Metal Dilators Research Articles

(042) Bilateral Orchiectomy as a Standalone Gender-Affirming Procedure: Does it Compromise Skin Grafts Available for Later Vaginoplasty?

Abstract Introduction Penile inversion vaginoplasty is the gold-standard gender-affirming surgical technique for creating a neovaginal canal. While bilateral simple orchiectomy (BSO) is usually completed at the same time as vaginoplasty, long wait times associated with vaginoplasty have highlighted pre-vaginoplasty BSO as a more immediate opportunity to mitigate gender dysphoria, decrease estrogen dosages, and completely eliminate antiandrogen hormone therapy. The impact of standalone BSO on later vaginoplasty is defined by a single study that associated BSO with a decrease in scrotal skin and a need for extragenital skin grafts-findings that have fueled hesitation around pre-vaginoplasty BSO. Objective To provide a detailed comparison of pre- and intraoperative skin graft measurements and postoperative neovaginal depth between patients who underwent BSO prior to versus concurrent with vaginoplasty. Methods All consecutive patients who underwent penile inversion vaginoplasty at a single institution were identified in a retrospective chart review. Demographic characteristics and the following measurements of vaginoplasty skin grafts were collected and compared between groups: preoperative stretched penile length (measured from base to 1cm proximal to the glans ridge on gentle stretch), preoperative stretched scrotal skin length (measured on gentle stretch in two parts: from the penoscrotal junction to mid scrotum, then from midscrotum to mid perineum), and intraoperative scrotal skin tube length (defined as the amount of scrotal skin that could be harvested and tubularized on a metal dilator (Figure 1A)). Results 57 patients completed penile inversion vaginoplasty between August 2017 and May 2023: 17(30%) completed pre-vaginoplasty BSO and 40(70%) BSO concurrent with vaginoplasty (mean age ± SD = 36.6 ± 12.6y and 37.4 ± 12.8y, p>0.05). Notably, there was no significant difference in length of preoperative scrotal skin or intraoperative tubularized scrotal skin grafts (Figure 1B). While pre-vaginoplasty BSO patients had less neovaginal depth (p<0.05), they also had significantly less preoperative penile skin (p<0.01). Conclusions Contrary to the singular study in the literature, we found no between-group differences in scrotal skin measurements. Furthermore, zero patients required extragenital skin grafts to achieve mean neovaginal depth of 14.4±1.0cm, which approximates the average depth among studies reporting routine use of extragenital skin. Less neovaginal depth amongst BSO patients is expected, as this group had less penile skin available to line the canal. Findings from this study may help address patient and provider fears that BSO decreases scrotal skin available for later vaginoplasty, thereby lessening the decision-making burden of balancing the pros and cons of early BSO. Disclosure No.

(147) Gender-Affirming Bilateral Orchiectomy as a Standalone Procedure: Does it Compromise Skin Grafts Available for Later Vaginoplasty?

