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Background: Double j (jj) routinely inserted cystoscopically in retrograde manner in managing various causes of ureteric obstruction. sometimes we face situations at which the jj failed to be inserted in such conventional route or carrying high degree of difficulty. antegrade jj can be successful alternative modality in managing such failures/ difficulties.Aim of the work: Evaluate the antegrade ureteric stenting as an alternative to the retrograde ureteric stenting in the difficult cases of ureteric obstruction and to evaluate the predictors of success/failure of this procedurePatients & Methods: Prospective non-blinded interventional study that is conducted from the department of urology faculty of medicine Ain Shams University, Cairo, Egypt, between 2016 till 2020. included 78 patients with different causes of ureteric obstruction in two groups; group(I) included 28 patients with ureteric obstruction who had failed retrograde ureteric stenting; for them antegrade jj stenting were tried & group (II) included 50 cases of ureteric obstruction with high probability of difficulty or failure of retrograde stenting for them retrograde jj stenting tried first in 34 cases & if failed retrograde stenting were tried, while antegrade stenting tried directly in 16 patients due to high patients vulnerability.Results: In patients of group(I) antegrade stenting succeeded in 26 (92.86) patients & failed in 2 (7.14) patients.in group (II) retrograde trial succeeded in (7) cases & antegrade tried in (43) cases (27 cases after retrograde trial failure & 16 cases tried from the start), antegrade stenting succeeded in 39 (90.7%) cases & failed in 4(9.3%) cases. dye study e.g flow of dye to bladder showed statistically significant predictor of success/failure in both groups. most prevalent complications were hematuria in group(I) in (57 %) of the studied cases(hemoglobin drop didn’t exceed 1 gm /dl & hematuria subsided with genera measures) while in group (II) no complications occurred in (44%) of cases. nephrostomy tube needed in(21%) of cases in group (I) & needed in (38%) of cases in group(II)Conclusion: Antegrade ureteric stenting is successful alternative in cases of failure of conventional retrograde stenting & show high success rate in cases of high probability of difficulties.

Hydroureteronephrosis (HUN) of the renal transplant (RT) can be obstructive or non-obstructive, refluxing or non-refluxing, and can cause allograft dysfunction. HUN of the RT as a manifestation of rejection is uncommon and has not been described in children. We describe two pediatric RT recipients who presented with late-onset HUN, 5 and 10 years after transplantation. Both had new-onset HUN which occurred at the time of rejection; HUN resolved in both patients after treatment of rejection. Renal function stabilized in both patients without the need for stent or nephrostomy tube placement. There was no obstruction or vesicoureteral reflux (VUR). Edema of the uroepithelial cells leading to transient obstruction causing HUN is a most likely explanation. We conclude that treatment of rejection in patients without obstruction or VUR may lead to resolution of HUN without the need for urological interventions.

Background To retrospectively assess the experience of day-surgery semi tubeless ultra-mini percutaneous nephrolithotomy (UMP) for the treatment of kidney stones by experienced surgeons. Methods Clinical data of 358 patients with kidney stones (254 males and 104 females; mean age: 59.60±11.70) who were performed UMP surgery in Shanghai Jiao Tong University School of Medicine affiliated Renji Hospital from June 2015 to December 2018. Patient demographics, operative data, complications, and readmission rates were recorded. Day-surgery UMP was defined as discharge of patients either the same day or within 24 h after surgery. Semi tubeless UMP was defined as no placement of DJ and nephrostomy tube after surgery. Results The average size of stones was 14.56±6.24 mm (range, 4-30 mm). There are solitary stones in 192 cases, multiple stones in 142 cases and 29 cases with Staghorn stones. F13 outer sheath was used for all operations; 358 patients completed UMP on the day of admission; 326 (91.06%) patients achieved same-day discharge or received overnight observation prior to discharge, and 32 patients (8.94%) required full admission (longer than 24 h). The readmission rate was 0.56% (2 patients). The postoperative complications within 1 week occurred in 36 (10.06%) patients, including 23, 10, 3 of grades I, II, IIIa complications (Clavien-System). The average operation time was 29.64 min and the hemoglobin drop were 13.42±9.55 g/L. The stone clearance rate was 91.62% (328/358). The semi tubeless rate war 95.25% (341/358). Conclusions For day-surgery semi tubeless UMP, experienced surgeons gain excellent patient outcomes in appropriately selected patients. Day-surgery semi tubeless UMP is worth promoting.

