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INTRODUCTION: We aimed to evaluate the effectiveness and safety of the newly launched thulium fiber laser (TFL) with holmium laser lithotripsy in the miniaturized percutaneous nephrolithotomy (Miniperc) procedure for renal stones. METHODS: The prospective study included patients with renal stones of size >1 cm to ≤3 cm. The patients who opted for extracorporeal shock wave lithotripsy, retrograde intrarenal surgeries, and stones >3 cm were excluded from the study. Demographics such as patient's age, sex, stone volume, and hardness were evaluated. The patients were randomized into holmium and TFL group for stone lithotripsy. Both the procedures were evaluated for stone disintegration time, operative time, hospital stay, intra- and postoperative complications, and stone-free rate. RESULTS: A total of 125 patients with renal stones who underwent Miniperc were included in this study. The average size of the stone was comparable in both the groups (P = 0.053). The median stone disintegration time with holmium laser was 20 min 45 s and with TFL, it was 11 min 19 s (P < 0.001). The most common complications were Clavien grade I and II complications (P = 0.128). Prolonged postoperative hematuria was observed in the Thulium fiber laser group, which was conservatively managed. The stone-free rate with TFL (94.9%) was better than Holmium lithotripsy (90.9%). CONCLUSIONS: The TFL has significant less stone disintegration time which effectively reduced the operative time of Miniperc procedure. The stone-free rate is better, but the incidence of self-limiting hematuria is higher with TFL as compared to Holmium laser.
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OBJECTIVE: The objective of this study was to compare mini-percutaneous nephrolithotomy (PCNL) performed by standard and Miniperc techniques in pediatric patients. MATERIALS AND METHODS: This was a retrospective study conducted at our institution between January 2012 and December 2017. The outcomes of pediatric renal stones treated by mini-PCNL done by Miniperc and standard techniques were compared in terms of the drop in the hemoglobin, stone-free rate, and analgesic requirement in the first 24 h. RESULTS: A total of 57 children (age: 1-16 years), who underwent mini-PCNL by Miniperc equipment (n = 23) and standard equipment (n = 34), were included in this study. The postoperative mean drop in hemoglobin was significantly higher in mini-PCNL done by standard compared to the Miniperc technique. The stone-free rate was 95.65% in the Miniperc group and 94.12% in the standard mini-PCNL group. The need for analgesics was significantly lower in the Miniperc group compared to the standard mini-PCNL group (P = 0.0002). In the Miniperc group, the majority of the patients required only one dose of analgesics, whereas, in the standard mini-PCNL group, around 44% of the patients required three or more than three doses of analgesics to reduce postoperative pain. CONCLUSION: Both the techniques were safe and efficacious in the management of pediatric renal stone and stone clearance. However, the Miniperc technique resulted in significantly less pain and a lower dosage of analgesics.
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Malacoplakia is an inflammatory lesion which can affect any organ in the body but predominantly affects the genitourinary system and mainly the bladder. Malacoplakia of the bladder has variable presentations and is associated with urinary infection or immunosuppression. Mullerianosis of the bladder is a rare lesion that consists of two out of the three tissues, endometriosis, endocervicosis, or endosalpingiosis. It is usually associated with a previous cesarean section or pelvic surgery. The diagnosis is confirmed on histopathological examination. Malacoplakia and mullerianosis are usually isolated lesions of the bladder. We present a unique case of coexistence of malacoplakia and mullerianosis in the urinary bladder, reported for the first time in the literature.