Abstract Introduction Gender-affirming penile inversion vaginoplasty is the gold-standard technique for creating a neovaginal canal. While bilateral simple orchiectomy (BSO) is typically completed intraoperatively with vaginoplasty, long wait times associated with vaginoplasty have highlighted pre-vaginoplasty BSO as a more immediate opportunity to mitigate gender dysphoria, decrease estrogen dosages, and completely eliminate antiandrogen hormone therapy. The impact of standalone BSO on later vaginoplasty is defined by a single study that associated BSO with a decrease in scrotal skin and a need for extragenital skin grafts-findings that have fueled hesitation around pre-vaginoplasty BSO. Objective Given that neovaginal depth is dependent on penile and scrotal skin available during vaginoplasty, this study aims to provide a detailed comparison of pre- and intraoperative skin graft measurements and postoperative neovaginal depth between patients who underwent BSO prior to versus concurrent with vaginoplasty. Methods A retrospective chart review identified all consecutive patients who underwent penile inversion vaginoplasty at a single institution. In addition to demographic characteristics, the following measurements of vaginoplasty skin grafts were collected and compared between groups: preoperative stretched penile length (measured from base to 1cm proximal to the glans ridge on gentle stretch), preoperative stretched scrotal skin length (measured on gentle stretch in two parts: from the penoscrotal junction to mid scrotum, then from midscrotum to mid perineum), and intraoperative scrotal skin tube length (defined as the amount of scrotal skin that could be harvested and tubularized on a metal dilator (Figure 1A)). Results A total of 57 patients completed penile inversion vaginoplasty between August 2017 and May 2023: 17(30%) completed pre-vaginoplasty BSO and 40(70%) BSO concurrent with vaginoplasty (mean age ± SD = 36.6 ± 12.6y and 37.4 ± 12.8y, p>0.05). Notably, there was no significant difference in length of preoperative scrotal skin or intraoperative tubularized scrotal skin grafts (Figure 1B). While pre-vaginoplasty BSO patients had less neovaginal depth (p<0.05), they also had significantly less preoperative penile skin (p<0.01). Conclusions Contrary to the previously described study, we found no between-group differences in scrotal skin measurements. Furthermore, zero patients required extragenital skin grafts to achieve mean neovaginal depth of 14.4±1.0cm, which approximates the average depth among studies reporting routine use of extragenital skin. Less neovaginal depth amongst BSO patients is expected, as this group had less penile skin available to line the canal. Findings from this study may help address patient and provider fears that BSO decreases scrotal skin available for later vaginoplasty, thereby lessening the decision-making burden of balancing the pros and cons of early BSO. Disclosure No.

A comparative analysis of the efficacy and safety of mini-percutaneous nephrolithotomy performed in the supine and prone positions for the treatment of pediatric kidney stones: a single-center experience.

Mini-percutaneous nephrolithotomy (MPCNL), which has a smaller tract size (14-20 Fr) than conventional percutaneous nephrolithotomy, has been shown to be safe and effective in pediatric patients with large and complex upper urinary tract stones. This study aimed to compare the efficacy and safety of MPCNL between the supine and prone positions in a pediatric population. The data of pediatric patients who underwent MPCNL at our center between January 2010 and March 2023 were retrospectively analyzed. According to the surgical position, the patients were divided into the prone (Group P) and supine (Group S) groups. In both groups, dilatation was performed using 14-18 Fr metallic dilators. The two groups were compared in terms of perioperative data, postoperative stone-free rates (SFRs), and complications. There were 36 (59%) patients in Group P and 25 (41%) patients in Group S. Stones were mostly located in the pelvis (49.2%) and second most frequently in the lower pole (27.9%). Fluoroscopy time was shorter in Group S but did not statistically significantly differ compared to Group P (p = 0.181). However, operation time was statistically significantly shorter in Group S (73.8 ± 35 vs. 99.8 ± 37.4min, p = 0.008). Although there was no significant difference, relatively higher SFR were detected in Group S (88% vs. 83%, p = 0.725). Endoscopic combined intrarenal surgery (ECIRS) was performed on six (24%) patients in Group S, and the SFR was 100% among these patients. There was no significant difference between the two groups in terms of the presence of complications (16.7% vs. 16%, p = 0.945). Both supine and prone MPCNL appear to be safe and effective in the pediatric age group, with similar stone-free and complication rates. In the supine procedure, the operation time is shortened compared to the prone. In addition, simultaneous retrograde access has the potential to increase the overall success rate of surgery.