Myiasis is caused by the presence of dipterous larvae in humans and animals. It is usually associated with poor hygienic conditions. A urologist rarely comes across myiasis. We report a case of myiasis around a recently placed nephrostomy tube. A 55-year-old male farmer from a rural area underwent right percutaneous nephrolithotomy. The procedure was terminated because of bradycardia and arrhythmia. There were residual calculi. A nephrostomy was kept. His relook nephroscopy was planned, but he was not willing. Hence, he was discharged with an indwelling nephrostomy tube. Two weeks later, he presented with severe pain around the right nephrostomy tube with surrounding pruritus. The wound hygiene was poor. He was found to have maggots around the nephrostomy tube. These were treated by local instillation of turpentine oil and oral and topical ivermectin, followed by manual removal of the maggots.

Introduction: Percutaneous Nephrolithotripsy (PCNL) is one of the most accepted surgical modality for removal of renal stone. Placement of a nephrostomy tube at the end of PCNL is a standard procedure for PCNL, however many reports have showed the safety and efficacy of tubeless PCNL for the removal of renal stone. Aims: The present study aimed to report the outcomes of PCNL with or without nephrostomy tube. Methods: It is Prospective Hospital Study conducted from June 2017 to April 2020 in the Department of Urology Nepalgunj Medical College. Total 153 patients under inclusion criteria were divided into two groups. Group 1 (75 patients) was allocated to patients who were being treated under standard PCNL procedure while Group 2 (78 patients) was allocated for patients who were being treated under Tubeless PCNL procedure. The two groups were compared for operation time (minutes), hospital stay (days), post operative dose of analgesic (mg), post operative complications such as, leakage (%), bleeding (%) and infection (%). Data were analyzed from SPSS and p-value less than 0.5 was considered as significant. Results: In Group II the mean hospital stay, analgesic dose and rate of leakage was significantly lesser than Group I (p0.05). Conclusion: Tubeless PCNL procedure causes more rapid recovery and earlier discharge from the hospital, reduction in postoperative pain and no leakage when compared to standard tubless PCNL.

Background: Ureteral stricture disease is a troubling urologic issue that can be managed with surgical reconstruction or, more conservatively, with chronic nephrostomy tubes or ureteral stents. These indwelling tubes require exchanges and are prone to complications such as encrustation or stent failure. Metallic ureteral stents are designed to be more resistant to extrinsic compression and allow for exchanges at longer intervals. However, encrustation or tissue ingrowth can occur with these stents as well. The removal of encrusted or embedded metallic ureteral stents poses a difficult clinical scenario. We present a case of an encrusted metallic stent embedded in a proximal ureteral stricture requiring percutaneous endoscopic removal with a novel looped-wire technique. Case Presentation: A 50-year-old Caucasian man with bilateral ureteral stricture disease, managed with chronic indwelling metallic stents, failed retrograde removal on the right during routine exchange. Staged procedures with percutaneous nephrostomy, followed by combined percutaneous antegrade and retrograde endoscopy were required to observe and access the embedded stent. The exposed metallic surface was unable to be grasped by available instruments through flexible endoscopy. Under endoscopic control with fluoroscopic guidance, a polytetrafluoroethylene (PTFE)-coated guidewire was looped around the metallic stent. With gentle traction on the wire loop, the embedded stent curl was delivered out of the stricture and into the renal pelvis from where it was extracted carefully with graspers inserted through a rigid nephroscope. Follow-up antegrade fluoroscopic studies with contrast showed no extravasation. Conclusion: Percutaneous removal of metallic stents retained within the ureter has unique challenges. We present a novel method of extraction of a retained metallic stent with a looped PTFE-coated guidewire, which may safely and effectively be used in complex situations.

