DJ Stent Research Articles

Scoring System to Personalize Management of Emphysematous Pyelonephritis.

Emphysematous pyelonephritis (EPN) is a life-threatening condition that requires prompt diagnosis and treatment. The prognosis of EPN is variable, and there is no single treatment that is universally effective. In this study, we developed a scoring system to predict the prognosis of EPN and to guide management. The scoring system was developed based on a retrospective analysis of 91 patients with EPN. Nineteen risk factors for emphysematous pyelonephritis were assessed with univariate and multivariate analysis. Seven factors were found significant on analysis. The scoring system was developed by including these 7 risk factors: renal stone disease, leukocytosis, raised creatinine, EPN grade, and septic shock. The score ranged from 1 to 18, with a higher score indicating a worse prognosis. The scoring system was able to stratify patients into three risk groups: good risk, intermediate risk, and poor risk. The scoring system can be used to personalize the management of EPN. Patients in the good-risk group may be managed with conservative treatment, while patients in the intermediate-risk and poor-risk groups may require intervention, such as DJ stenting, percutaneous nephrolithotomy or nephrectomy. The scoring system is a valuable tool for predicting the prognosis of EPN and guiding management. It can help clinicians to tailor treatment to the individual patient and to improve outcomes. The prognostic score helps identify patients who are at high risk. This score helps in the selection of appropriate management options.

Double J Ureteral stent removal in children non cystoscopically: A preferred innovation.

Objective: To determine the feasibility of non cystoscopic removal of double J ureteral (DJ) stent using a foley catheter with suture in children in terms of success rate, number of attempts required and complications. Study Design: Cross Sectional study. Setting: Department of Pediatric Surgery, Services Hospital, Lahore. Period: August 2022 to August 2023. Methods: All the children who underwent DJ stent placement for any urological procedure were included if DJ stent was seen in the bladder postoperatively. After informed consent, under sedation and aseptic measures, the foley catheter with suture already passed through its eye, was introduced per urethral after adequate lubrication. The foley was given five to six rotations in clockwise direction for right sided and anti-clockwise for left sided stents respectively and pulled out keeping traction on the suture. In case of three failed attempts, a cystoscope was introduced under general anesthesia and the stent was removed. Successful removal, number of attempts needed, time taken, and post removal complications were noted to determine feasibility of the procedure. Results: Out of twenty patients, 17 patients (85%) underwent successful removal of DJ stent. The failure rate was 15% as three patients required cystoscope assisted removal. In 13 patients (76.5%) DJ stent was removed in first attempt, whereas in 4(23.5%) patients it required two attempts. Mean time taken was 8.83±7.33 minutes. Complications were noted in 2 patients (10%). Conclusion: Removal of DJ stent in children without cystoscope, using a foley catheter with suture is a safe and feasible procedure with a high success rate and should be attempted in selected cases.

Emphysematous Pyelonephritis: Nephrectomy is not necessary, a narrative review

Emphysematous pyelonephritis (EPN) is a severe, life-endangering, necrotising, gas-producing infection affecting the kidney and perinephric tissue. It is associated with renal loss, high morbidity, and mortality. Diabetes, obstructive uropathy, female gender and hypertension are the most common risk factors. Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis are the most common pathogens causing Emphysematous pyelonephritis. EPN presents as a clinical triad of fever, flank pain, and nausea. Non-contrast CT scan is the mainstay of early diagnosis of EPN. It is diagnosed by demonstrating gas in renal parenchyma and perinephric tissue. Huang and Sang's classification is used for the classification and management of EPN. Treatment of EPN progressed from early nephrectomy to minimally invasive treatments including newer and advanced antibiotics and percutaneous drainage along with Percutaneous nephrostomy and DJ stenting. Early nephrectomy was the treatment of choice in the last century however newer studies suggest conservative treatment is associated with renal preservation, decreased morbidity and mortality. The initial use of broad-spectrum antibiotics such as Third-or fourth generation cephalosporins and carbapenems is recommended. Emergency drainage is indicated with a larger-sized pigtail catheter as pus is thick and frequent blockage of tubes is common. Nephrectomy should be done for those patients who fail to respond to conservative therapy i.e., antibiotics and percutaneous drainage. This review aims to provide comprehensive, evidence-based recommendations for the diagnosis and management of this life-threatening urological infection Emphysematous pyelonephritis. Keywords: Emphysematous pyelonephritis, Diabetes, Antibiotics, Conservative, Percutaneous drainage, Nephrectomy

Effect of indwelling ureteral stents on sexual function: a real-world observational study.