(411) The “Unfolding” Technique for Penile Prosthesis Implantation in Post-priapism Corporeal Fibrosis

Abstract Introduction `- In neglected cases of ischemic priapism, there is usually severe corporeal fibrosis that can render penile prosthesis implantation later on extremely difficult. - Although many researchers described different approaches to overcome difficulties during surgery, none of them offered satisfactory results. Objective `- to describe a new technique to insert a large sized penile prosthesis in patients suffering from ED after neglected ischemic priapism with resultant severe corporeal fibrosis. Methods `- A new surgical technique was done in 15 patients suffering from ED after prolonged ischemic priapism with severe corporeal fibrosis. - Surgery starts by a circumcision incision, complete degloving & delivery of the penis through a midline perineal incision. - The penile urethra is then dissected away from the ventral surface of both corpora cavernosa - A midline ventral incision is done between both corpora cavernosa. This incision is then deepened till it reaches the inner surface of the tunica albuginea. At this point, the scalpel is then rotated 90 degrees to unfold the core of fibrosis into a flat sheet continuous with tunica albuginea. - The process is then repeated on the other side. - The proximal crura are then dilated in the usual manner by metal dilators. The distal part of the corpora are bluntly dilated by the closed blades of scissors. - After inserting the penile prosthesis, both sheets of fibrosis are closed over both prosthetic rods in the midline and the penile urethra is then fixed back to its position. - The penis is then retuned to its normal anatomical site & the skin is closed. Results `- Successful surgery was achieved in 13 out of 15 patients (86.7%). - 2 patients developed infection that necessitated surgical removal of the rods. - no incidence of urethral injury, crossover or corporal perforation Conclusions `- The new “un-folding” technique is feasible and useful technique in patients with ED after prolonged ischemic priapism - The incidence of complications esp. urethral erosion, crossover and corporal perforation. Disclosure No

Conservative surgical repair in cervical atresia associated with partial or complete absence of the vagina

To describe the surgical technique of laparoscopically assisted uterovaginal/vestibular anastomosis in patients with cervical atresia associated with partial or complete absence of the vagina. Surgical video article. Local institutional review board approval and written permission from the patients were obtained. Tertiary referral center. The surgical video presents surgical correction in 3 different patients with cervical agenesis. The first patient, aged 14 years, had a normoconformed uterus and total absence of the vagina. The second patient, aged 12 years, demonstrated a left unicornuate uterus and partial absence of the vagina. The third patient, aged 13 years, displayed a right unicornuate uterus and total absence of the vagina. Laparoscopic time and perineal time. During laparoscopy, the entire abdominopelvic cavity was assessed to evaluate the uterine morphology and size to exclude anomalies such as hematometra. The adnexa and adhesions were evaluated and any endometrial flare-ups were treated appropriately. A laparoscopic ultrasound probe was used to evaluate the size and location of the endometrial cavity. In cases with total absence of vaginas, an H-shaped incision in the hymenal dimple allowed a larger area of available tissue for the anastomosis. A tunnel was then created by blunt finger dissection between the bladder and rectum. Simultaneously, the uterus was pushed caudally by an assistant while the operator grasped it from below using an internal probe. A circular myometrial incision at the uterine caudal body allowed to reach the endometrial cavity and open it. The edges of the uterine cavity were then anastomized with the edges of the hymenal incision. In cases with partial absence of vaginas, the creation of the tunnel between the vagina and rectum was not necessary and the open uterus was anastomosed with the margins of the vaginal dome, engraved on the guide of a metal dilator. All patients received broad-spectrum antibiotics (i.e., cephalosporins of the last available generation) on the day before surgery and on the day of surgery. Intraoperative anatomic and ultrasound data, neovaginal length, and recovery of menstrual function 180 days after surgery. The surgical procedure was successful in all cases. No major complications were recorded, and in particular, no bladder or rectal injuries occurred. No stenosis of the neocervix was recorded. The main hospital stay of the patients was 3.5 ± 1.5 days. In each case, the neovagina developed gradually over time after surgery because of the upward traction action exerted by the uterus through its natural ligament apparatus (cardinal ligaments and ovarian vessels). This fact eliminated the requirement for the use of a mold after surgery. At the 15-week follow-up, vaginoscopy was performed, with mucus observed at the site of uterovaginal anastomosis in all cases. None of the patients developed infection after surgery because of the avoidance of molds or pessaries and the natural mucus production. Six months after surgery, the length of the neovagina was >4 cm in all 3 cases. Laparoscopic-assisted uterovaginal/vestibular anastomosis may be considered the treatment of choice for patients with cervical atresia associated with partial or complete absence of the vagina.