Ways to increase the effectiveness of nephrostomy tube sanitation for preventing undesirable effects of external drainage (in particular, encrustation) were studied. A method for invasive ultrasound treatment was proposed. A technique for sanitation of ureteral stents was also developed. Ultrasound treatment of an ureteral stent was shown to be an effective and safe way of reducing salt obstruction. It can be recommended for use as a part of treatment aimed at preventing obstructive pyelonephritis.

Objective To ascertain the safety and efficacy of percutaneous nephrolithomy in patients with previous open renal surgery. Study design Descriptive study. Place and duration of study The Kidney Centre Postgraduate Training Institute, Karachi from January to December 2018. Methodology Patients with previous open renal surgery underwent percutaneous nephrolithomy during study period (Group A). Equal number of percutaneous nephrolithomy patients without previous open surgery taken as controls (Group B). Safety was defined in terms of 'blood loss' as change in hemoglobin (HB) level and 'blood transfusion,' while efficacy was defined in terms of 'stone clearance' and were compared between both the groups. Results There were a total of 87 patients. Both groups had comparative gender ratio [p = 0.858]. Mean age [p = 0.132] and BMI [p = 0.879] of patients in both groups was not significantly different from each other. Both groups showed no statistically significant difference in terms of values of stone size [p = 0.186], stone laterality [p = 0.437] stone location [p = 0.949], preoperative Hb [p = 0.095], postoperative Hb [p = 0.423] and change in Hb (indicating blood loss, p = 0.398). Puncture levels were significantly different among both groups (supracostal puncture in 18 and 36 patients; infracostal puncture in 63 and 51 patients in groups A and B, respectively, p = 0.006), while operative time [p = 0.787], calyx punctured [p = 0.051], double puncture [p = 0.787], nephrostomy tube [p = 0.288] were statistically not different among groups. Similar number of patients demonstrated residual stones [p = 0.773], along with residual stone sizes [Group A (0.5; 0.5) and Group B (0.65; 0.38)] [p = 0.445]. Intra- and postoperative complications like blood transfusion [p = 0.700] and fever [p = 1.000] along with hospital stay [p = 0.614] were comparable among groups. Conclusion Percutaneous nephrolithomy is safe and effective in previously operated kidneys despite the possibility of calyceal anatomy distortion and scarring. Key Words: Percutaneous nephrolithotomy, Open surgery, Kidney calculi.

Background Injury of the renal collecting system is a well-known complication of percutaneous nephrolithotomy (PNL). Large injuries may cause excessive bleeding and fluid extravasation and require adequate drainage using several modalities such placement of JJ stents. Herein, we report on two cases in which the upper coil of the JJ stent got buried in the fibrous tissues which formed due to an injury of the collecting system during PNL. Case presentation 40 years old male and 32 years old female underwent standard PNL for partial and total staghorn calculi, respectively. During the procedure in both cases, the renal pelvis was injured. In both cases, JJ stent was used to drain the collecting system. Trial to remove the JJ stent 6 weeks following the procedure failed because the upper coils of the stents were embedded in the fibrous tissues at the perforation site. Laser incision of the fibrous tissues and releasing the upper coil of the stents were performed using percutaneous approach in the first case and flexible ureterorenoscopy (fURS) in the second patient. The procedures were uneventful in both cases. Conclusion This is the first report of embedded JJ stents which got buried by fibrous tissues at the site of collecting system injury that occurred during PNL. To prevent this complication in such cases, we suggest draining the collecting system using nephrostomy tube instead of JJ stent. Alternatively, the upper coil of the stent should be placed away from the injury site.

