Manish B. Bansal

Peri-operative complications of holmium laser enucleation of the prostate: experience in the first 280 patients, and a review of literature

To evaluate, in a prospective study, the complications in 280 patients undergoing holmium laser enucleation of the prostate (HoLEP) at our institution, and to review previous reports to determine the overall incidence and types of various complications, and analyse their causes and means of prevention.

Tubeless percutaneous nephrolithotomy: a prospective feasibility study and review of previous reports

To evaluate the status of tubeless percutaneous nephrolithotomy (PCNL) in managing renal and upper ureteric calculi, from initial experience and a review of previous reports.

Influence of prostate size on the outcome of holmium laser enucleation of the prostate

To analyse the effect of prostate size on the outcome of holmium laser enucleation of prostate (HoLEP, an established procedure for treating symptomatic benign prostatic hypertrophy, BPH), in the initial 354 patients at 1 year of follow‐up.

Tubeless percutaneous nephrolithotomy: 3 years of experience with 454 patients

To present our experience with 454 patients who had tubeless percutaneous nephrolithotomy (TPCNL) over last 3 years.

A Randomized Trial Evaluating Type of Nephrostomy Drainage after Percutaneous Nephrolithotomy: Small Bore v Tubeless

PURPOSE To compare the outcome of tubeless percutaneous nephrolithotomy (PCNL) with small-bore nephrostomy drainage after PCNL. PATIENTS AND METHODS We tested the hypothesis that tubeless PCNL is superior to small-bore nephrostomy drainage after PCNL in terms of postoperative pain, analgesic requirement, and hospital stay. To show a 10% difference in these parameters, a sample size of 30 persons per group would be needed. All patients undergoing PCNL from September 2005 to May 2006 were included in the study. Patients meeting the inclusion and exclusion criteria were then randomized to either a tubeless approach with insertion of a ureteral stent or placement of an 8F nephrostomy tube without insertion of a ureteral stent. The perioperative outcomes of patients in the two groups were compared. RESULTS Tubeless PCNL was performed in 33 patients, and an 8F nephrostomy tube was placed in 32 patients. The two groups had comparable demographic data. The hemoglobin drop and complication rate between the two groups were comparable. Patients undergoing tubeless PCNL experienced less postoperative pain (P = 0.001), needed less analgesia (P = 0.006), and were discharged 9 hours earlier than patients in the other group. Complete stone clearance was achieved in 87.87% patients in the tubeless group and 87.5% patients in the nephrostomy group. In the tubeless group, 39.4% of patients had bothersome stent-related symptoms, of whom 61.5% needed analgesics and/or antispasmodic agents. CONCLUSIONS Tubeless PCNL offers the potential advantages of decreased postoperative pain, analgesic requirement, and hospital stay without increasing the complications. It was associated with stent-related discomfort in 39% of patients.

Evaluation of fluid absorption during holmium laser enucleation of prostate by breath ethanol technique

PURPOSE In a prospective manner we studied various factors affecting fluid absorption during HoLEP. We also simultaneously evaluated changes in serum electrolytes and hemoglobin decrease during HoLEP. MATERIALS AND METHODS This prospective study comprised of 53 patients who underwent HoLEP at our institute. Irrigation fluid was normal saline tagged with ethanol (1% w/v). Intraoperatively a standard breath analyzer was used to monitor expired breath ethanol levels during the procedure at 10-minute intervals. Patients who absorbed irrigating fluid as indicated by positive intraoperative breath tests were considered absorbers. Serum electrolyte and hemoglobin estimations were done before and after surgery. Total irrigation time, amount of irrigation fluid used, weight of resected tissue and presence of capsular perforation were recorded. Statistical analysis was performed to observe the effects of various factors on the amount of intraoperative fluid absorption. RESULTS Of 53 patients studied 14 (26.41%) demonstrated fluid absorption in the range of 213 to 930 ml (mean 459). Preoperative prostate weight, total irrigation time, amount of irrigation fluid used and resected tissue weight were all significantly greater in absorbers. Similarly, absorbers had a statistically significant decrease in hemoglobin level postoperatively. There was no statistically significant change in serum electrolytes between absorbers and nonabsorbers. CONCLUSIONS Preoperative weight of prostate, total irrigation time, amount of irrigation fluid used and weight of resected tissue all directly influence the amount of fluid absorption during HoLEP. There is no significant change in serum electrolytes and no risk of the transurethral resection syndrome.

Simultaneous transurethral cystolithotripsy with holmium laser enucleation of the prostate : a prospective feasibility study and review of literature

To report experience with holmium laser enucleation of the prostate (HoLEP) simultaneously with transurethral holmium laser cystolithotripsy (HLC) for managing bladder outlet obstruction (BOO) and associated vesical calculi; we also review previously reported cases of managing vesical calculi and associated BOO.

Knotted upper end : a new complication in the use of an indwelling ureteral stent

Use of the indwelling ureteral stent is a key factor in the management of stone disease by extracorporeal shock wave lithotripsy. We report on a knotted stent in a patient with a solitary kidney, which had to be removed percutaneously. This case demonstrates that the ureteral stent is not free of serious complications.

The management of renal matrix calculi : a single-centre experience over 5 years

To define incidence of renal matrix calculi in patients undergoing percutaneous nephrolithotomy (PCNL), and describe its clinical, laboratory and radiological features; we also studied the efficacy of PCNL in managing this rare entity.

Tubeless Percutaneous Nephrolithotomy in Patients with Previous Ipsilateral Open Renal Surgery : A Feasibility Study with Review of Literature

PURPOSE To present our initial experience of tubeless percutaneous nephrolithotomy (PCNL) in patients with previous ipsilateral open renal surgery. PATIENTS AND METHODS Twenty-five patients with previous ipsilateral open renal surgery underwent tubeless PCNL at our institute. Patients with large renal and/or upper ureteral calculi, irrespective of the number and size of the stones, amount of hydronephrosis, or the renal parameters, were selected for the procedure. Exclusion criteria were patients needing more than two percutaneous tracts, significant bleeding, and a significant residual stone burden that would necessitate a staged PCNL. The perioperative outcome of these patients (study group) was retrospectively compared with an historic cohort of the same number of patients with a history of open surgery for renal calculi who underwent ipsilateral PCNL with routine placement of a nephrostomy tube (control group). RESULTS The two groups had comparable demographic data. Patients in the study group needed less postoperative analgesia (P = 0.000). They were discharged a mean of 10 hours earlier (P = 0.000). Two patients in both groups required blood transfusion. No urinoma or urinary leak from the nephrostomy site occurred in the study group. The incidence of other postoperative complications was comparable in both groups. Complete stone clearance was achieved in 88% of patients in the study group and 84% patients in the control group. CONCLUSION The tubeless approach in patients with a history of open renal surgery is associated with decreased analgesia requirement and hospital stay without compromising stone-free rates or increasing the complications.