Ureteral DJ stents are commonly used devices in urology. However, stent placement may cause LUTS and affect the quality of life. We evaluated the direct relationship between ureteral stents and sexual function. From October 2022 to December 2023, 82 male and 90 female sexually active patients who underwent ureteroscopy at Beijing Tiantan Hospital, Capital Medical University, were enrolled. The basic information, surgical data, and two questionnaire data including the International Index of Erectile Function-5 and the Female Sexual Function Index of patients before the operation (baseline, T0), on the day of the ureteral DJ tube extraction (T1), and 4weeks after ureteral DJ tube extraction (T2) were collected to analyze the changes in the patients' sexual function. The average age of male patients was 36years and of female patients 39 years. Before the ureteral DJ stent placement, the mean ± SD IIEF-5 score was 22.86 ± 0.91, and the average FSFI score was 31.66 ± 1.44. On the day of the ureteral DJ stent removal, the IIEF-5 score was 16.37 ± 2.62 (p < 0.01) and the FSFI score was 15.83 ± 4.05 (p < 0.01). Four weeks after ureteral DJ stent removal, the average IIEF-5 score was 22.77 ± 1.06 (p = 0.61) and the average FSFI score was 30.99 ± 1.79 (p = 0.78). Indwelling ureteral stents after ureteroscopy can temporarily affect the sexual function of both male and female patients, typically recovering within 4 weeks after stent removal.

Microbial Colonization Pattern of Indwelling Double J Stents in Children.

Indwelling double-J-stent (DJ stent) kept post-urological procedures may cause urinary tract infections (UTIs) due to polymicrobial biofilm formation and colonisation. To determine the incidence and microbiological characteristics of DJ stent related UTIs in a paediatric population. Patients under the age of 18 admitted for DJ stent removal following pediatric urological procedures were enrolled into the study. Prior to surgical removal of the DJ stent, a urine sample was collected and the stent was cystoscopically removed under anesthesia. The ends of the stent were inoculated into culture media and incubated up to 48 hours. When growth was observed, an antibiogram was obtained using a panel of anti-microbial agents. The study group consisted of 27 patients (M: F = 23:4) with a mean age of 4.3 years (1 month - 13 years). The commonest indication for stent placement was Pyeloplasty, 19 (70%). Stent colonisation was found in 8 out of 27 patients (29.6%; CI 12-51%) and E.Coli (33%) was the commonest organism. Polymicrobial growth was noted in 4 patients. Organisms were sensitive to Cephaerazone/ Sulbactam and Amikacin, and resistant to other Cephalosporins. All 8 culture positive patients were asymptomatic and a repeat urine culture revealed no growth. Colonisation did not lead to active UTI and post stent removal the urine became sterile. Microbial colonisation was noted in 30% of patients with indwelling DJ stents. Prior knowledge of culture & sensitivity pattern helps to cover the patients with appropriate antibiotic on the day of stent removal.

The impact of double-J ureteral stenting before radical cystectomy on the development of upper tract urothelial carcinoma.