Background and ObjectiveTo investigate the safety, efficacy, and feasibility of performing mini PCN (MIP-M Karl Storz) as a day case procedure. We report our experience and outcomes from our case series which to our knowledge is the first reported in the UK. Material and MethodsTen patients appropriate for mini PCN and day-case surgery were selected prospectively. All 10 patients underwent a mini PCN procedure in a prone position. Access was achieved by the operating surgeon under fluoroscopic guidance in 9 cases and by a consultant uroradiologist under ultrasound guidance in 1 patient with a ureterosigmoidostomy using a Kellet needle and the MIP-M system (Karl Storz, Germany). Stones were fragmented with a 550um laser fibre and retrieved by both the Vortex effect and a grasper. Drainage was achieved with a 6 Fr antegrade stent in 9 cases and a 10 Fr nephrostomy tube in one patient. Stone related outcomes, duration of surgery, length of stay and complications were recorded. ResultsAll cases were completed as planned. The mean operating time was 93 minutes. A day case rate of 80% was achieved. Two patients were admitted overnight for social reasons; one lived on a nearby island and was not ready for discharge in time to catch the last ferry and another no longer had a responsible adult at home to monitor him overnight. All patients were deemed radiologically stone free. No readmissions, transfusion, infections or other complications were recorded at 90 days postoperatively. ConclusionWe have shown that day-case mini PCN is a feasible and safe procedure in selected patients. A larger number of cases are needed to establish our patient selection criteria and corroborate our early outcomes.

Introduction: Ambulatory percutaneous nephrolithotomy (PCNL) has been limited to highly selected patients. The objective of our study was to compare complication and stone-free rates after ambulatory PCNL in standard selection criteria vs. extended criteria patients. Methods: We conducted a retrospective review of prospective data on all patients who underwent ambulatory PCNL at one academic center from 2007–2018. Extended criteria patients were defined as one or more of: age >75 years, body mass index (BMI) >30 kg/m2, American Society of Anesthesiologists (ASA) >2, bilateral stones, solitary kidney, transplant kidney, complete staghorn calculi, stone burden >40 mm, multiple tracts, or prior nephrostomy tubes/stents. Primary outcomes were complication rates (Clavien-Dindo classification) and stone-free rates. Results: We identified 118 patients, of which 92 (78%) met extended criteria. Mean BMI was 31 kg/m2 and 45% were ASA 3 or higher. Mean sum maximum stone diameter was 24 mm. Multiple stones were present in 25%, bilateral stones in 7%, and complete staghorn stones in 4% of patients. There was no difference in complication (12% vs. 18%, p=0.56), emergency department visit (12% vs. 18%, p=0.56), or re-admission (4% vs. 5%, p=1) rates between standard and extended criteria patients respectively. Of the complications, 85% were Clavien-Dindo grade 1. Stone-free rates were not different between standard (84%) and extended (83%) criteria patients (p=1). No extended criteria variables were associated with complications in multivariable analysis. Conclusions: Complication and stone-free rates were not different between standard and extended selection criteria patients undergoing ambulatory PCNL. This data indicates that many of the preoperative patient and stone factors that have previously been used as exclusion criteria for ambulatory PCNL are not strictly necessary.

Background Percutaneous Nephrolithotomy (PCNL) is the preferred technique for treating large renal stones (over 2cm in diameter). It involves keyhole surgery performed through a small skin incision overlying the kidney. Objectives Our study aimed at evaluating the safety and efficacy of local hemostatic sealant (surgiflo®) use in tubeless PCNL to enhance postoperative outcomes of PCNL. Patients and Methods We randomized our patients into two groups, Group A nephrostomy tube was used as standard PCNL, and at group B tubeless PCNL was done followed by injection of the local hemostatic flowable gelatin matrix (surgiflo®) under fluoroscopic guidance in the prone position Results There was no statistically significant difference between two groups regarding demographic data age, sex and BMI (P- value 0.280, 0.736 and 0.440 respectively), stone site and size (P- value 0.525 and 0.533 respectively), operative time (P- value 0.855), intraoperative complications as blood loss and pelvicalyceal perforation, (P- value 0.92 and P- value 0.83 respectively), postoperative complication as fever, haematuria and UTI (P- value 1.000, 0,113 and 1.000 respectivly), and Hb drop (P- value 0.735). Conclusion Tubeless PCNL with hemostatic sealant use is associated with less pain, no leakage from nephrostomy tract, less narcotic agent use, and a shorter hospital stay.

INTRODUCTION AND OBJECTIVE:Sepsis secondary to obstructive uropathy is a Urological emergency associated with significant mortality and morbidity. Urgent decompression using retrograde placement of...

