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Management of urolithiasis in an ectopic pelvic kidney is challenging and laparoscopic pyelolithotomy and laparoscopy-guided percutaneous nephrolithotomy (PCNL) are commonly favored options. We report a case of ultrasound-guided supine mini-PCNL in ectopic pelvic kidney in an adolescent female. Complete stone clearance was achieved with an uneventful postoperative period. Ultrasound-guided supine mini-PCNL is safe and effective treatment option for the management of calculus in the ectopic pelvic kidney. The risk of injury to surrounding structures associated with ultrasound modality of access can be avoided with proper case selection and careful technique.
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Introduction: Technological advancements have made it possible to attempt retrograde intrarenal surgery (RIRS) in patients with large renal calculi. The objective of this study was to compare the intraoperative adverse events, postoperative complications and stone free rates (SFR) of RIRS in patients with renal calculi of varying sizes. Methods: Patients who underwent RIRS for renal calculi between January 2016 and June 2020 were categorized into six size groups according to the longest dimension or cumulative measurement of the longest dimension of calculi as follows: Group 1 (1-9 mm), Group 2 (10-19 mm), Group 3 (20-29 mm), Group 4 (30-39 mm), Group 5 (40-49 mm) and Group 6 (≥50 mm). All the patients were followed up for a period of 6 months post treatment completion and the outcomes of interest were computed and compared. Results: Two hundred and ten patients were included in the analysis. Intraoperative adverse events were noted in 9.5%, 8%, 16.9%, 9.1%, 6.7% and 28.6% of the patients in groups 1-6, respectively (P = 0.453). The postoperative complications were noted in 4.8%, 5.3%, 6.8%, 15.2%, 26.7% and 42.9% of patients in groups 1-6, respectively (P = 0.024). The final SFRs were 95.2%, 100%, 96.6%, 90.9%, 86.7% and 71.4% in groups 1-6, respectively (P = 0.012). Conclusions: RIRS is an effective treatment option for the management of renal stones, including those larger than 20 mm in size. We noted a size dependent increase in the postoperative complications and a reduction in the SFRs. The majority of the postoperative complications were low grade and no stone related events occurred in the patients who were managed conservatively for residual stones after surgery, on the short term follow up.
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Patients with ureteral defects and salvageable renal units present a challenge in reconstructive urology. Vermiform appendix interposition is an option in the management of mid-ureteral defects that can not be managed by primary ureteroureterostomy. Laparoscopic appendicular interposition ureteroplasty is a technically demanding and an infrequently attempted procedure. We present a video demonstration of laparoscopic appendicular interposition for a 4-cm long right mid-ureteral defect in an elderly male. Laparoscopic appendicular interposition ureteroplasty for mid-ureteral defects can provide good long-term functional outcomes with results comparable to an open approach and has the advantage of reduced morbidity.
RESUMEN
INTRODUCTION: Whole-body bone scintigraphy (WBBS) is considered to be the standard of care in the initial skeletal evaluation of patients with carcinoma prostate. Magnetic resonance imaging (MRI) is a potential alternative technique for detecting bone metastasis. The objective of this study was to compare the diagnostic performance of WBBS with a single-photon emission computed tomography-computed tomography (SPECT-CT) correlation of the suspicious WBBS lesions to the axial skeleton (AS)-MRI in diagnosing bone metastasis in patients with carcinoma prostate. METHODS: WBBS and AS-MRI were both performed during the initial skeletal evaluation in 35 patients of carcinoma prostate with the prostate-specific antigen (PSA) in the range of 10-50 ng/ml. Suspicious lesions on the WBBS were correlated on SPECT CT. The presence or absence of metastasis was determined by best valuable comparator. The validity parameters of WBBS and AS-MRI were computed and compared. RESULTS: The sensitivity, specificity, positive predictive value, and negative predictive value of WBBS and AS-MRI for detecting patients with bone metastasis were 55.6%, 88.5%, 62.5%, 85.2% and 100.0%, 96.2%, 90.0%, 100%, respectively. The kappa value and the accuracy of WBBS were 0.457 and 80.0%, respectively. The kappa value and accuracy of AS-MRI were 0.928 and 97.1%, respectively. CONCLUSIONS: The diagnostic performance of AS-MRI in detecting patients with bone metastasis due to carcinoma prostate is superior to that of WBBS with SPECT-CT correlation of the suspicious lesions in the PSA range of 10-50 ng/ml.