A Retrospective Comparison of the Balloon Dilator and the Telescopic Metal Dilator for Tract Dilatation during Percutaneous Nephrolithotomy

Background: Percutaneous nephrolithotomy (PCNL) is the procedure of choice for the management of large renal calculi. Nephrostomy tract dilatation is an essential step in PCNL. However, the types of dilatations used depend on the surgeon’s preference. Objective: To compare the effectiveness and safety of the balloon dilator (BD) against the telescopic metal dilator. Materials and Methods: The present study involved 238 patients that underwent PCNL between January 2011 and February 2020. They were divided into two groups based on the adopted tract dilatation technique. The balloon dilatation group included 69 cases, and the telescopic metal dilator group included 169 cases. They were analyzed in terms of demographics and perioperative outcomes. Results: The two PCNL groups were similar in age, stone burden, and stone density. There was no statistically significant differences in the stone-free status at 59.4% versus 56.8% (p=0.711), tract dilatation failure rates at 1.5% versus 0.6% (p=0.511), estimated blood loss at 200 mL versus 200 mL (p=0.311), blood transfusion rates at 11.6% versus 8.9% (p=0.520), and total operation time at 120 minutes versus 120 minutes (p=0.573) for the balloon dilatation group and the telescopic metal dilator group, respectively. The duration of the nephrostomy placement in the balloon dilatation group was significant longer than the telescopic metal dilator group at 3 days versus 4 days (p=0.005). Conclusion: Both BD and telescopic metal dilator possess equivalent effectiveness and safety for PCNL. Keywords: Percutaneous nephrolithotomy; Renal calculus; Balloon dilator; Telescopic metal dilator

One-Shot Dilatation vs Metal Dilator During Percutaneous Nephrolithotomy in Flank-Free Supine Position: A Randomized Controlled Study.

Background: The creation and dilatation of the nephrostomy tract is a fundamental step in percutaneous nephrolithotomy (PCNL). In one-shot dilatation (OSD), we used a single Amplatz dilator over a central Alken rod. PCNL in the supine position is as effective and safe as in the prone position. The Barts flank-free modified supine position sums several advantages of the different supine positions. We evaluated the efficacy and safety of OSD compared with metal telescopic dilator (MTD) during PCNL while the patient was in Barts flank-free modified supine position. Materials and Methods: Within 2.5 years, 150 patients with kidney stone candidates for PCNL were randomized into two equal groups according to the dilatation technique. In the OSD group, dilatation was performed using a single Amplatz dilator (30F) and in the MTD group dilatation was performed by sequential MTD (9-30F). All PCNL procedures were done with patients in Barts flank-free modified supine position. Patient characteristics, operative data, and results were collected for statistical analysis. Results: There are no statistically significant differences between both groups regarding patients' characters. The tracts were effectively dilated in all patients. Statistical analyses show a significant difference (p ˂ 0.05) between both groups regarding the time of dilatation (seconds; 68 ± 15 vs 147 ± 18), time of X-ray exposure (seconds; during dilatation; 36 ± 10 vs 61 ± 15 and the total; 157 ± 16 vs 181 ± 20), hemoglobin loss (mg/dL; 0.7 ± 0.2 vs 1.2 ± 0.3), and hospital stay (days; 3 ± 0.6 vs 3.7 ± 0.7) with favorable results to OSD. Complication rates were comparable between the two groups. Conclusions: OSD is efficient as MTD during PCNL while patients are in Barts flank-free modified supine position, with less dilatation time, X-ray exposure, blood loss, and hospital stay than MTD.

An insight into predominance of pulmonary complications on right side in supracostal percutaneous nephrolithotomy.