BACKGROUND: The tubeless percutaneous nephrolithotomy (PCNL) was proposed to eliminate the side effects of the nephrostomy tube in recent years, such as pain, channel infection, postoperative bleeding, and longer hospital stay. But there is neither clinical guidelines nor consensus about tubeless PCNL in clinical practice. The study is aimed to how to implement the tubeless PCNL step by step, including case selection preoperatively, improving the technique of the surgeon, making the correct decisions at the end of the procedure, which had not been previously examined. METHODS: From January 2017 to March 2018, 364 consecutive patients requiring PCNL were comprehensively analyzed preoperatively and patients were selected for scheduled tubeless PCNL based on four aspects. The selected patients were divided into two groups according to whether the nephrostomy tube was finally placed. The mean operative time, intraoperative blood loss, stone clearance rate, visual pain score, postoperative hospitalization days and perioperative complications were all evaluated. RESULTS: Based on the preoperative evaluation, 42 patients were selected for tubeless PCNL, among which there were finally 37 cases of completed tubeless PCNL. Compared with patients undergoing conventional PCNL, there were not statistical differences in the mean operative time (P=0.207) or intraoperative blood loss (P=0.450) in the tubeless group. Stone clearance rate was 100% in both groups. The visual pain scores in the tubeless PCNL group were lower on operation day (P=0.029), first postoperative day (P

Staghorn calculi comprise a unique subset of complex kidney stone disease. Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for staghorn stones. Despite continuous refinements to the technique and instrumentation of PCNL, these stones remain a troublesome challenge for endourologists and are associated with a higher rate of perioperative complications than that for non-staghorn stones. Common and notable intraoperative complications include bleeding, renal collecting system injury, injury of visceral organs, pulmonary complications, thromboembolic complications, extrarenal stone migration, and misplacement of the nephrostomy tube. Postoperative complications include infection and urosepsis, bleeding, persistent nephrocutaneous urine leakage, infundibular stenosis, and death. In this review, we report recommendations regarding troubleshooting measures that can be used to identify and characterize these complications. Additionally, we include information regarding management strategies for complications associated with PCNL for staghorn calculi. Keywords: Percutaneous nephrolithotomy, Staghorn, Complications, Management, Urolithiasis

Backgrounds/aims Operation room (OR) time is of great value affecting surgical outcome, complications and the daily surgical program with financial implications. Methods We retrospectively evaluated 570 consecutive patients submitted to ureteroscopy or ureterorenoscopy for the treatment of ureteral or renal stones. Demographic parameters, patient's stones characteristics, type of ureteroscope, surgeon experience and surgical theater characteristics were analyzed. OR time was calculated from the initiation of anesthesia to patient extubation. Multivariate analysis was conducted using a linear regression test with multiple parameters to identify predictors of OR time. Results Eight factors were identified as significant. These include total stones volume, ureteroscope used, stone number, nurses experience, radio-opacity of the stone on kidney-ureter-bladder X-ray, main surgeon experience, operating room type, and having a nephrostomy tube prior to surgery. Conclusions The surgical team experience and familiarity with endourological procedure, and the surgical room characteristics has a crucial impact on OR time and effectiveness.

We report two cases of complicated Urinary Tract Infection, one with nephrostomy tube left in-situ and other with bladder outlet obstruction, caused by Trichosporon loubieri. Both patients responded well to antifungal treatment along with change/removal of catheters. In both the cases, correct identification of T. loubieri was done by IGS1 sequencing. Prompt identification and timely management headed to good clinical outcome. Hence, clinicians should be aware of T. loubieri as an emerging fungi causing human infections. Keywords: Trichosporon loubieri, Urinary tract infection, Nephrostomy tube, Bladder outlet obstruction, IGS1 sequencing

