Jejunal Injury as a Rare Complication of Percutaneous Nephrolithotomy: Case Report.

Background: Colonic injury represents a rare complication of percutaneous nephrolithotomy (PCNL). Injury of the small bowel is very rare, with only anecdotal case reports in the literature. We report here a rare PCNL complication of jejunal perforation without concomitant colonic injury. Case Presentation: A 45-year-old male underwent PCNL for multiple left kidney stones. At the beginning of the procedure, we faced difficulty in achieving access, but after that the procedure was straightforward and ended smoothly. However, from the third day, the postoperative course became stormy with progressive development of picture of acute peritonitis. Laparotomy was mandatory and jejunal perforation was found and repaired. Conclusion: Although extremely rare, small bowel injury should be kept in mind during planning for percutaneous nephrolithotomy. Prompt diagnosis and active treatment should be undertaken without delay especially if picture of acute peritonitis is developed.

Extracorporeal shockwave lithotripsy monotherapy for treating patients with bladder stones.

OBJECTIVES: To describe our experience with extracorporeal shockwave lithotripsy (ESWL) for the treatment of bladder stones of <20 mm. PATIENTS AND METHODS: This study was prospectively performed in two hospitals (Althawrah Modern General Hospital, and Ibn Sina Specialized Hospital) between November 2012 and November 2015. In all, 44 patients presented with urethral or bladder stones. The location and size of the stones was assessed by abdominal ultrasonography and plain abdominal radiography of the kidneys, ureters and bladder. All patients with radiopaque stones of <20 mm underwent ESWL monotherapy after fixation of a Foley catheter in a supine position under intravenous analgesia. RESULTS: The mean size of the stones was 15.8 mm and spontaneous evacuation occurred after removal of the Foley catheter without the need for adjuvant procedures in 40 patients (90.9%). Four patients (9%) developed acute urinary retention due to urethral impaction of large stone fragments. In two of them, the urethral catheter was successfully re-inserted pushing the fragments back to the bladder and a complementary session of ESWL resulted in more fragmentation of the stones, with spontaneous passage after catheter removal. In the other two patients (4.5%), the catheter could not be re-inserted and urgent endoscopic intervention was required. CONCLUSIONS: ESWL monotherapy is safe and effective method for treatment of bladder stones with no other causes of infra-vesical obstruction. Several indications can be met including patients with high anaesthetic risk, patients fearing anaesthesia or endoscopic procedures, and patients who have difficulty in positioning.

Challenges in renal transplantation in Yemen.

Background Renal replacement therapy was first introduced in Yemen in 1978 in the form of hemodialysis. Twenty years later, the first renal transplantation was performed. Kidney transplantations were started in socially and financially challenging circumstances in Yemen in 1998. A structured program was established and has been functioning regularly since 2005. A pediatric transplantation program was started in 2011. Material and Methods This was a prospective study of 181 transplants performed at the Urology and Nephrology Center between May 1998 and 2012. All transplants were from living related donors. The immunosuppressive protocol consisted initially of double therapy with steroid and mycophenolate mofetil (MMF). Subsequently, triple therapy with addition of a calcineurin inhibitor was introduced. Primary graft function was achieved in 176 (97.2%) recipients. Results Cold ischemia time was 48-68 min. Episodes of acute rejection in 12 patients were treated with high-dose steroids. Anti-thymocyte globulin (ATG) was used in cases of vascular or steroid-resistant rejection in 2 patients. The post-transplant complications, either surgical or medical, were comparable to those recorded in the literature. Conclusions Renal transplantation is a good achievement in our country. The patients and graft survival rates are comparable to other reports.

Tubeless percutaneous nephrolithotomy with double-J stent compared with external ureteral catheter to decrease postoperative complications.

OBJECTIVE: To compare the efficacy of tubeless percutaneous nephrolithotomy (PCNL) using double-J stent and tubeless PCNL with external ureteral catheter in decreasing post-PCNL complications. METHODS: This prospective randomized comparative study includes 148 cases with kidney stones. They were operated by either tubeless PCNL with double-J stent (Group 1) or tubeless with ureteric catheter (Group 2). Group 1 consists of 72 cases (54 males and 18 females). Group 2 consists of 76 patients (56 males and 20 females). Both groups were compared from the point of post-PCNL complications without using tissue sealants or tract cauterization. The study was carried out in the Department of Urology, Al-Thawrah Modern General and Ibn-Seena Hospital, Sana'a, Yemen between January 2008 and January 2010. RESULTS: In Group 1, the post-PCNL complications were leakage of urine in 4 (5.6%), hematuria >48 hours in 6 (8.3%), fever in 2 (2.8%), and the length of hospital stay was 36-48 hours. In Group 2, the post-PCNL complications were leakage of urine in 13 (17.1%), hematuria in 9 (11.8%), 5 (6.6%) has fever, colonic injury in one, and fluid collections in 8 (10.5%). There was significant difference in urine leakage (p=0.028). CONCLUSION: Tubeless PCNL with double-J stent was the best method to decrease the complications and length of hospital stay.