To analyse pulmonary complications following supracostal percutaneous nephrolithotomy especially after right sided supracostal punctures, both in initial and relook PCNL. From February 2016 till date, 90 patients underwent PCNL in Government Medical College, Jammu through supracostal puncture - 53 on right side and 37 on left side. All supracostal punctures were made about 7-8.5 cm from midline. Tract dilatation was done using metal dilators and calculi were fragmented using pneumatic lithotripsy. Patients with supracostal superior calyceal punctures were evaluated for chest complications intraoperatively by fluoroscopy, X-ray chest on evening of postoperative day 0 and repeated thereafter on third and seventh postoperative days. Stone configuration included complete staghorn in 16, partial staghorn in 23, multiple stones in 16 and pelvic stone in 35 cases. Age range of patients was 07-76 years. There was 14.4% (13 out of 90) incidence of early or delayed chest complications - 20.8% (11 out of 53) on right side and 5.4% (2 out of 37) on left side. Pulmonary complications in supracostal punctures; especially on right side should not be underestimated. There are always chances of delayed hydrothorax after supracostal puncture. A chest X-ray should be repeated after 1 week in patients with supracostal PCNL punctures.

Miniaturized Percutaneous Nephrolithotomy in the Supine Position under Regional Anesthesia to Remove Large Renal Calculi: A Case Report

Background: Percutaneous nephrolithotomy (PCNL) is traditionally performed under general anesthesia, with the patient in the prone position. However, various concerns have been raised regarding the prone position, especially in morbidly obese patients with compromised cardiopulmonary status and comorbidity issues. Our aim was to demonstrate our experience with supine miniaturized PCNL performed under spinal anesthesia in a high-risk patient. Case Report: A 76-year-old Thai woman with obesity and severe hyperglycemia presented with two large right kidney stones. She was scheduled for prone PCNL. During admission, she was in a severe hyperglycemic state, with a blood glucose level of 537 mg/dL. She required an intravenous insulin infusion and was monitored until stable. Because she had significant potential risk for general anesthesia, we decided to remove the stone by supine miniaturized PCNL under spinal anesthesia. She was placed in the Galdakaomodified supine Valdivia position. Cystoscopy was performed and a ureteric catheter was inserted into right ureteric orifice. The lower pole access was carefully punctured under ultrasonographic guidance. The tract was dilated with a metallic one-step dilator and a 12 Fr nephroscope was used. Lithotripsy was undertaken using a holmium laser through a 550 micron laser fiber. The procedure was completed with no deterioration of the patient. Conclusion: A patient with kidney stones, obesity, and poor glycemic control has an increased risk of perioperative complications. We report the first case of supine miniaturized PCNL performed under spinal anesthesia in Thailand. It is a safe and feasible method that provides satisfactory positive clinical outcomes. Keywords: Supine; Miniaturized percutaneous nephrolithotomy; Regional anesthesia

Vesical stone management by percutaneous cystolitholapexy versus open vesicolithotomy among children.

Objective: To compare outcomes, safety and complications of vesical stone management among children by open vesicolithotomy versus percutaneous cystolitholapaxy. Study Design: Cross Sectional study. Setting: Department of Urology and Kidney Transplantation Pir Abdul Qadir Institute of Medical Sciences Gambat. Period: July 2020 to December 2020. Material & Methods: Children with vesical stone, having age 1-12 years and fulfilling inclusion criteria were selected for this study. Total 50 cases were selected using non-probability consecutive sampling technique. Patients were divided into two groups Group-A and Group-B on the basis of given treatment each group containing 25 cases. Patients in Group-A were underwent open vesicolithotomy and those in group-B were underwent percutaneous cystolitholapexy. Procedure was done under general anesthesia. Alken metallic dilators were used for the dilatation of tract. Adult nephroscope with 24Fr sheath was used. Postoperative outcomes of both methods were compared with each other. Pneumatic fragmentation was used to break stones > 1.5cm in size. Results: Total 50 cases were studied, 25 cases in each group-A and group-B. Stone size was 1-3 cm in both groups. Age range of the patients was 1-12 years with mean age of 4.25 ± 1.4 years. Mean hospital stay was 2.6 days in group-A and 1.3 days in group-B. Mean requirement of analgesia (ketorolac) was 30.2mg in group-A and 14.8mg in group-B. Most common postoperative complication was fever observed in 28% cases in group-A and hematuria observed in 24% cases in group-B. Conclusion: Percutaneous cystolitholapexy is a minimal invasive procedure suitable among children with high success rate and minimum complications like postoperative fever, hematuria, urinary leakage and pain.