It is controversial whether the use of a double-J stent (DJ) in patients with bladder cancer before radical cystectomy (RC) increases the risk of tumour seeding in the upper tract and thus the risk of metachronous upper tract urothelial carcinoma (UTUC). The aim of our study is to investigate the risk of upper tract recurrence after RC in patients previously managed with a DJ stent. A total of 699 patients who had undergone RC between January 2003 and March 2022 with complete perioperative data and pathological outcome were included in our study. Patients treated preoperatively with a DJ stent were identified and compared for development of metachronous UTUC with those who did not receive prior internal stenting. Multivariable Cox regression analysis was used to determine predictors of UTUC occurrence among the possible pathological features; risk factors for mortality after RC were also examined. Of 699 patients, 117 (16.7%) were managed preoperatively with a DJ stent. The overall probability of metachronous UTUC was 1%, 4% and 6% at 1, 3 and 5 years, respectively. The groups with and without DJ stenting were comparable regarding their clinicopathologic features, except for the higher incidence of hydronephrosis in the DJ group. At similar follow-up periods (median follow-up 32 months), metachronous UTUC was detected in four (3.4%) patients in the DJ group and in 13 (2.2%) in the non-stented group (P=0.44). The median interval (IQR) from cystectomy to UTUC was 40.5 (20-49) months in the DJ group and 37 (24-82) in the non-stented group (P=0.7). In the multivariable analysis, only presence of CIS (HR 3.83, 95% CI 1.19-12.29, P=0.024) and positive ureteral margin (HR=5.2, 95% CI 1.38-19.57, P=0.015) were predictors of metachronous UTUC. The study is limited by the retrospective nature and relatively short follow-up. Ureteral stenting for management of hydronephrosis in patients with bladder cancer undergoing RC is a viable option, without higher risk for UTUC or mortality. Patients with positive ureteral margin and CIS are considered high-risk groups for upper tract recurrence and should receive long-term, rigorous follow-up.

Lost in the shadows: shedding light on forgotten ureteral stent syndrome

Abstract Ureteral stents have been essential in urology for over four decades, yet the challenge of retained or forgotten stents persists. This syndrome occurs when a DJ stent remains beyond its recommended removal time, typically more than 2 weeks, leading to complications like migration, fragmentation, and encrustation. We present a case of a 50-year-old woman with a two-month history of right flank pain, burning urination, and intermittent fever. She had undergone right stent lithotripsy 3 years prior. Imaging revealed a fractured double J stent with significant renal and bladder stones, extensive ureteral encrustation, and a large retroperitoneal collection. The right kidney showed cortical thinning and gross hydronephrosis. Initial management included broad-spectrum antibiotics, a pigtail catheter, and percutaneous nephrostomy. In a second session, mechanical cystolithotripsy and percutaneous nephrolithotomy removed the bladder and renal calculi, and the fractured stent ends. The patient recovered uneventfully. Forgotten ureteral stents often require staged endoscopic interventions due to encrustation. Timely stent removal is critical and often overlooked due to inadequate counseling. Establishing a stent registry and an automated reminder system via a mobile app could help prevent these occurrences.

The Non-Accessible Ureter: Can History, Gender, Age, BMI, Radiology and Stone Size Predict the Requirement of Pre-Stenting in Narrow Ureters

Abstract: Background: The difficulty in access to the ureter during stone removal surgery enhances the chances of redo-surgery, DJ stenting, and associated complications, this failure leads to mistrust in the doctor-patient relationship. Objective: This study aims to provide a comprehensive evaluation of the incidence &amp; management of narrow ureters after failure to negotiate retrograde access of rigid or flexible Ureteroscope (6/7.5 Fr ). Materials and Methods: This is a Prospective, cross-sectional study, conducted at the urology department of Tabba Kidney Institute, from June 2022 to June 2023. The minimum required sample size was 250. Patients aged between &gt; 18 to &lt;60 diagnosed with Unilateral and bilateral ureteric stones and hydronephrosis without ureteric stone obstruction were included in the study. SPSS 22 was used to analyze the data, the chi-square test was applied, with p-value &lt;0.05 as significant. Result: The overall mean age of the study population was estimated as 40.71 ± 12 years, while gender distribution indicated 138 (55.2%) male and 112 (44.8%) female patients. Group distribution identified 172 (68.8%) patients with negotiable ureter (Group A), while 78 (31.2%) with non-negotiable ureter (Group B). Conclusion: We conclude that in our population there is a higher incidence of narrow ureters, as compared to other studies which are not accessible even using the same dilatation technique, so it is safe to counsel the patients pre-operatively about the possibility of the narrow ureter and need for pre-stenting. Tabba Ureter Accessibility (TUA) score can be used as a tool to predict the possibility of a narrow ureter. Keywords: Narrow ureter, Ureteric stone, DJ stent, Ureterorenoscope, Dehydration, Hematuria.

