Pawan K. Kesarwani

Upper pole access for complex lower pole renal calculi

Authors from New Delhi assessed the efficacy of superior pole access for complex lower pole calyceal calculi; they found this to be the best way of approaching such complex stones, allowing faster and better clearance with a single puncture.

Tubeless Percutaneous Nephrolithotomy

Introduction: To assess the efficacy, safety and morbidity of tubeless percutaneous nephrolithotomy. Materials and Methods: One hundred and fifty-two patients with renal and upper ureteric calculi were included in this study. Sixty-nine patients (71 renal units; group 1) in whom no nephrostomy tube was placed at the conclusion of the procedure was compared with a similar control group of 83 patients (group 2) in whom a nephrostomy tube was placed. Operating time, blood loss, analgesia requirement, puncture site urinary leakage, hospital stay and mean convalescence period were compared in both groups. Results: Both groups were similar with respect to age, sex distribution and stone size. Operating time and blood loss were less in group 1 although they did not reach statistical significance. The mean analgesic requirement, puncture site urinary leakage and hospital stay were significantly less in group 1. Conclusion: Tubeless percutaneous nephrolithotomy is a safe and effective procedure in this selected group of patients.

Hemostasis in Tubeless PNL: Point of Technique

Introduction: Tubeless PNL (percutaneous nephrolithotomy), in a highly selected group of patients, is a modification aimed at reducing the morbidity of PNL. We present a simple technique of achieving tract hemostasis as an adjunct to the safe performance of a tubeless PNL. Materials and Methods: Charts of 40 consecutive patients who underwent tubeless PNL at our center were reviewed. In the latter 20 consecutive patients, diathermy coagulation of the intrarenal bleeders and tract was done and these patients were compared with the earlier 20 patients in whom fulguration was not done. Drop in hemoglobin, postoperative analgesic requirement, operating time, length of hospitalization and postoperative complications were compared. Results: No statistical difference was found between the operative times and drop in hemoglobin for both the groups. The length of hospitalization and postoperative analgesic requirement were significantly less in the fulguration group. No significant complications were noted in either of the two groups. Conclusions: Fulguration of visible intrarenal and tract bleeders is a simple, safe and effective hemostatic adjunct in patients undergoing tubeless PNL.

Spontaneous perirenal hematoma during coronary angiography.

We report a case of spontaneous perirenalhematoma that developed acutely during anelective coronary angiography in a 65-year-oldman with suspected coronary artery disease,probably related to the use of heparin duringangiography. The patient did not have anysystemic vasculitides and was not receivingantiplatelet or anticoagulant agents prior tothe angiography. Serial follow-up highresolution CT scans with 2 mm cuts in the renalareas showed resolution of the hematoma but nounderlying mass lesion or any otherabnormality.

Chronic renal infarct simulating renal mass: Diagnostic challenge

A 36-year-old male presented with symptomatic left renal mass simulating renal cell carcinoma. He underwent left radical nephrectomy and histopathology revealed chronic renal infarct with calcifications. The case description warrants the inclusion of focal chronic renal infarcts in the differential diagnosis of renal masses, especially following history of previous trauma.

An unusual complication of urethral stent.

A 62-year-old man with recurrent urethralstricture and an indwelling urethral stent presented to us with symptoms of difficultvoiding. Retrograde urethrogram confirmed narrowing of the lumen of the urethra and avisual internal urethrotomy was done. However, during the urethrotomy, dense fibrosisaround the stent was encountered making the incision difficult and leading tobreakage of the blade of the urethrotome.

Vesicocervical fistula: an unusual complication of vesicovaginal fistula repair

A rare case of vesicocervical fistula following repair of a vesicovaginal fistula is presented. The patient complained of cyclical menouria since the first repair done 15 years ago and gradually worsening urinary incontinence. A laparoscopic assisted repair of the fistula was performed and the patient is fully continent at 12-months follow up.