The utility of instruments and disposables during endourologic practice among Egyptian urologists

Objective: We aimed to investigate the prevalence of utilization of different endourological instruments and disposables among Egyptian urologists and to see how availability could affect the deviation from the universal standards that might result in reduced patient safety. Patients and method: We surveyed members of the Egyptian Urological Association by a questionnaire evaluating the importance of different instruments and disposables used during ureteroscopy and percutaneous nephrolithotomy. All responses were collected by a commercially available Internet-based survey host ( www.surveymonkey.com ) over 8 weeks. Results: One hundred and fifty-two responses were received. For ureteroscopy, the most mandatory instruments and disposables included the C-arm device (83%), Dormia basket (61%), ureteral stone forceps (58%), pneumatic lithotripter (50%), and regular PTFE guide wire (49%). The instruments and disposables described as optional included 4.5 Fr ureteroscope (74%), flexible ureteroscope (70%), and hydrophilic guidewire (67%). For percutaneous nephrolithotomy, the most mandatory instruments and disposables were pneumatic lithotripter (78%), Alken metal dilator (75%), fascial dilator (45%), and regular PTFE guidewire (42%); while instruments and disposables described as optional included flexible cystoscope (70%), hydrophilic guidewire (67%), balloon dilator (57%), and laser machine (52%). Conclusion: The prevalence of the utilization of newly introduced instruments and disposables is low among Egyptian urologists.

Implementation of Supine Percutaneous Nephroscopic Surgery to Remove an Upward Migration of Ureteral Catheter in Infancy: A Case Report

BackgroundDouble-J stents are favorably utilized after pyeloplasty. In rare situations, the stent may migrate upward. Here, we demonstrate the implementation and result of a supine percutaneous nephroscopic surgery (PNS) to retrieve a proximately migrated ureteral catheter in a pediatric patient.Patient and MethodsA 1-year-old boy was suffering from an upward migration of a ureteric catheter into the right ureter after an open Anderson-Hynes pyeloplasty. The child was placed in the Galdakao-modified supine Valdivia (GMSV) position and a PNS procedure was performed. The calyceal access was carefully punctured by ultrasonographic guidance. The nephrostomy tract was dilated with a metal dilator using a one-step technique. An exploratory nephroscopy of the renal pelvis was conducted with a 12Fr miniature nephroscope and the migrated ureteral catheter was removed. A hybrid guidewire was retrogradely inserted into the ureteric orifice using a rigid ureteroscope. An antegrade double J stent was inserted in the proper position and a percutaneous nephrostomy was performed.Results and ConclusionThis is the first report of a successfully removed upwardly migrated ureteral catheter with concurrent insertion of an antegrade double J stent by supine PNS in the GMSV position in an infant. The patient recovered well after surgery with no adverse event, demonstrating that this operation can be carried out safely on pediatric patients.

Comparison of single-step renal dilatation and serial renal dilatation in percutaneous nephrolithotomy: A retrospective case-control study.