The effect of endoscopic renal and ureteral stone surgeries on renal blood flow in children: a prospective trial

Aim: To assess the impact of endoscopic stone surgeries on renal perfusion and blood flow in children. Materials and methods: Children who underwent percutaneous nephrolithotomy (PCNL), retrograde intrarenal surgery (RIRS), ureterorenoscopy (URS), endoscopic combined intrarenal surgery (ECIRS) were included to the study. Renal Doppler ultrasonography (RDUS) was performed one day before the operation, and on the postoperative 1st day and 1st month. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured, and resistive index (RI) was calculated with the (PSV-EDV)/PSV formula. RDUS parameters were compared before and after surgery and between ipsilateral and contralateral kidneys. Results: A total of 45 children with a median age was 8 (2–17) years were included (15 (33.3%) girls, 30 (66.7%) boys). PCNL was performed in 13 children (28.9%), RIRS 11 (24.4%), URS 12 (26.7%), and ECIRS 9 (20%). There was no significant difference in renal and segmental PSV, EDV and RI values of operated kidney in the preoperative, postoperative periods. There was no significant difference between RDUS parameters of the ipsilateral and contralateral kidneys in preoperative or postoperative periods. PSV and EDV values were significantly higher in the 1st postoperative month in the group without preoperative DJ stent than in the group with DJ stent (p = 0,031, p = 0,041, respectively). However, RI values were similar. The mean RI were below the threshold value of 0.7 in each period. Conclusion: RDUS parameters didn’t show a significant difference in children. Endoscopic surgeries can be safely performed in pediatric stone disease.

A Case of Giant Uterine Leiomyomas Posted for Total Abdominal Hysterctomy with DJ Stenting

A Case of Giant Uterine Leiomyomas Posted for Total Abdominal Hysterctomy with DJ Stenting

Clinical efficacy of mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for the management of upper urinary tract calculus (1–2.5 cm) in children ≤10 years of age

With improvements in endoscopic surgery, open surgical procedures for urinary system stones have cleared the path for the use of less invasive treatment modalities in patients with pediatric kidney stone disease. Extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery (RIRS) are among the treatment options available. To prospectively evaluate the outcomes of mini-percutaneous nephrolithotomy and retrograde intrarenal surgery (RIRS) for children ≤10 years of age with upper urinary tract calculus (1-2.5cm). Sixty pediatric patients with single or multiple renal stones (1-2.5cm in diameter) were collected prospectively and equally divided into two groups to undergo RIRS or mini-PCNL. The operative and postoperative outcomes of both groups were analyzed. The groups' mean ages and genders were comparable. The mean stone size for the RIRS group was 1.86cm and 1.69cm for the PCNL group (P=0.449). The PCNL group had statistically longer mean fluoroscopy and hospitalization times. The stone-free rates (SFRs) after a single procedure were 27 (90%) in the PCNL group and 25 (83.33%) in the RIRS group (P=0.706). The UAS was placed in 13 (43.33%) patients in the RIRS group. In the RIRS group, 14 (46.67%) children required preoperative DJ stent application to passively dilate the ureteric orifice. As regard post DJ stenting, 13 (46%) cases applied DJ in the mini PCNL group. major complications were observed in either group. Minor complication (Clavien 1-3) rates were 16.66% and 13.33% for the PCNL and RIRS groups, respectively. There were no differences found between the RIRS and mini-PCNL groups regarding operative time. The mean cost of RIRS was $703.96 and $537.03 for the mini-PCNL. According to the results of this study, mini-PCNL and RIRS are effective procedures for treating renal stones in children up to 2.5cm with comparable success and complication rates. Hospital stay, radiation exposure, and fluoroscopy time are significantly lower in RIRS than in the mini PCNL technique. Although RIRS is effective, a major disadvantage is the greater requirement for JJ stent insertion either before or after the procedure and the consequent need for a second procedure for removal.

