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Objectives: In performing mini-percutaneous nephrolithotomy (PCNL), we aimed at achieving the trifecta of stone-free status and no complications in a single treatment session. We analyzed our experience to determine negative predictors for achieving these three-fold goals. Patients and Methods: The data of all consecutive patients who underwent tubeless mini-PCNL between July 2015 and March 2020 in two hospitals were retrospectively reviewed. Stone-free was defined as no residual stones. Complications were recorded and graded according to modified Clavien classification. Patients were divided into two groups according to the outcome (trifecta and non-trifecta). Factors affecting the outcome were compared between both groups by using univariate and multivariate analyses to detect independent unfavorable risk factors. Results: The study included 944 patients with mean age 40.2 years (standard deviation: 13.6). The stone-free rate after one session of mini-PCNL was 90.7%. Auxiliary procedures were needed in 14 patients (1.5%). Complications were observed in 76 patients (8.1%). Trifecta was achieved in 792 patients (84%). Independent unfavorable risk factors in multivariate analysis were number of caliceal groups affected by the stones (relative risks were 1.95 to 2.27 and 5.7 for one, two, and three caliceal groups respectively) and number of percutaneous tracts (relative risk was 2.2). Stone size and complexity were not significant predictors of missing trifecta in multivariate analysis. Conclusions: Mini-PCNL can achieve a high rate of trifecta (84%) for different stone sizes and complexities. Stones distribution in multiple caliceal groups and multiple tracts are the independent unfavorable risk factor.

The objective of this study was to evaluate the results of internal urethrotomy with endoscopically placed small intestinal submucosa (SIS) graft for treatment of selected cases of recurrent urethral stricture.This prospective study included 10 patients with recurrent inflammatory bulbar urethral stricture of 0.5-2 cm in length with no dense spongiofibrosis. Following the 12 o'clock visual internal urethrotomy, a prepared 12F Foley's silicon catheter with the SIS patch was introduced into the urethra over a preplaced super-stiff guidewire. The advancement of this catheter was monitored via a 15F urethroscope to enable us to put its balloon with the overlying SIS patch at the site of the urethral incision. Thereafter, the balloon was inflated with saline and the catheter was secured with a silk suture to the glans. In addition, a suprapubic cystostomy was fixed for bladder drainage. These catheters were kept in place for 2 weeks. The patients were followed up at regular intervals using uroflowmetry and ascending urethrography.At 3-month follow-up, only two cases showed mild recurrent stricture and the rest of cases had a normally patent functional urethra. The subsequent follow-up studies of all the eight successful cases for 12-18 months revealed no evidence of recurrent stricture in all of them and no more interventions were required for any of them. On the other hand, the two cases with recurrent stricture showed a satisfactory response to regular monthly urethral dilatation.Endoscopic urethroplasty using SIS patch can be considered as a minimally invasive solution for cases with recurrent, short urethral stricture that are associated with mild spongiofibrosis.

Purpose: To present the combination of laparoscopy and nephroscopy for the treatment of stones in pelvic ectopic kidneys. Patients and Methods: The series included seven male and four female patients (mean age 43 ± 9 years). Laparoscopy-assisted percutaneous nephrolithotomy (PCNL) was performed for caliceal stones in five patients after failure of shockwave lithotripsy, while laparoscopic pyelolithotomy was performed for large or branched renal pelvic stones in six patients. Results: The mean operative time was 164 ± 30 minutes. There were neither complications nor conversions to open surgery. The stone-free rate was 91% (10 patients). One patient had a residual caliceal fragment that was treated with shockwave lithotripsy. The mean hospital stay was 3.5 ± 0.7 days. Conclusion: The combination of laparoscopy and nephroscopy is feasible, safe, and effective for the treatment of stones in pelvic kidneys.