Background:Access to the pelvi-calyceal system and subsequent dilatation of the tract are among the initial important steps in percutaneous nephrolithotomy (PCNL). In this study, we share our experience with single-step renal dilatation when compared to multiple serial renal dilatation in PCNL.Materials and Methods:This is a retrospective study wherein 35 patients who underwent PCNL by single-step renal dilatation by appropriate size Amplatz Dilator were compared with 35 patients who underwent multi-step serial renal dilatation using serial metallic Alken dilators. These patients were analyzed on the basis of demographic profile, total intra-operative time, fluoroscopic time, intra-operative and postoperative complications, stone clearance, requirement of blood transfusion, duration of hospital stay, and follow-up.Results:There were no significant differences in the demographic profile among the patients in these two groups. The mean total operative duration and fluoroscopic duration were less in single step renal dilatation group, and these have been found to be statistically significant (P < 0.05). There were no statistically significant differences in the rates of other complications – incomplete stone clearance, bleeding and hematoma formation, requirement of blood transfusion, duration of hospital stay, and follow-up.Conclusion:Operative duration and rate of radiation exposure are significantly less in PCNL by single-step renal dilatation; however, there is no statistically significant difference in the rates of other complications.

Single-Step Renal Dilatation Is a Novel Technique in Percutaneous Nephrolithotomy: A Prospective Randomised Study

Purpose: To evaluate the feasibility, safety and efficacy of one-shot dilation (OSD) in percutaneous nephrolithotomy (PCNL). Materials and Methods: In a prospective randomised study including 62 patients divided into two groups, the first had RD before PCNL using the standard metallic telescopic dilators (Alken), and the second had RD using the 30-F Amplatz dilator over the central Alken dilator. The operative duration, with X-ray exposure, was calculated. The procedure outcome in terms of complications, stone-free rates and hospital stay was evaluated statistically. Results : The tract was dilated correctly in all cases. The operative duration and X-ray exposure was shorter in patients undergoing single-step RD (P &lt; 0.05). There were perioperative complications, according to the Clavien grading system, in 15 (25%) patients but there was no statistically significant difference between the groups. The stone-free rates were comparable in both groups. Conclusion : A single-step RD during PCNL is feasible, with a shorter operative duration and X-ray exposure. The outcomes were comparable with those of a standard metallic telescopic RD Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.70-73

Comparison of percutaneous cystolitholepexy with vesicolithotomy in peadiatric age group for safety and efficacy.

Objectives: Urolithiasis is the common disease of tropical and subtropical areas and in children, the urinary bladder is the most common site for stone formation in the lower urinary tract. Which account for 5% of urinary calculi .Most common cause of vesical stone is dietary deficiencies, treatment options are continuously refine from vesicolithotomy to scar less procedures, aim of this refinement to reduce the morbidity and complication. The purpose of study to evaluate post-operative outcome in terms of safety and accuracy of percutaneous cystolitholapaxy (PCVL) with open vesicolithotomy in children having Vesical stones. Study Design: Retrospective Comparative study. Setting: Department of Urology Sheikh Zayed Hospital Rahim Yar Khan. Period: January 2018 to December 2018. Material &amp; Methods: Data collected of 15 patient who underwent for open vesicolithotomy (group-I) and 15 children underwent for PCCL (group II) the patients' age ranged from 1 year to 10 years. The stone size ranged from 1cm to 3cm in both groups, the procedure was performed under anesthesia with intubation. Dilation of the tract was made with help of alken metallic dilators. We use the adult nephroscope with 24Fr sheath, the same which used for PCNL. Pneumatic fragmentation was required for stones larger than 1.5 cm. Results: Procedures completed with complete stone clearance. The average hospital stay was 2.1 days in group I and 1.0 in group II. Analgesia requirement were 29.3 vs 12.3mg. in group I, six patients (40%) had fever while in group II only one patient(6.7%) has fever. 5 patients observed with hematuria in group I while In group II it was observed in 2 patients. Conclusions: PCCL is a minimal invasive procedure with less morbidity in term of postoperative pain, urinary leakage, fever and hospital stay, and it is a cost effective option for small vesical stones.