COMPARISON OF SUCCESS OF EXTRACORPOREAL LITHOTRIPSY (ESWL) AND LASER URETERORENOSCOPY IN PROXIMAL URETERIC STONES

Managing ureteral stones to achieve complete stone clearance with minimal patient morbidity involves several therapeutic approaches. The commonly used methods include extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS), percutaneous nephrolithotripsy, laparoscopic ureterolithotomy, and open ureterolithotomy. However, definitive evidence-based options for managing large proximal ureteral stones are lacking. Objective: To compare extracorporeal shock wave lithotripsy (ESWL) and laser ureterorenoscopy (URS) success rates in treating proximal ureteric stones. Methods: This randomized controlled trial was conducted in the Department of Urology &amp; Renal Transplantation at Bahawal Victoria Hospital, Bahawalpur, from January 1, 2020, to May 31, 2021. One hundred four patients, aged 20 to 60, with single proximal ureteric stones measuring 8-15 mm, were included. Patients with pyonephrosis, sepsis, bleeding disorders, solitary kidney, previous open ureterolithotomy, chronic renal failure, proteinuria, recurrent urinary tract infections, congenital urinary tract obstruction, bladder outflow obstruction, chronic liver disease, or a history of chronic drug usage were excluded. Patients were randomized into two groups: Group A underwent URS lithotripsy with DJ stent placement, while Group B underwent ESWL with DJ stent placement. A single surgeon performed all procedures. Pre-operative antibiotics and analgesics were administered to all patients. Stone clearance was assessed two weeks post-procedure. Statistical analysis was performed using appropriate methods, with a p-value ≤ 0.05 considered significant. Results: The mean age of patients in Group A was 37.52 ± 11.20 years, and in Group B was 36.73 ± 10.57 years. Most patients (75, 72.12%) were between 20 and 40. Out of the 104 patients, 63 (60.58%) were male, and 41 (39.42%) were female, with a male-to-female ratio of 1.7:1. Complete stone clearance was achieved in 44 (84.62%) patients in Group A (URS group) and 30 (57.69%) patients in Group B (ESWL group), with a statistically significant p-value of 0.002. The study concluded that the stone clearance rate after laser ureterorenoscopy (URS) is significantly higher than extracorporeal shock wave lithotripsy (ESWL) for proximal ureteric stones.

Bilateral ureteral stones; factors affecting treatment decision.

To evaluate certain factors that may affect the decision-making process for the rational management approach in cases presenting with bilateral ureteral stones. A total of 153 patients presenting with bilateral ureteral stones from 6 centers were evaluated and divided in three groups. Group 1 (n:21) Patients undergoing DJ stent insertion in one ureter and ureterorenoscopic (URS) lithotripsy for the contralateral ureteral stone. Group 2 (n:91), URS lithotripsy for both ureteral stones and Group 3 (n:41) patients undergoing bilateral DJ stent insertion. The outcomes of the procedures and the relevant patient as well as stone related factors have been comparatively evaluated in three groups. While associated UTI rates and serum creatinine levels were significantly higher in bilateral DJ group, previous URS history was found to be significantly higher in cases undergoing bilateral URS than those undergoing bilateral DJ stenting. URS was performed significantly more often in cases with lower ureteral stones and DJ stenting seems to be more rational approach in upper ureteral stones. In patients with lower ureteral stones, larger and harder stones, endourologists tended to perform URS as the first option. Decision making for a rational approach in cases with bilateral ureteral stones my be challenging. Our findings demonstated that serum creatinine levels, associated UTI, location and the hardness of the stone and previous ureteroscopy anamnesis could be important factors in making a decision between JJ stenting and ureteroscopic stone extraction in emergency conditions.

