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PURPOSE: To evaluate available options for the management of nephrolithiasis in patients with autosomal dominant polycystic kidney disease (ADPKD). MATERIALS AND METHODS: Case files of all the patients with ADPKD treated in our hospital in the last 18 years were evaluated. Their demographic details, clinical presentations, investigations, treatments, and outcomes were critically analyzed. RESULTS: There were a total of 19 patients (23 renal units) with nephrolithiasis among 452 consecutive cases of ADPKD. Male-to-female ratio was 3.75:1. The mean age of the patients was 43.3 years (range 23 to 60 years). The most common presentations were pain and hematuria (27.7% each). Mean serum creatinine was 7.2 mg/ dl (range 0.8-18.1 mg/dl) at presentation. The mean stone size was 115 mm(2) (range 36 to 980 mm(2)). The majority of the stones were calyceal (n = 10). Ten renal units (nine patients) required intervention, while the rest were treated conservatively. Treatment offered included open nephrectomy for non-functioning infected kidney (n = 1), extracorporeal shock wave lithotripsy (ESWL, n = 3), ureterorenoscopy (URS, n = 3), and percutaneous nephrolithotomy (PCNL, n = 3). All patients undergoing URS and PCNL had complete clearance, while those undergoing ESWL had a residual stone. Two failed ESWL patients required an auxiliary procedure (retrograde intrarenal surgery, RIRS) and the other was kept under observation. Mean follow-up after treatment was 4.2 years (one month to six years). None of the patients had major complications. CONCLUSION: Careful selection of the endourological procedure can give good results in patients of ADPKD with nephrolithiasis.
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Spontaneous subcapsular renal hematoma is not a common entity. We report a 38-year-old lady presenting with sudden onset right flank pain with uncontrolled hypertension and she was found to have subcapsular collection in the right kidney on ultrasonography. Finding was confirmed on computed tomography. Except hypertension, no particular cause for the condition could be found. Symptoms and size of the collection decreased on conservative treatment. They completely disappeared on ultrasonography at 6 months follow-up. She was asymptomatic at 18 months follow-up.
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Hem-o-loc clips have been used for vascular control in laparoscopic surgery. We describe a case presenting with lower urinary tract symptoms after laparoscopic radical prostatectomy. Evaluation revealed migrated hem-o-loc clips causing obstruction and symptoms in bladder neck region. Clip removal with endoscopy relieved the symptoms. Diagnosis warrants high index of suspicion as clips are radiolucent and other more common differential diagnosis like bladder neck contracture may have similar presentation. For the prevention, loose clips should be actively searched for and retrieved from abdomen and clip application near proposed anastomotic site should be avoided.
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OBJECTIVES: To present our experience with 13 patients undergoing laparoendoscopic single-site live donor nephrectomy. METHODS: The Quadport/Triport (Advanced Surgical Concepts, Ireland) was inserted through an incision in the umbilicus. Apart from standard laparoscopic instruments, we used extra-long harmonic scalpel, suction, and bent instruments, particularly for upper pole dissection. After securing the hilum, the graft was brought near the umbilical extraction site with a grasper inserted through an extra 3- or 5-mm port and easily retrieved with the help of 2 fingers. The parameters analyzed were warm ischemia time, operative time, blood loss, postoperative visual analogue score, grafts retrieval time, and artery, vein, and ureteral length. RESULTS: Mean body mass index was 22.18 +/- 3.42 kg/m(2) (range 17.9-29.78). The mean operative time, blood loss, warm ischemia time, and hospital stay were 176.9 +/- 42.47 minutes, 158 +/- 78 mL, 6.79 +/- 1.7 minutes, and 3 +/- 0.45 days (range 2-5), respectively. Graft artery, vein, and ureteral length was 3.8 +/- 0.4, 4 +/- 0.12, and 14.5 cm (range 13-16), respectively. The urine output was prompt in all cases. Visual analogue score in the donor at 2 weeks was 0/10 in all cases. Eleven patients required extra 3- or 5-mm port. Cosmesis was excellent, with the mean incision length of 5.23 +/- 0.96 cm. CONCLUSIONS: The laparoendoscopic single-site donor nephrectomy in our initial experience is efficacious and a feasible, minimally invasive option for donors in renal transplantation. Further prospective studies with conventional laparoscopic donor nephrectomy are required to establish its current status.