Amit Bhattu

Sterilization of endoscopic instruments.

Purpose of review Sterilization of endoscopic instruments is an important but often ignored topic. The purpose of this article is to review the current literature on the sterilization of endoscopic instruments and elaborate on the appropriate sterilization practices. Recent finding Autoclaving is an economic and excellent method of sterilizing the instruments that are not heat sensitive. Heat sensitive instruments may get damaged with hot sterilization methods. Several new endoscopic instruments such as flexible ureteroscopes, chip on tip endoscopes, are added in urologists armamentarium. Many of these instruments are heat sensitive and hence alternative efficacious methods of sterilization are necessary. Although ethylene oxide and hydrogen peroxide are excellent methods of sterilization, they have some drawbacks. Gamma irradiation is mainly for disposable items. Various chemical agents are widely used even though they achieve high-level disinfection rather than sterilization. This article reviews various methods of endoscopic instrument sterilization with their advantages and drawbacks. Summary If appropriate sterilization methods are adopted, then it not only will protect patients from procedure-related infections but prevent hypersensitive allergic reactions. It will also protect instruments from damage and increase its longevity.

Evolution of shockwave lithotripsy (SWL) technique: a 25-year single centre experience of >5000 patients.

To assess the impact of various treatment optimisation strategies in shockwave lithotripsy (SWL) used at a single centre over the last 25 years.

Ultrasound-guided antegrade access during laparoscopic pyeloplasty in infants less than one year of age: A point of technique

BACKGROUND: Access to urethras and ureters of infants may be hazardous and injurious through an endoscopic route. Placement and removal of stents in infants requires anaesthesia and access through these small caliber urethras. We describe our technique of placing antegrade splint during a laparoscopic pyeloplasty in these infants. MATERIALS AND METHODS: An ultrasound-guided percutaneous renal access is obtained. Telescopic metal two part needle is passed into the kidney over a guide wire. A second guide wire is passed through the telescopic metal two part needle. The tract is dilated with 14 Fr screw dilator. Over one guide wire, a 5 Fr ureteric catheter is passed and coiled in the renal pelvis. Over the other wire, a 14 Fr malecot catheter is placed as nephrostomy. Laparoscopic pyeloplasty is then done. During pyelotomy, the ureteric catheter is pulled and advanced through the ureter before the pyeloplasty is completed. The ureteric catheter thus acts as a splint across the anastomosis. Ureteric catheter is removed on the 3rd post operative day and nephrostomy is clamped. Nephrostomy is removed on 4th post operative day if child is asymptomatic. The modified technique was successfully done in five patients aged less than one year old. All patients tolerated the procedure well. Post operative period was uneventful in all. CONCLUSION: Ultrasound-guided ante grade nephroureteral ureteral splint for infant laparoscopic pyeloplasty is safe. It avoids the need for urethral instrumentation for insertion and removal of stents in these small patients.

Robotic Donor Nephrectomy

Unlike any other surgery the living donor nephrectomy is a surgery in person who is actually not a patient. Considering the principle of “Primum non nocere” (First do no harm) the responsibility of donor surgeon is highest as it is surgery in person who is not a patient. With this philosophy, the donor surgery evolved from open to laparoscopy and later further modified into robotic assisted laparoscopic living donor nephrectomy (RDN). Robotic platform results in better morbidity profiles for donors than standard laparoscopic approach. It also had advantage in hilar dissection and preservation of longer renal graft artery length in right donor nephrectomy. The graft outcomes of RDN are comparable to LDN. The future development of dedicated robotic single port surgical platforms and instruments as well as multiport approach with transvaginal graft retrieval will be the future direction of development.

Difficult Situations in Percutaneous Nephrolithotomy (PCNL) for Solitary Kidney and Renal Failure

The management of stones in patients with chronic kidney disease requires coordination between the treating nephrologists, the urologist, and the anesthetist.

Xanthogranulomatous pyelonephritis (XGPN) mimicking a "renal cell carcinoma with renal vein thrombus and paracaval lymphadenopathy".

We present a case of Xanthogranulomatous pyelonephritis mimicking as a renal cell carcinoma. This was an elderly lady who presented with pyonephrosis due to urolithiasis. On evaluation she was found to have a space occupying mass in the right kidney. Further investigations revealed an enhancing tumor with renal vein thrombus and paracaval lymphadenopathy. Subsequent histopathology showed evidence of XGPN with no malignancy. This case report highlights the fact there are a number of imaging and clinical overlaps in the diagnosis, assessment and management of this entity.