To investigate the effect of missed internal ureteral stents (IUS) on renal function and to describe different modalities of management and associated morbidity.A retrospective study included patients with missed IUS (1 year). The complications of missed IUS were categorized according to the forgotten, encrusted, calcified (FECal) grading system. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation at time of initial stent placement and time of stent removal. An age- and sex-matched group of patients who had IUS and had available follow-up for the same duration of the study group were used as a control.A total of 46 missed IUS in 46 patients were included. Complicated stents were reported in 34 (73.9%) patients. FECal grade 1 was reported in 16 (57.2%) patients followed by grade 2 and 4 in 5 (17.8%) patients each. Retrograde removal, visual cystolitholapaxy, ureteroscopy with laser disintegration of encrustations and combined retrograde and antegrade approach have been used in 21, 5, 10, and 9 patients, respectively. In the missed IUS group, the mean±standard deviation (SD) eGFR has declined from 65.5±26.3 mL/min/1.73m(2) to 54.3±30 mL/min/1.73m(2) (P=0.001). While in the control group, the mean±SD eGFR has increased from 57.5±30 mL/min/1.73 m(2) to 66.7±27 mL/min/1.73 m(2) (P=0.001).Missed IUS were associated with significant complications that necessitated more invasive intervention. In addition, IUS had a negative impact on renal function at time of removal.

To present our experience with ureteroscopy for the treatment of pediatric ureteral calculi.The records of 32 children with an average age of 8.7 years (range 2-15 years) treated with rigid ureteroscopy between June 1994 and July 2003 were reviewed. In 33 ureteral units, 8F rigid ureteroscopy was carried out 35 times to treat stone disease. Stones were located in the upper ureter in 2 cases, the middle ureter in 2 cases, and the lower ureter in 29 cases. Stone size ranged from 4 to 15 mm (mean 7 mm). Dilatation of the ureteral orifice was necessary in 10 procedures.The management of stone in 29 children (90.7%) was straightforward, and a single procedure was sufficient to clear the ureters. In 2 children (6.2%), repeat ureteroscopy was undertaken to render the ureters stone free, and in 1 child (3.1%), it was not possible to remove the stone. Stones were fragmented with pneumatic lithotripsy in 2 cases and with the holmium laser in 9; in the remaining 22 cases, the stones were removed without fragmentation. Intraoperative complications occurred in 3 children (9.3%) and consisted of extravasation (1 patient) and stone migration (2 patients). The early postoperative complications were hematuria in one patient and renal colic in another. Of the patients, 28 were followed 3 to 48 months. No stricture was detected at the site of stone impaction in any patient.In the hands of an experienced surgeon, ureteroscopy can be a safe and efficient treatment for ureteral stones in children.

To determine factors affecting patients' discomfort during the period self-retaining ureteral stents are in place.Between April 2001 and May 2003, 58 male and 42 female patients underwent temporary double-pigtail stenting. The indications were endopyelotomy in 39 patients, ureteroscopy in 32, laparoscopic pyeloplasty in 18, and endoureterotomy in 11. The stents were silicone in 56 patients and Percuflex in 44. The median stenting period was 8 weeks (range 4-16 weeks). Patient discomfort was evaluated by a questionnaire conducted by the physician before stent removal. Tested variables were patients' sex, side of the stent, urine culture, stent material, stent length and diameter, and stenting duration. The site of the upper coil (renal pelvis or calix), the site of the lower coil (in the same side or crossing the midline), and the shape of the lower coil (complete circle or not) were also tested. Univariate and multivariate analysis were carried out to determine significant independent variables, with P0.05 being significant.Of the total, 59 patients experienced discomfort consisting of dysuria, urgency, urge incontinence, loin pain, suprapubic pain, frequency, nocturia, or gross hematuria or some combination. Significant factors associated with discomfort were a positive urine culture, crossing of the lower end of the stent to the opposite side, caliceal position of the upper coil, and longer stenting duration.Proper positioning of the coils of the stent, eradication of infection, and shorter stenting duration are advised to decrease patient discomfort during the period of ureteral stenting.

It is rare for hydatid disease to be encountered primarily in the urogenital system or retroperitoneum. Moreover, prostatic involvement is extremely rare. We present a case report of prostatic hydatid cyst that was treated with laparoscopic excision. We reviewed diagnosis and management of hydatid disease of the urogenital tract.

