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Caliceal diverticulum management has been performed using various modalities, including ureteroscopy, percutaneous treatment, and laparoscopy. We present our experience with laparoscopic management of caliceal diverticulum in two patients with large caliceal diverticulum and a history of failed open surgery because of the incorrect diagnosis of a simple renal cyst. In laparoscopy, both patients had an uneventful intraoperative and postoperative course. On follow-up, both of them were symptom free without any evidence of diverticulum in imaging. We reviewed the literature and found that laparoscopic management of caliceal diverticulum has been reported in 37 adult patients other than our cases. We performed a pooling analysis and discussed different aspects of the approach.

We read with great interest the paper by York and colleagues [1] entitled "Randomized controlled trial comparing three different modalities of lithotrites for intracorporeal lithotripsy in PCNL". This study showed that the safety and efficacy of Cyberwand, Lithoclast Select, and the StoneBreaker lithotripters are similar and comparable. They stated that "the clearance rate of “hard” stones (defined as brushite, cystine, and uric acid stones) was comparable across the 3 groups). We would like to point out that this statement is one side of the coin. It is possible that the clearance rate of "soft” stones was different. This paper did not perform analysis between "soft" stone compositions. Previous studies with higher sample size showed that stone composition is an important factor that affect stone clearance rate of different types of lithotripters [2]. Furthermore, we want to make a minor criticism of this study: the low sample size of this study may be responsible for this non-significant finding.

Laparoscopic partial nephrectomy is a demanding procedure. To popularize the procedure, simplifying the technique is of great concern for most laparoscopic urologists. Our objective was to evaluate the results of laparoscopic partial nephrectomy (LPN) when eliminating bolster in repair of the tumor bed.Thirty-three patients with single sporadic renal masses who underwent LPN are included in this study. After tumor excision, both parenchymal tissue and collecting system (if violated) were closed with a single row of polyglactin 2/0 stitches in running fashion. No bolster was applied in the renal defect, even in broad tumor beds. To avoid time-consuming knot tying, the sutures were buttressed by the use of Hem-o-Lok clips. No ureteral stenting was performed after repair. Data on perioperative and early postoperative outcomes were collected prospectively.Mean tumor size was 4.06 +/- 1.13 cm (range 1.80-6 cm), with 15 tumors larger than 4 cm in greatest diameter. Blood loss was minimal. Mean ischemia time was 25.8 +/- 6.9 minutes (range 14-39 min). Urine leakage occurred in one (3.0%) patient and was managed conservatively. Three (9.0%) patients received blood transfusion. All of the procedures were completed laparoscopically without the need for open conversion or postoperative surgical intervention.LPN could be accomplished safely without the use of bolster. Such an approach could help simplify the procedure and consequently popularize it among urologists.

To evaluate meperidine-sparing effect of intravenous (IV) paracetamol in patients undergoing percutaneous nephrolithotomy (PCNL).One hundred patients who underwent PCNL were randomized to paracetamol (n=50) and placebo (n=50) groups. Patients received 100 mL of physiologic saline with or without 1 g IV paracetamol every 8 hours after PCNL up to 24 hours in the paracetamol and placebo groups, respectively. Patients in both groups received intramuscular meperidine in case of unrelieved pain. The visual analog scale (VAS) was used to evaluate pain intensity scores in the postoperative period. Total meperidine consumption, mean VAS score in the first 6 and 24 hours, demographic variables, operative variables, and side effects were recorded.The mean VAS pain intensity scores at 6 and 24 hours were 50.22 and 41.32 mm in the paracetamol and 75.29 or 65.5 mm in the placebo group (P0.001). The mean consumed meperidine dose was 54.40 mg and 77.60 mg in the paracetamol and placebo groups, respectively (P0.001).In this study, IV paracetamol significantly reduced total meperidine consumption and pain intensity scores compared with placebo. IV paracetamol can be an effective and safe part of multimodal analgesia regimes for postoperative pain management after PCNL.

The objective of this study was to describe our experience with laparoscopic simultaneous bilateral dismembered pyeloplasty in two pediatric cases by using three midline ports.A 5-year-old boy and a 5-month-old male infant with bilateral ureteropelvic junction obstruction underwent bilateral laparoscopic transperitoneal dismembered pyeloplasty. A 10-mm trocar was placed through the umbilicus, and two 5-mm trocars were also placed in the midline superior and inferior to the umbilicus. On the left side, dismembered pyeloplasty was performed through a transmesocolic approach. Double-J ureteral stent was inserted through one of the trocars on both sides.The postoperative period was uneventful. Patients were discharged on postoperative days 4 and 5. Oral feeding was tolerated on the first postoperative day. In a 6-month follow-up period, excretory urography and renal scan showed resolution of obstruction.Laparoscopic dismembered pyeloplasty can be performed in a single session for pediatric patients with bilateral ureteropelvic junction obstruction. This can obviate the need for two sessions of anesthesia induction and intubation. However, more studies with large number of patients are needed to confirm this result.