Objectives: To compare the outcomes of Percutaneous Nephrolithotomy (PCNL) with or without nephrostomy tube. Materials & Methods: This prospective comparative study intended to compare the outcomes between PCNL without nephrostomy tube and PCNL with nephrostomy tube. A total of 50 cases of renal stone disease planned for PCNL in Dhaka Medical College Hospital from July 2015 to June 2017, were included in this study according to the statistical calculation. Cases were randomly allocated to group A (PCNL without nephrostomy tube) and group B (PCNL with nephrostomy tube). Each group consisted of 25 patients. The outcome variables were post operative pain, requirement of analgesic, leakage of urine and post operative hospital stay. Data were analyzed and compared by statistical tests. Results: No significant differences were found regarding age (p = 0.95), sex (p = 0.55) and operation time (p = 0.36) between two groups. Post operative pain (p < 0.0007) and analgesic requirement (p < 0.0001) were less in group A than group B cases. Leakage of urine is higher in group B in comparison to group A (p < 0.0001). Post operative hospital stay is shorter in group A than group B cases which is statistically significant (p < 0.0001). Conclusions: Percutaneous nephrolithotomy without nephrostomy tube is better than percutaneous nephrolithotomy with nephrostomy tube in selective cases. It significantly reduces post operativepain, analgesic requirement and postoperative hospital stay. So percutaneous nephrolithotomy without nephrostomy tube is safe and effective.

BACKGROUND: Percutaneous nephrolithotomy (PCNL) is the primary method for the treatment of renal calculi. The preservation of the nephrostomy tube after operation brings severe pain to the patients. We use a 1,470 nm semiconductor laser to stop bleeding after the operation, which cannot reserve the nephrostomy tube, fully reflect its safety and effectiveness, and provide a new method for clinical practice. METHODS: Forty-two patients with renal stones who came to our hospital from March 2016 to September 2019 were randomly divided into two groups: laser operation group (20 patients) and traditional operation group (22 patients). The stone removal rate, surgical effect, and postoperative complications were compared between the two groups. RESULTS: There was no significant difference in the stone clearance rate between the two groups at the 4th week after operation (P>0.05). However, the incidence of postoperative infection, incision pain, and massive bleeding in the laser surgery group were lower than those in the traditional surgery group (P0.05). The average postoperative hospital stay in the laser surgery group was shorter than that in the traditional surgery group, and the difference was statistically significant (P0.05). CONCLUSIONS: The 1,470 nm laser is safe, effective, and feasible in PCNL operation, especially in hemostasis of the renal puncture channel, and it is worth popularizing.

Acinetobacter junii is one of more than 50 different species belonging to the genus Acinetobacter. This bacterium is rarely reported to cause human infections. Here we described a rare case of Acinetobacter junii, which grew in urine culture approximately one month after the patient was discharged from the hospital with antibiotics for a urinary tract infection, which caused left obstructing renal calculi requiring nephrostomy tube placement., Highlights • Acinetobacter is often considered to be ubiquitous in nature. • Acinetobacter junii is rarely reported to cause human infections. • A rare case of Acinetobacter junii, which grew in urine culture, was described.

INTRODUCTION AND OBJECTIVE:There is an obvious distinction between countries regarding nephrostomy tube (NT) after percutaneous nephrolithotomy (PNL). Large-bore NT PNL (LB-PNL) seems to provide he...

INTRODUCTION AND OBJECTIVE:Renal access in percutaneous nephrolithotomy may be obtained via a pre-existing nephrostomy tube (NT) tract; however, emergently placed NTs are not always ideal for subse...

BackgroundGiant hydronephrosis is rare with a controversy about the complete loss of renal functions. Our objective is to present our center’s experience with the management of cases of clinically visible giant hydronephrosis considering the potential residual functions. Our study is a retrospective case series of clinically visible giant hydronephrosis which was managed during the period July 2001–June 2016. Demographic and clinical variables were studied with specific considerations to the potential residual functions.ResultsOf more than 82,000 urological interventions, only 47 cases (0.057%) were operated upon for clinically visible giant hydronephrosis. Group 1 included 21 patients (mean age = 50.43 ± 13.71 years) who were treated initially by nephrostomy tube, and group 2 included 26 patients (mean age = 42.96 ± 15.16 years) who were treated primarily by nephrectomy. The main clinical presentation was abdominal distention (61.7%), while 13 patients (27.7%) were unaware of the swellings. The commonest underlying causes of hydronephrosis were urolithiasis (68.1%) and bilharzial ureteral strictures (23.4%). The contralateral kidney was diseased in 22 cases (46.8%) including the bilateral clinically visible hydronephrosis in 7 cases (15%). Indications of placement of a nephrostomy tube included uremia, infections, and evaluation of renal functions, where 5 cases of group 1 regained significant split function ranged 14–33%.ConclusionsClinically visible giant hydronephrosis is an extreme form of renal dilatation with different etiologies such as urolithiasis and bilharziasis. Initial placement of a nephrostomy tube may save significant residual functions in these kidneys.

