Pediatric Percutaneous Nephrolithotomy-Experience of a Tertiary Care Center.

OBJECTIVE: To present the experience of pediatric percutaneous nephrolithotomy (PCNL) of our center. MATERIALS AND METHODS: This study was conducted from 1995 to 2015, on patients <15 years of age having renal and upper ureteral stones who underwent PCNL. Stones were classified as per Guy's stone score (GSS). Standard bull's eye technique was used for subcostal puncture. To avoid supracostal puncture, puncture was done in full inspiration or by oblique tract. If these maneuvers failed, then supracostal puncture was done. Tract was dilated to 24F. RESULTS: Six hundred sixty PCNLs were performed on 639 patients. Puncture was subcostal in 87.6% cases with tract dilated as much as 24F. Pelvicaliceal system was most commonly accessed through middle calix (73.94%). Upper caliceal puncture (23.78%) was more frequently used in complete (82.35%) and partial staghorn (51%) stones. Two tracts were made in 16 (2.42%) cases, because of large stone burden. Average operative time was significantly longer in complex (45.43 minutes) compared to simple stones (29.39 minutes). Overall success rate was 94.39%, but it was significantly lower in partial (91.37%) and complete staghorn stones (82.35%). Complications were present in 21.66% cases and were classified according to Clavien grading. Majority of patients (97.9%) had minor complications (Clavien grade 1 & 2). On multivariate analysis, GSS ≥2, stone size >200 mm2, and multiple caliceal, partial, and complete staghorn stones were predictors of failure and complications. CONCLUSION: PCNL is a minimally invasive surgical technique for removal of renal and upper ureteral stones, which have low morbidity rate, high success rate, and short hospital stay. Although the uses of smaller instruments are on the rise, procedure can still be safely performed in children using adult instruments. Supracostal approach if done cautiously does not increase morbidity rate.

Long-term Functional, Urodynamic, and Metabolic Outcome of a Modified Orthotopic Neobladder Created With a Short Ileal Segment: Our 5-year Experience.

OBJECTIVE: To assess the long-term functional, urodynamic, and metabolic outcomes of our modified neobladder. MATERIALS AND METHODS: In this prospective study from January 2010 to October 2014, 42 consecutive male patients with bladder tumor underwent radical cystectomy and orthotopic urinary diversion with modified ileal neobladder using 25 cm ileal segment. During follow-up, functional outcome, urodynamic studies, metabolic parameters, and renal parameters were assessed at regular intervals. Complications were graded as early (<3 months) or late (>3 months). RESULTS: There were no perioperative deaths. At a mean follow-up of 27.2 months, good or satisfactory daytime and nighttime continence were achieved in 100% and 93.8% of patients, respectively. Mean maximal bladder capacity was 588 mL at 3 years. Mean resting pressure and voiding pressures were 20.1 cm H2O and 34.6 cm H2O at 3 years, respectively. Good bladder compliance was achieved in all patients by 1 year. Mean maximum urine flow rate (Qmax) was 18.5 mL at 3 years. Postvoid residual volume was insignificant in all the patients and none of the patients were on clean intermittent self-catheterization. None of the patients developed severe metabolic acidosis. Vitamin B12 levels were within normal range in all patients. Early complications were seen in 12 patients (28.6%), whereas late complications were observed in 5 patients (12%). CONCLUSION: Our results demonstrate that our modified technique of using a short ileal segment to create a near-spherical, compliant, low-pressure reservoir provides an acceptable, safe, and functional alternative to the standard Hautmann neobladder.

Sigmoid orthotopic neobladder after radical cystectomy for bladder tumour: an Indian experience.

OBJECTIVE: To determine the long-term results of constructing a sigmoid neobladder after radical cystectomy for transitional cell carcinoma (TCC) of the urinary bladder. PATIENTS AND METHODS: The study included 170 patients with TCC of the bladder and a normal sigmoid colon. After radical cystectomy the neobladder was formed by completely detubularizing an isolated sigmoid colon segment. Subsequently patients were followed by clinical, biochemical, radiological and urodynamic assessments. RESULTS: Four patients died soon after surgery; the neobladder-related delayed complications were death in three patients, loss of five renal units, and electrolyte imbalance in five patients. Uretero-intestinal anastomotic narrowing was another frequent delayed complication. Most (97%) patients had nocturnal incontinence, and most voided with a good stream with a minimal postvoid residual urine volume. CONCLUSION: The sigmoid neobladder, despite some limitations, is the best option for diverting urine after radical cystectomy.