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Background Double-J stents are favorably utilized after pyeloplasty. In rare situations, the stent may migrate upward. Here, we demonstrate the implementation and result of a supine percutaneous nephroscopic surgery (PNS) to retrieve a proximately migrated ureteral catheter in a pediatric patient. Patient and Methods A 1-year-old boy was suffering from an upward migration of a ureteric catheter into the right ureter after an open Anderson-Hynes pyeloplasty. The child was placed in the Galdakao-modified supine Valdivia (GMSV) position and a PNS procedure was performed. The calyceal access was carefully punctured by ultrasonographic guidance. The nephrostomy tract was dilated with a metal dilator using a one-step technique. An exploratory nephroscopy of the renal pelvis was conducted with a 12Fr miniature nephroscope and the migrated ureteral catheter was removed. A hybrid guidewire was retrogradely inserted into the ureteric orifice using a rigid ureteroscope. An antegrade double J stent was inserted in the proper position and a percutaneous nephrostomy was performed. Results and Conclusion This is the first report of a successfully removed upwardly migrated ureteral catheter with concurrent insertion of an antegrade double J stent by supine PNS in the GMSV position in an infant. The patient recovered well after surgery with no adverse event, demonstrating that this operation can be carried out safely on pediatric patients.

Chinnakhet Ketsuwan, Charoen Leenanupunth, Yada Phengsalae, Premsant Sangkum, Wisoot Kongchareonsombat, Nongnart Kaewjai, Phanida Timjapoe Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, ThailandCorrespondence: Phanida Timjapoe Tel +66-2-2011536Fax +66-2-2794704Email phanida.timj@gmail.comBackground: Extracorporeal shock wave lithotripsy (ESWL) is the only non-invasive treatment for urolithiasis; however, it can cause anxiety and pain for patients. Several new nonpharmacological adjuvant approaches have been developed to reduce adverse events.Objective: To analyze the efficacy of watching movies during ESWL to relieve anxiety and pain.Methods: A total of 84 patients were randomly divided into two groups. The experimental group consisted of 42 patients who watched their own selected movies during the ESWL session, while the control group included 42 patients who did not watch movies. Basic characteristics, hemodynamic parameters, State-Trait Anxiety Inventory, Visual Analog Scale for pain, willingness to repeat the procedure, and patient satisfaction rates were collected and analyzed.Results: After watching movies during ESWL, patients had a significantly lower anxiety level (p = 0.001) and a higher satisfaction rate (p = 0.021). No statistically significant differences were found in terms of demographic data, hemodynamic parameters, pain scores, or willingness to repeat the procedure.Conclusion: Watching self-selected movies during an ESWL can effectively reduce anxiety and improve satisfaction.Keywords: extracorporeal shock wave lithotripsy, movie, anxiety

Background Percutaneous nephrolithotomy (PCNL) is accepted as the gold standard of care for the treatment of large renal calculi. Kidney hemorrhage, which requires blood transfusion, is one of the most common complications after percutaneous kidney stone surgery. Objective To evaluate perioperative factors associated with transfusion requirements during PCNL. Materials and methods A total of 226 patients with kidney calculi undergoing PCNL between January 2011 and December 2019 were reviewed retrospectively. We analyzed the impact of perioperative clinical factors on the necessity of blood transfusion during PCNL. Results The overall blood transfusion rate was 9.29%. Multiple perioperative determinants were significantly correlated with the application of packed red blood cells (PRCs), including larger stone size (p = 0.006), multiple tract punctures (p = 0.029), presence of staghorn calculi (p = 0.026), and long operative time (OT; p = 0.017). Multivariate analysis demonstrated that only multiple tract punctures independently affected blood transfusion requirements during PCNL (p = 0.038). Conclusion In accordance with the present study, only the multiple tract punctures were associated with blood transfusion requirements in PCNL.

Noppavut Sirirak, Premsant Sangkum, Yada Phengsalae, Wisoot Kongchareonsombat, Charoen Leenanupunth, Wattanachai Ratanapornsompong, Chinnakhet Ketsuwan Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, ThailandCorrespondence: Chinnakhet Ketsuwan Tel +66-2-2011536Fax +66-2-2794704Email chinnakhet.ket@mahidol.ac.thBackground: The Size, Topography, Obstruction, Number, and Evaluation of Hounsfield units (S.T.O.N.E.) scoring system has been proposed as a novel prognostic surgical classification for urolithiasis in predicting success rate and complications.Objective: We carried out an externally validated S.T.O.N.E. score on rigid ureteroscopic lithotripsy (rURS).Materials and Methods: The data of patients who had undergone rURS between 2012 and 2019 at a tertiary referral center were audited retrospectively. The S.T.O.N.E. score was calculated based on factors determined through preoperative computed tomography images and was analyzed in association with stone-free rate (SFR), operating time, surgical complications, and length of stay (LOS).Results: A total of 155 patients were included in the study with a median stone size of 10 mm (7– 12) and a median S.T.O.N.E. score of 9 (8– 10). The overall SFR was 89.68%. SFRs were 100.0%, 97.83%, and 77.42% in low (5), moderate (6– 9), and high (10– 13) score groups, respectively. The S.T.O.N.E. score (p = 0.002) and stone size (p = 0.037) were predictive factors for SFR in multivariate analysis. Moreover, there was a significant correlation between the S.T.O.N.E. score and operative time, LOS, and presence of complications (r = 0.22, p = 0.006; r = 0.30, p < 0.001; and r = 0.27, p < 0.001, respectively). The area under the curve of the receiving operator characteristics’ curve for the S.T.O.N.E. score was 0.815.Conclusion: The S.T.O.N.E. scoring system is simple and effective in predicting postoperative outcomes; therefore, this score would be a valuable tool in clinical planning for every patient who undergoes rURS.Keywords: ureteroscopy, S.T.O.N.E. score, stone-free rate