Introduction & Objectives: Despite indications of international guidelines the use of antimicrobical prophylaxis (AMP) for routine nephrostomy catheter replacement is still quite common. So far in studies sustaining guidelines' indications, data about incidence of ineffective complications after nephrostomy replacement are poor. Aim of the study is to determine the frequency of febrile ineffective complications after office nephrostomy tube replacement in patients that did not receive AMP. Materials & Methods: We prospectively enrolled all patients that underwent routine office nephrostomy tube replacement between July 2018 and September 2019 in our tertiary referral center. Each procedure was evaluated as an independent event. Clinical, microbiological and demographic data were collected. All patients that received AMP were excluded. 15-days after the nephrostomy tube replacement all patients received a phone interview aimed to investigate presence of fever, assumption of antimicrobial therapies and hospital admissions. Univariate and multivariate binomial logistic regression analysis was performed to assess the risk of infectious disease presented with temperature, flank pain and or hematuria that needed antibiotics administration. Results: In the study period 145 routine nephrostomy tube replacements were performed. Before 19 procedures patients received AMP, these cases were excluded from the analysis. Mean patients’ age was 78 (56-92). Charlson comorbidity index (CCI) score was ≤2 in 23,8% of patients, 3-4 in 23% and ≥5 in 53,2%. Mean glomerular filtration rate (CDK–EPI) was 36.8 ml/min (s.d. 18.6). In 34 cases urine culture was positive but no patients received AMP. After 17 (13.49%) procedures patients reported temperature. In this subgroup 7 patients received antibiotic therapy while in 10 cases fever resolved spontaneously. 3 patients needed hospitalization, 2 for nephrostomy malfunction and 1 for temperature with elevations of inflammatory markers. At multivariate analysis only CCI score ≥5 showed to be significantly associated (p=0.03) with the risk of ineffective complications needing antibiotics administration. Conclusions: Episodes of fever after nephrostomy tube replacement could occur after about 10% of procedures. In our series of elderly patients with high burden of comorbities only 7 patients received an antibiotic therapy because of temperature or suspected ineffective complications related to the nephrostomy tube replacement, only one first aid readmission for ineffective complications was reported. Our prospective series strongly suggest that AMP can be safely omitted before routine office nephrostomy tube replacement.

INTRODUCTION AND OBJECTIVE: Despite indications of international guidelines the use of antimicrobical prophylaxis (AMP) for routine nephrostomy catheter replacement is still quite common. So far in studies sustaining guidelines' indications, data about incidence of infective complications after nephrostomy replacement are poor. Aim of the study is to determine the frequency of febrile infective complications after office nephrostomy tube replacement in patients that did not receive AMP. METHODS: We prospectively enrolled all patients that underwent routine office nephrostomy tube replacement between July 2018 and September 2019 in our tertiary referral center. Each procedure was evaluated as an independent event. Clinical, microbiological and demographic data were collected. All patients that received AMP were excluded. 15-days after the nephrostomy tube replacement all patients received a phone interview aimed to investigate presence of fever, assumption of antimicrobial therapies and hospital admissions. Univariate and multivariate binomial logistic regression analysis was performed to assess the risk of infectious disease presented with temperature, flank pain and or hematuria that needed antibiotics administration. RESULTS: In the study period 145 routine nephrostomy tube replacements were performed. Before 19 procedures patients received AMP, these cases were excluded from the analysis. Mean patients’ age was 78 (56-92). Charlson comorbidity index (CCI) score was ≤2 in 23,8% of patients, 3-4 in 23% and ≥5 in 53,2%. Mean glomerular filtration rate (CDK–EPI) was 36.8 ml/min (s.d. 18.6). In 34 cases urine culture was positive but no patients received AMP. After 17 (13.49%) procedures patients reported temperature. In this subgroup 7 patients received antibiotic therapy while in 10 cases fever resolved spontaneously. 3 patients needed hospitalization, 2 for nephrostomy malfunction and 1 for temperature with elevations of inflammatory markers. At multivariate analysis only CCI score ≥5 showed to be significantly associated (p=0.03) with the risk of infective complications needing antibiotics administration. CONCLUSIONS: Episodes of fever after nephrostomy tube replacement could occur after about 10% of procedures. In our series of elderly patients with high burden of comorbities only 7 patients received an antibiotic therapy because of temperature or suspected infective complications related to the nephrostomy tube replacement, only one first aid readmission for infective complications was reported. Our prospective series strongly suggest that AMP can be safely omitted before routine office nephrostomy tube replacement.

Objective: To determine possible risk factors for accidental nephrostomy tube dislodgement and compare two different tube types in this context in patients with chronic catheters. Materials and Methods: We conducted a retrospective study of long-term patients with nephrostomy tube. We performed a comparative analysis, studying the possible variables that were related to catheter dislodgement. In addition, a subanalysis was also carried out comparing different catheter designs (Pigtail and Foley) in case this could be related to the dislodgement. Results: Two hundred five cases were collected. A total of 51.2% of cases had a pigtail nephrostomy and 48.8% Foley type, and accidental dislodgement occurred in 26.3% of cases. In multivariate analysis, we observed that first time nephrostomy tube placement entailed higher risk of accidental dislodgement than successive placements (odds ratio [OR] 1.95, confidence interval [CI] 1.01-3.74, p = 0.04). In the pigtail-type catheter patient subgroup, tubes placed by a resident were more prone to accidental dislodgement than those placed by an attending physician (OR 3.39, CI 1.29-8.91, p = 0.01), while first episode cases were more likely to have become dislodged than in a subsequent event (OR 3.17, CI 1.17-8.57, p = 0.02). In addition, the mean (in days) until nephrostomy tube dislodgement in cases where this occurred was 20.32 +/- 3.52 for pigtail and 60.92 +/- 5.15 for Foley (p < 0.01 in Kaplan-Meier's test). Conclusion: Nephrostomy tube displacement in long-term patients is a common problem. Some factors associated with the catheter could increase the risk of involuntary displacement, such as being a first event or being inserted by less experienced resident doctors. In addition, pigtail type nephrostomies tend toward accidental dislodgement earlier than Foley ones.

We report a case of a broken re-entry Malecot nephrostomy tube inserted after an uneventful percutaneous nephrolithotomy (PCNL) procedure. The remained parts within the renal pelvis and around the kidney were removed using a percutaneous approach under general anesthesia using the PCNL access tract. Although this complication did not cause severe morbidity, it converted a successful uneventful PCNL procedure to a grade IIIB complicated one according to the modified Clavien classification system. This complication should be held in mind and a percutaneous approach should be considered before attempting an open surgery.

Introduction Percutaneous nephrolithotomy procedure is generally used to treat stones resistant to other treatment modalities. Colonic perforation even though rare, is a serious complication that increases patient's morbidity. This case report describes the case of a patient with retrorenal colon who underwent percutaneous nephrolithotomy for management of pelvis/lower calyceal staghorn stone. Case presentation A 63-year-old female patient presented for the management of a staghorn pelvis-lower calyceal stone. The patient had a preoperative computed tomography scan of the abdomen and pelvis that showed an incidental finding of left retrorenal colon. Under computed tomography scan guidance, a nephrostomy tube was successfully placed by an interventional radiologist, and then she underwent percutaneous nephrolithotomy. Conclusion This case report aims to stress on the importance of doing a computed tomography scan whenever a prior abdominal surgery is performed. We strongly believe that gastrointestinal injuries could be avoided by using computed tomography guided access in high risk patients.