SINGLE SESSION BILATERAL PERCUTANEOUS NEPHROLITHOTOMY (PCNL) IN HORSESHOE KIDNEY PATIENT WITH BILATERAL STAGHORN STONES: A CASE REPORT

Objective: To analyze the outcomes of single-session bilateral PCNL in a horseshoe kidney patient with bilateral staghorn stones in terms of safety and effectiveness. Case(s) Presentation: A 64-year-old woman with bilateral staghorn stones on HSK. She had an anesthesia status of ASA 2, with type 2 diabetes mellitus (uncontrolled with oral medication), 47% of ejection fraction from echocardiography and her body mass index was 21.7 kg/m2. A single session of bilateral PCNL was performed, with 150 minutes of surgery and total blood loss of ± 50 cc. A 4.7 Fr DJ stent was placed on the right kidney, a 5 Fr ureteral catheter was left in the left kidney, and a 16 Fr foley catheter was placed as a right and left nephrostomy. Control plain abdominal x-ray showed no residual stones. Postoperatively, the patient was hospitalized for 3 days, there were no significant complaints and discharged in good condition. Discussion: The procedure was performed in the prone position for two reasons. First, is to avoid intestinal injury during puncture and dilatation, the second is to simplify the positioning of the C arm, as well as the endourology monitor, and the other instruments. Conclusion: Single-session bilateral PCNL for HSK patients with bilateral staghorn stones, in our experience, is quite safe and effective. Keywords: Horseshoe kidney, single-session bilateral percutaneous nephrolithotomy (PCNL), staghorn stone.

PROFILE OF NEPHROLITHIASIS PATIENTS TREATED WITH MINI-PERCUTANEOUS NEPHROLITHOTOMY (MINI-PCNL): A SINGLE CENTER EXPERIENCE IN JAMBI, INDONESIA

Objective: This study aims to describe the characteristics of patients undergoing mini-PCNL at our center in Jambi, Indonesia. Material &amp; Methods: This is a descriptive study involving patients with kidney stones treated with mini-PCNL during 2017 – 2021 in Jambi. The selection of the study subjects was using total sampling method. All patients had a medical history taken and a physical examination performed prior to surgery. The procedure was performed by three operators in one referral district hospital. Results: From 2017 to 2021, a total of 188 mini-PCNL procedures were performed at our center for the removal of kidney stones. However, only 186 cases were included in this study after excluding 2 due to incomplete data. The mean age of patients in this study was 49.3 years old (ranging from 12–87 years old) with the majority being male (101/165 [61.21%]). Of 186 cases, a total of 175 cases had no residual stone and only 11 had residual stone (stone-free rate [SFR] 94.08%). Most patients presented with hydronephrosis, and DJ stent placement was performed in 44 out of 186 cases. The SFR decreased as the stone size increased. Conclusion: Mini-PCNL proves to be a valuable choice for managing kidney stones, especially for medium-sized and hard stones, leading to enhanced patient results and reduced post-operative complications. Keywords: Kidney stone, mini-PCNL, stone free rate.

Dj Stenting: Retrospective Analysis of Indications and its Attached Complexity

Background: Ureteric stents are commonly used to manage nephro-ureterolithiasis and other ureteric obstructions, but their use is often associated with various complications. Understanding the indications for stenting and the frequency and nature of these complications is critical for improving patient outcomes. Objective: To analyze the indications for and complications associated with double-pigtail ureteric stenting in a retrospective cohort. Methods: This retrospective study involved 110 renal units in 90 patients who received double-pigtail ureteric stents from October 2022 to March 2024 to relieve ureteric obstruction. Stents were inserted both retrogradely via cystoscopy and antegradely through nephrostomy. The types of stents used were either polyurethane, intended for up to 3 months, or silicone, for longer durations. Follow-up included regular imaging to monitor stent position and complications, with data analysis performed using SPSS version 25. Results: The primary indications for stenting included nephro-ureterolithiasis (88 patients), post-abdominopelvic surgery (11), prostate cancer (5), retroperitoneal fibrosis (4), and after irradiation (2). Complications were noted in 31% of patients, with bacteriuria and fever most common. Hydronephrosis was reported in 27 of these cases, with symptoms unchanged in 21, worsened in 3, and de novo in 3. Other complications included stent migration (8%), fragmentation (10%), and forgotten stents (4.5%). Stent removal was necessary in many cases due to severe complications. Conclusion: Ureteric stents are effective for managing ureteric obstruction but are associated with significant risks, including infection, migration, and hydronephrosis. Careful patient monitoring and timely management of complications are essential to optimize outcomes.