Feasibility and safety of tract dilation under ultrasound guidance in standard percutaneous nephrolithotomy

Objective To investigate the feasibility of tract dilation monitored by ultrasound in percutaneous nephrolithotomy (PCNL), and the risk factors for its failure. Methods A retrospective study was conducted on patients underwent PCNL with only one access (F24) using balloon dilator and sequential dilators (Amplatz and telescopic metal dilators) from December 2014 to December 2018 in Beijing Tsinghua Changgung Hospital. A total of 231 patients (130 males and 101 females) underwent ultrasound-guided PCNL with a mean age of (52.3±9.8) years were included in our study. Mean BMI was (25.8±3.1)kg/m2. Mean size of stone was (3.9±1.1)cm, 51.1% (118/231) of which were staghorn stones. Under ultrasound guidance, after puncture of the target calyx, the balloon dilator was advanced through the guide wire, and inflated to establish the F24 standard renal access. Patients’ clinical parameters such as age, gender, BMI, stone diameter, history of open nephrolithotomy were collected. Risk factors for the failure of ultrasound guided balloon dilation were analyzed by logistic regression analysis. Results Tract dilation succeed in 89.2 % cases (206 succeed, 25 failed) at first attempt. Median tract dilation time was 4.2 min (2.2-8.0 min). Mean operation time was 85.5 min(45.0-120.0 min). Median hemoglobin drop at the first postoperative day was 16.0 g/L (5.0-25.8 g/L). The total rate of complication was 9.1% (21 cases), including 18 cases Clavien Ⅰ and 3 cases Clavien Ⅱ. The stone free rate was 89.6%(207/231). Logistic regression analysis revealed that lower pole access (P=0.014) was a risk factor for the failure of access establishment, while the presence of hydronephrosis of target calyx (P<0.001) would significantly increase the success rate. Conclusions Tract dilation using balloon catheter can be safely monitored by ultrasound with high success rate and low complication rate. Lower pole puncture will make tract establishment difficulty. Patients with a hydronephrotic target calyx are more suitable for this procedure. Key words: Kidney calculi; Percutaneous nephrolithotomy; Ultrasound guidance; Balloon dilation

Tract dilation monitored by ultrasound in percutaneous nephrolithotomy: feasible and safe.

To investigate the feasibility and safety of tract dilation monitored by ultrasound in percutaneous nephrolithotomy (PCNL) and identify suitable patients for this technique. Patients who underwent PCNL with only one access (24Fr) using the balloon dilator or sequential dilators (Amplatz and telescopic metal dilators) from December 2014 to May 2018 in Beijing Tsinghua Changgung Hospital were retrospectively reviewed. Patients' demographic information, intra- and postoperative data were analyzed. Factors which would increase the success rate of ultrasound-guided balloon dilation were investigated by logistic regression analysis. There were 986 PCNLs performed. 207 cases underwent balloon dilation, while 411 underwent sequential dilation. The two groups did not significantly differ in age, sex, BMI, stone diameter, access location, operation time, postoperative complication rate, and stone-free rate. The balloon dilation group comprised 207 patients (115 males, 92 females) with a mean age of 51 ± 10years. Mean BMI was 25.2 ± 3.3kg/m2. Mean stone size was 3.6 ± 1.2cm, 47.3% of which were staghorn stones. Hydronephrosis of the targeted calyx occurred in 78.3% of patients. Within the balloon dilation group, tract dilation failed in 24 cases (11.6%) on the first attempt. The successful and failed subgroups had comparable outcomes. Multivariate analysis revealed that the risk factors for the failure of access establishment were the presence of staghorn stones (p = 0.032), prior ipsilateral open nephrolithotomy (p = 0.026), and lower pole access (p = 0.039), while the success rate was significantly higher in those with a hydronephrotic target calyx (p = 0.001). Tract dilation using balloon catheter can be safely monitored by ultrasound, and is most suited to patients with a hydronephrotic target calyx.

Safety and Efficacy of Percutaneous Nephrolithotomy in Patients with Large Stones

Aims: The aim of the study is to evaluate the safety and efficacy of tubeless percutaneous nephrolithotomy (PCNL) in patients with large stones. