Predictive Factors for the Peri-operative Outcome of Ureteroscopic Lithotripsy for Proximal Ureteric Stones.

BACKGROUND: Proximal ureteric stones are considered one of challenging location for lithotripsy using semirigid ureteroscopes. Aim of the study was to assess clinical and radiological characteristics associated with outcome of lithotripsy using semirigid ureteroscope for proximal ureteric stones. METHODS: Prospective observational study was done on patients who underwent semirigid ureteroscopic lithotripsy for proximal ureteric stone. Stone and ureteral mormphomeric parameters were documented from computed tomography urogram. Stone free status and complication rates were studied. To determine predictive factors for outcomes, multivariate regression analysis and receiver operative curve were used. RESULTS: One hundred patients were included in study. Demographic characteristics, stone size, density and mode of lithotripsy had no impact on stone free rate or complications. The mean ureteral wall thickness(p = 0.002), distance of stone from pelvi-ureteric junction(p = 0.005), degree of hydronephrosis(p = 0.0001) and peri-ureteric fat stranding (p = 0.038) were found to have significant association with stone free rate on univariate analysis. On multivariate analysis, mild hydronephrosis(p = 0.003) and distance of stone from pelvi-ureteric junction(p = 0.022) were significant for stone free rate. CONCLUSIONS: Mean ureteral wall thickness, stone distance from pelvi-ureteric junction, presence of peri-ureteric fat stranding and hydronephrosis affect stone free rate on univariate analysis. On multivariate analysis for stone free rate, stone distance from pelvi-ureteric junction and mild hydronephrosis were significant. There was no significant impact of any stone or ureteral morphometry on complication rate.

Prostatic Urethral Length as a Predictor for Surgery in Benign Prostatic Hyperplasia.

BACKGROUND: Benign prostatic hyperplasia is associated with structural and morphological changes including elongation of prostatic urethral length. The aim of our study was to assess whether prostatic urethral length could predict need of surgery in patients with benign prostatic hyperplasia. METHODS: This prospective observational study was conducted over a 12-months duration. All the patients who presented with lower urinary tract symptoms secondary to benign prostatic hyperplasia were evaluated with International Prostate Severity Score, serum Prostate Specific Antigen, Transrectal Ultrasound was done to measure prostatic urethral length, prostate volume, Intravesical prostatic protusion and Post-void Residual Urine. Patients not responding to medical treatment and complications secondary to benign prostatic hyperplasia underwent surgery. Logistic regression analysis was performed to identify risk factors associated with surgery. RESULTS: A total of 153 patients were included in the study. Eighty-three (54.2%) patients underwent surgery during the study period. Prostate volume, intravesical prostatic protrusion, post-void residual volume, serum prostate specific antigen, and prostatic urethral length were significantly higher in the surgical group. The mean prostatic urethral length in the surgical group was 39.47 + 10.2 mm and in the nonsurgical group was 26.20 + 6.72 mm (p <0.0001). According to the ROC curve-based prediction of surgery, the area under the curve for PUL was 0.866 and the best cutoff value was 31.5mm (81% sensitivity and 84.3% specificity). CONCLUSIONS: BPH patients with longer PUL may require surgical management. PUL measured by TRUS may be a predicting factor for the need of surgery in BPH Keywords: Benign prostatic hyperplasia; lower urinary tract symptoms; prostatic urethral length.

Does Relocation of Lower Pole Stone During Retrograde Intrarenal Surgery Improve Stone-Free Rate? A Prospective Randomized Study.

Purpose: The aim of this study was to compare the stone-free rate (SFR) of in situ treatment vs relocation and lithotripsy for lower pole stones of less than 2 cm following retrograde intrarenal surgery (RIRS). Methods: This prospective randomized study was undertaken from June 2019 to May 2020 in patients undergoing RIRS for lower pole renal stones less than 2 cm in diameter. Patients were randomized into two groups: in situ lithotripsy group and relocation lithotripsy group. The in situ lithotripsy group underwent laser lithotripsy for lower pole stones without relocation of the calculus, and the relocation lithotripsy group had their stones relocated to a favorable location using a tipless Nitinol basket, followed by laser lithotripsy. Laser lithotripsy was achieved using the holmium:YAG (Ho:YAG) laser (120 W) with a 200-µm laser fiber. A Double-J stent was placed in all patients at the end of the procedure. Patient demographics, stone characteristics, operative outcomes, and complications were evaluated. The SFR was determined at 1 month postoperatively with a kidney, ureter, and bladder radiograph (KUB) and ultrasound KUB. Results: Sixty-eight patients were included in the study: in situ group (n = 35) and relocation group (n = 33). The mean stone size and stone density were similar between the groups. The total operative duration, lasing duration, and total energy used were similar between the groups. At the 1-month follow-up, the complete SFR was 85.7% and 91% in the in situ lithotripsy and relocation lithotripsy groups, respectively (p = 0.506). Conclusions: Relocation followed by subsequent laser lithotripsy was associated with similar SFRs as with in situ laser lithotripsy for lower pole renal calculi less than 2 cm in diameter following RIRS using the Ho:YAG laser.

Comparative Study of Percutaneous Nephrolithotomy in Supine and Prone Positions.

BACKGROUND: The aim of the study is the compare efficacy and safety of percutaneous nephrolithotomy in supine and prone positions. Percutaneous nephrolithotomy is conventionally performed in prone position but in recent years numbers of supine percutaneous nephrolithotomies is increasing globally. METHODS: The hospital based cross-sectional observational study was conducted in the Department of Urology, Bir Hospital from July 2018 to January 2020. A total of 81 consecutive patients undergoing percutaneous nephrolithotomy were divided into two groups, with 38 patients in Supine (Group 1) and 43 patients in Prone (Group 2) positions, respectively. Patient's demographics, access time, operative duration, stone free rate, radiation dose and duration, irrigation fluid volume, post-operative hemoglobin drop and complications were compared. RESULTS: Demographic and stone characteristics were comparable in both groups. Supine Group (Group 1) had significantly shorter operative duration than Prone Group (Group 2), 44.63 ± 12.44minsvs 53.02 ±12.67mins (p< 0.04). The mean radiation duration was 99.11 ± 61.17secs in Group 1 and 108.40 ± 51.65 secs in Group 2 (p=0.46), respectively. Although the mean radiation dose was lower in Group 1 (375.1µGym2) than in Group 2 (465.7 µGym2), it was not statistically significant(p=0.24). The stone free rate at 1 month duration were comparable with 92.1% and 93.02% in Group 1 and Group 2 respectively (p=0.16). Overall complication rates were similar in both groups (15.7% in Group 1 vs 16.2% in Group 2), respectively. None of the patients in both groups had complications higher than Clavien IIIa. CONCLUSIONS: PCNL in supine position has significantly shorter operative time with similar complications and stone free rates as compared to prone position.

Tamsulosin versus tadalafil as a medical expulsive therapy for distal ureteral stones: A prospective randomized study.

PURPOSE: This study aimed to compare the safety and efficacy of tamsulosin and tadalafil as medical expulsive therapy for distal ureteral stones. MATERIALS AND METHODS: This prospective randomized study was conducted at the Department of Urology of Bir Hospital over a period of 12 months in patients with distal ureteral stones sized 5 to 10 mm. Patients were randomly divided into 2 groups: group A received tamsulosin 0.4 mg and group B received tadalafil 10 mg at bedtime for 2 weeks. Stone expulsion rate, number of ureteric colic episodes and pain score, analgesic requirements, and adverse drug effects were noted in both groups. Statistical analyses were performed by using Student t-test and chi-square test. RESULTS: Altogether 85 patients, 41 in group A and 44 in group B, were enrolled in the study. The patients' average age was 31.72±12.63 years, and the male-to-female ratio was 1.5:1. Demographic profiles, stone size, and baseline investigations were comparable between the 2 groups. The stone expulsion rate was significantly higher in the tadalafil group than in the tamsulosin group (84.1% vs. 61.0%, p=0.017). Although the occurrence of side effects was higher with tadalafil, this difference was not significant (p=0.099). There were no serious adverse effects. CONCLUSIONS: Tadalafil has a significantly higher stone expulsion rate than tamsulosin when used as a medical expulsive therapy for distal ureteral stones sized 5-10 mm. Both drugs are safe, effective, and well tolerated with minor side effects.

Hybrid laparoscopic endoscopic single-site surgery for radical cystoprostatectomy and orthotopic ileal neobladder: an initial experience of 12 cases.

BACKGROUND AND PURPOSE: Laparoscopic endoscopic single-site surgery (LESS) has recently emerged as an attempt to enhance cosmetic benefits and reduce morbidity; however, LESS for radical cystectomy is still not well established. Here we describe the technique of hybrid LESS for radical cystoprostatectomy and orthotopic ileal neobladder (RC-OIN), and evaluate its feasibility and safety. PATIENTS AND METHODS: Between November 2008 and October 2009, 12 men with bladder cancer underwent hybrid LESS for RC-OIN. A homemade multichannel port, made from two stretchable rings and a surgical glove with trocars and valves attached to its fingers, was placed into a 4- to 5-cm midline incision in the lower abdomen and was used for laparoscopic instruments. Another subumbilical port was placed for the laparoscope. Extended bilateral pelvic lymphadenectomy was performed by the lateral view; radical cystoprostatectomy was completed laparoscopically; construction of the ileal neobladder was performed extracorporeally; and the neobladder was anastomosed to the urethral stump laparoscopically, with a slipknot running suture technique. Perioperative, functional, oncologic data and complications were collected and analyzed. RESULTS: All operations were performed successfully without conversion to conventional laparoscopic radical cystectomy or open surgery. There was no perioperative mortality or port-related complications. The median operative time was 383 minutes. Median blood loss was 150 mL. A median of 25 lymph nodes were removed. Surgical margins were tumor free in all cases. CONCLUSIONS: Hybrid LESS for RC-OIN is technically feasible with effects similar to those of conventional laparoscopic procedures. Further instrument and technique improvement are necessary to shorten operative time and reduce intraoperative difficulties.