligible patients who were undergone major abdominal surgeries were identified using uni and multivariate analysis. Cut Coff values, PPV, sensitivity and specificity of CAR and CRP was analysed by ROC curve. RESULTS: in our study 62% patient developed post-operative complications and CAR on post-op. day three found to be independent risk factor for prediction of post-op. complication and has higher PPV than CRP. CAR cut-off value of 2.16 is associated with more post op complications. CONCLUSION: From our study it can be hypothesized that patients having CAR value of more than 2.16 on post op day 3 should be monitored carefully for development of complications. So that early intervention could reduce the unwanted sequelae associated with it.