Optimizing outcome reporting after robotic flexible ureteroscopy for management of renal calculi: Introducing the concept of tetrafecta

Robotic flexible ureteroscopy (RFURS) has shown encouraging results in terms of stone free rate (SFR) and better ergonomics compared to conventional FURS. However, few studies have reported its outcomes. The goal of this study was to report our initial results of RFURS, furthermore we proposed a novel metrics for composite outcome reporting named tetrafecta. A retrospective analysis of electronic records of 100 patients treated with RFURS for renal stones between 2019 till 2023 was performed. Tetrafecta criteria included, complete stone removal after a single treatment session, without auxiliary procedures, absence of high-grade complications (GIII-V) and same-day hospital discharge. Mean patient age and stone size were 40.7 ± 9.2 and 11.7 ± 5.8 mm, respectively. Median stone volume was 916 (421–12,235) mm3. Twenty-eight patients had multiple renal stones. Staghorn stones were seen in 12 patients. Preoperative DJ stent was fixed in 58 patients. Median operative time and stone treatment time were 116 min (97–148) and 37 (22–69) min. The median stone treatment efficiency (STE) was 21.6 (8.9–41.6). A strong positive correlation between stone volume and STE (R = 0.8, p < 0.0001). Overall, 73 patients were stone free after the initial treatment session while tetrafecta was achieved in 70 patients. Univariate analysis showed that the stone size (p = 0.008), acute infundibulopelvic angle (p = 0.023) and preoperative stenting (p = 0.017) had significant influence on achieving tetrafecta. Multivariate analysis identified preoperative stenting (OR 0.3, 95% CI 0.1–0.8, p = 0.019) as the only independent predictor of tetrafecta achievement. A comprehensive reporting methodology for reporting outcomes of RFURS is indicated for patient counseling and comparing different techniques. Tetrafecta was achieved in 70% of cases. Presence of significant residual stones ≥ 3mm was the leading cause of missing tetrafecta. Absence of preoperative stent was the only predictor of missing tetrafecta.

Percutaneous nephrolithotomy in case of crossed fused renal ectopia: a case report

Crossed renal ectopia is a rare congenital anomaly that is frequently associated with gastrointestinal, cardiovascular, genital, and bone malformations. To best of our knowledge, there aren't many cases of inferior crossed fused renal ectopia of the right kidney documented in the literature at this time. A case of crossed-fused renal ectopia is presented here. A 32-year-old man arrived at our hospital complaining of pain in the right flank. Diagnosis: We suspected a single right kidney based on abdominal ultrasonography. An inferior left to right crossed-fused ectopic kidney with calculus in the right (normal) renal pelvis was the patient's diagnosis when combined with 3D computed tomography. Interventions: percutaneous nephrolithotomy with DJ stenting. Because the management of renal stone in this uncommon malformation is complicated, a preoperative assessment with contrast computed tomography is required before moving forward with surgery in order to explore a single kidney with calculi and avoid missing the diagnosis of crossed fused renal ectopia.

IgG4-related retroperitoneal fibrosis mimicking renal pelvis tumor: a case report and literature review

BackgroundRetroperitoneal fibrosis (RPF) is a rare disease characterized by the development of a fibroinflammatory mass in the retroperitoneum. Immunoglobulin-G4 related RPF was suggested as a secondary form of RPF and thought to be part of the spectrum of Immunoglobulin-G4 related diseases (IgG4-RD). Patients often present to the clinic because of flank pain. Ranging from mild to end-stage renal failure can be observed. The main purpose of treatment is to preserve renal function. As it is a rare condition, there is no definite treatment strategy. We report a case of 39-year-old man with left flank pain and diagnosis of IgG4-related RPF mimicking a renal pelvis tumor.Case presentationA 39-year-old male patient presented with left flank pain. MRI suggested solid retroperitoneal mass associated with hydronephrosis in the left kidney collecting system. Upon identifying the retroperitoneal origin of the mass during nephroureterectomy, the procedure was concluded following the acquisition of frozen section and routine pathological samples from the lesion. In the histopathological examination, inflammatory cells were observed and specific immunohistochemistry for IgG-4 was detected focally positive. Following the placement of a DJ stent, immunosuppressive therapy was initiated with Prednol and Azathioprine. After a one-year follow-up period, during which the patient received immunosuppressive treatment and underwent tri-monthly DJ stent replacements, the DJ stent was subsequently removed, revealing complete regression of hydronephrosis.ConclusionsWith the correct diagnosis and treatment of IgG4-related RPF, it is possible to prevent irreversible complications of the disease. Because it is a rare disease, case reports in the literature will be useful for treatment.

