Search

Discusses percutaneous renal surgery. Application of percutaneous renal puncture in decompressing obstructed kidneys; Identification of uncorrected coagulopathy as the only absolute contraindication to percutaneous surgery; Instruments necessary for percutaneous renal access, dilation and placing the nephrostomy tube.

Pelvi‐ureteric junction obstruction (PUJO) is defined as a functionally significant impairment of the flow of urine from the kidney's renal pelvis into the proximal ureter. Symptomatically, the patient may experience flank pain, recurrent infections, stone formation, and impairment of renal function. Although many cases of intrinsic PUJO are diagnosed at birth, a minority of patients may present in adulthood with previously silent disease or develop secondary PUJO to other causes. PUJO is therefore broadly categorised into both primary and secondary PUJO. A wide array of diagnostic scans and tests are available to aid in diagnosing and monitoring patients with PUJO. In patients with compromised renal function or symptomatic PUJO that require intervention, minimally invasive techniques are the 'gold standard' for surgical intervention. This review will detail the endoscopic, laparoscopic, and robotic options available to the urologist practicing in 2021, including the use of autografts and other emerging technologies. [ABSTRACT FROM AUTHOR]

The author discusses live demonstrations of urological surgery. The author mentions that during live surgery, the surgeon is aware of the large audience during the operation that may cause anxiety, while the patient may suffer delay in definitive treatment. He states that audiences claims that live surgery allows them to see how the surgeon deals with complications and problems that might occur.

After urinary diversion patients are at increased risk of long-term complications, including stones of the upper urinary tract and reservoir or conduit. Advances in instrumentation and techniques have expanded treatment options, while minimizing morbidity. Minimally invasive treatment methods include shockwave lithotripsy, antegrade and retrograde ureteroscopic lithotripsy and percutaneous nephrolithotomy. Percutaneous and laparoscopic techniques are applicable to stones within urinary diversions. Medical management is crucial for avoiding recurrent stones in these patients. [ABSTRACT FROM AUTHOR]

Objective To analyse our experience with and the outcomes and lessons learned from percutaneous nephrolithotomy ( PCNL) in the super obese (body mass index [ BMI] ≥50 kg/m2). Patients and Methods In this institutional review board approved study we retrospectively reviewed our PCNL database between July 2011 and September 2014 and identified all patients with a BMI ≥ 50 kg/m2. Patient demographics, peri-operative outcomes and complications were determined. Additionally, we identified a number of special PCNL considerations in the super obese that can maximize safe outcomes. Results A total of 21 PCNL procedures performed on 17 super obese patients were identified. The mean patient age was 54.8 years, the mean BMI was 57.2 kg/m2 and the mean stone area was 1 037 mm2. Full staghorn stones were observed in six patients and partial staghorns in four patients. The mean operating time was 106 min and the mean haemoglobin decrease was 1.2 g/ dL. The overall stone-free rate was 87%. There were four total complications: two Clavien grade II, one Clavien IIIb and one Clavien IVb. We identified several special considerations for safely preforming PCNL in the suber obese, including using extra-long nephroscopes and graspers, using custom-cut extra long access sheaths with suture 'tails' secured to easily retrieve the sheath, choosing the shortest possible access tract, readily employing flexible nephroscopes, placing nephroureteral tubes rather than nephrostomy tubes postoperatively, and meticulous patient positioning and padding. Conclusion With appropriate peri-operative considerations and planning, PCNL is feasible and safe in the super obese. Stone clearance was similar to that reported in previous PCNL series in the morbidly obese, and is achievable with few complications. [ABSTRACT FROM AUTHOR]

Objectives To examine the differences in 24-h urine composition between nephrolithiasis patients with and without diabetes mellitus ( DM) in a large cohort of stone-formers and to examine differences in stone composition between patients with and without DM. Patients and Methods A retrospective review of 1117 patients with nephrolithiasis and a 24-h urine analysis was completed. Univariable analysis of 24-h urine profiles and multivariable linear regression models were performed, comparing patients with and without DM. A subanalysis of patients with stone analysis data available was performed, comparing the stone composition of patients with and without DM. Results Of the 1117 patients who comprised the study population, 181 (16%) had DM and 936 (84%) did not have DM at the time of urine analysis. Univariable analysis showed significantly higher total urine volume, citrate, uric acid ( UA), sodium, potassium, sulphate, oxalate, chloride, and supersaturation ( SS) of UA in individuals with DM (all P < 0.05). However, patients with DM had significantly lower SS of calcium phosphate and pH (all P < 0.05). Multivariable analysis showed that patients with DM had significantly lower urinary pH and SS of calcium phosphate, but significantly greater citrate, UA, sulphate, oxalate, chloride, SSUA, SS of calcium oxalate, and volume than patients without DM (all P < 0.05). Patients with DM had a significantly greater proportion of UA in their stones than patients without DM (50.2% vs 13.5%, P < 0.001). Conclusions DM was associated with multiple differences on 24-h urine analysis compared with those without DM, including significantly higher UA and oxalate, and lower pH. Control of urinary UA and pH, as well as limiting intake of dietary oxalate may reduce stone formation in patients with DM. [ABSTRACT FROM AUTHOR]

Objective To evaluate perspectives of urologists viewing live case demonstrations ( LCD) and taped case demonstrations ( TCD)., Method A 15-question anonymous survey was distributed to attendees of the live surgery session at the American Urological Association 2012 national meeting ( Atlanta) and the second International Challenges in Endourology meeting ( Paris)., Results Of 1000 surveys distributed, 253 were returned completed (response rate 25%). Nearly half of respondents were in the academic practice setting and nearly 75% were beyond training., Just over 30% had performed a LCD previously. The perceived benefit of an LCD was greater than unedited and edited videos (chi-squared P = 0.014 and P < 0.001, respectively). Nearly no one selected 'not helpful' and a few selected 'minimally helpful' for any of the three forms of demonstration., Most respondents identified that opportunity to ask questions (61%) and having access to the full unedited version (72%), two features inherent to LCD, improved upon the educational benefit of edited videos., Most (78%) identified LCD as ethical. However, those that did not perceived lower educational benefit from LCD ( P = 0.019)., A slim majority (58%) would allow themselves or a family member to be a patient of a LCD and the vast majority (86%) plan to transfer knowledge gained at the LCD session into their practice., Conclusions Urologists who attended these LCD sessions identified LCDs as beneficial and applicable to their practice., LCDs are preferred over videos. The large majority considers LCD ethical, although not as many would volunteer themselves for LCD., Further studies are necessary to determine if there is actual benefit from LCD over TCD to patient care. [ABSTRACT FROM AUTHOR]