To evaluate the various anatomic factors, using computed tomography urography (CTU), that predispose to a lower-pole kidney stone formation on one side compared with the other.The study included 51 patients with a solitary lower-pole stone. Lower-pole infundibulopelvic angle (IPA), infundibular width (IW), infundibular length (IL), caliceal volume (CV), and number of minor calices of the affected lower calyx and normal contralateral kidney were measured based on CTU. The IPA was measured according to the methods of Sampaio and Elbahnasy. A comparison was made using multivariate analysis to determine whether any of these measurements predisposed one side to form stones.The mean IPA was 80.9 degrees (Sampaio), and 52.3 degrees (Elbahnasy) on the affected kidney and 87.5 degrees (P = 0.39) and 54 degrees (P = 0.36) on the normal side. The mean IW was 2.6 mm on affected side and 3.15 mm on the normal side (P = 0.03). The mean IL was 19.7 mm and 15.3 mm (P0.001) on the affected and normal kidneys, respectively. Mean CV was 1123 mm(3) on affected side and 286 mm(3) on the normal side (P0.001). The mean number of minor calices was comparable (n = 3) on both sides with no statistical significance. Using multivariate analysis, only caliceal volume and IW sustained their significance in the final model.CTU is a very useful imaging modality in the diagnosis of intrarenal anatomic variation. Larger caliceal volume and narrower IW are associated with stone formation in lower calyx.

Liver injury during percutaneous nephrolithotomy (PCNL) is very rare and is usually overlooked. In this report, we present a case of inadvertent liver injury during right supracostal PCNL and describe diagnostic tools, conservative management measures, and outcome. A literature review of potential risk factors and suggested techniques to avoid injuring the liver during PCNL is also presented.

To determine the predictors of the clinical outcome of residual fragments after extracorporeal shockwave lithotripsy (SWL).During the last 10 years, residual fragmentsor =5 mm were present in 99 male and 55 female patients (mean age 43.1 years) for3 months after SWL for renal stones. Follow-up with history, urine examination, and non-contrast CT scanning was carried out every 6 months or when symptoms developed. Clinically insignificant residual fragments were diagnosed in patients who became stone free or had asymptomatic fragments of the same size during follow-up. A clinically significant outcome was considered to have occurred in patients requiring secondary intervention for regrowth of the fragments or medical treatment for frequent symptomatic episodes. Univariate (Kaplan-Meier) and multivariate (Cox-regression) analyses were performed to determine significant predictors of the outcome. The mean follow-up was 31 months (range 6-80 months).Stone-free status, regrowth of fragments, and persistence of fragments of the same size were present in 21 (13.6%), 52 (33.8%), and 81 (52.6%) patients, respectively. A clinically significant outcome was documented in 75 patients (48.7%) as percutaneous nephrolithotomy was needed in 2, repeat SWL in 50, and medical treatment for symptomatic episodes in 23 patients. Significant independent predictors of a clinically significant outcome were fragment sizeor =4 mm and history of recurrent stone disease (P0.001).The term "clinically insignificant residual fragments" is not appropriate for all patients with post-SWL fragments, as 48.7% of patients had fragments that became clinically significant. Fragments of 4 to 5 mm and recurrent stone disease predicted clinical significance.

To evaluate the surgical feasibility of laparoscopic adrenalectomy and what laparoscopy offers for the surgeon and the patient.From March 1996 to June 2004, 43 transperitoneal laparoscopic adrenalectomies were performed for various pathological states. Functioning adrenal masses and solid masses5 cm were the most common indications. The mean size of the masses on abdominal CT was 6.8 cm in the largest diameter. All patients were assessed regarding the operative time, blood loss, complications, and conversion to open surgery. The postoperative course was reported with special attention to the complications and hospital stay.The mean operative time was 125 minutes with a mean blood loss of 60 mL. Intraoperative complications occurred in 3 cases (6.9%), necessitating conversion to open surgery in 2 to control bleeding from the avulsed right adrenal vein. A third case of conversion was elective because of difficult dissection of a large left pheochromocytoma from the renal hilum, so there was a 6.9% rate of conversion to open surgery. All patients showed early ambulation, early start of eating, and a short hospital stay (mean 2.6 days).Laparoscopic adrenalectomy is surgically feasible and can be applied for different adrenal pathologies. The procedure can be performed with a reasonable operative time, minimal blood loss, and an acceptable rate of complications. Laparoscopic adrenalectomy provides excellent postoperative recovery and convalescence with a short hospital stay.