P08 An usual case of pandrug-resistant Serratia marcescens in a 63 year-old-male: a case report

Abstract Objectives To highlight the growing burden of antimicrobial resistance in developing countries where there are no officially agreed local antibiotics guidelines. We are characterizing a case of growth of pandrug-resistant (PDR) Serratia marcescens in the urine culture of a 63-year-old-male. Patient and methods Our patient, who had a history of recurrent renal stones, underwent multiple urological procedures (including ureteroscopy and DJ stenting) in various regional hospitals in northern Pakistan. It is postulated that he became infected during these repeated procedures which were done in various hospitals without adequate sterile equipment. He presented with recurrent UTIs to GPs and was subsequently treated with oral fosfomycin for over 1 year in total. His baseline renal function remains unknown due to the absence of online records, but he was noted to have CKD IV. Subsequently, during his later visits to the hospital, he developed sepsis and his urine cultures confirmed carbapenem-resistant Pseudomonas aeruginosa, which was treated with IV antibiotics as per the susceptibility report. He was prescribed IV piperacillin/tazobactam (Tazocin) for a total period of 3 months on various occasions due to repeated presentations with urosepsis. He improved clinically with IV piperacillin/tazobactam. Following this, the patient was lost to follow-up. The patient once again presented acutely unwell with urosepsis. This time urine cultures confirmed the presence of S. marcescens (May 2023). The patient had pandrug resistance to all antibiotics including IV piperacillin/tazobactam. However it was decided to treat him with IV piperacillin/tazobactam due to previous good results. The patient improved clinically but his renal functions declined to CKD stage V. He was once again lost to follow up. He presented again to renal consultants with uraemic symptoms and at the moment he is being counselled for dialysis due to his end-stage renal disease. At present the patient is having asymptomatic bacteriuria; his urine cultures remain positive without any symptoms. A more recent urine culture (September 2023) showed growth of Escherichia coli (ESBL). Due to lack of symptoms, renal consultants agreed to manage the patient without further antibiotics. Results In May 2023, an antibiotic susceptibility profile was done under supervision of microbiologists. Unfortunately for the patient, the urine culture reported growth of S. marcescens and that the patient had pandrug-resistance. The profile included testing for the following antibiotics: amikacin, co-amoxiclav, aztreonam, cefepime, cefoxitin, ceftazidime/avibactam, cefalexin, co-trimoxazole, fosfomycin, meropenem, amoxicillin, ampicillin, cefaclor, cefixime, cefpodoxime, cefuroxime, ciprofloxacin, colistin, imipenem, nitrofurantoin, norfloxacin, polymyxin, piperacillin/tazobactam and sulbactam/cefoperazone. In September 2023, the second urine culture report with the growth of E. coli showed susceptibility to amikacin, cefoperazone/sulbactam, fosfomycin, imipenem and tigecycline. This report also confirmed resistance co-amoxiclav, ampicillin, cefixime, cefotaxime, ceftazidime, ceftriaxone, cefuroxime, cefradine, levofloxacin, nalidixic acid, nitrofurantoin, piperacillin/tazobactam and trimethoprim/sulfamethoxazole. Conclusions Unfortunately, the urine culture and susceptibility report signify the threat this patient faces in case he develops further urine infections. It is imperative to encourage development of local guidelines in developing countries too. We would recommend a multidisciplinary approach in treating difficult and long-term infections with constant support of microbiologists.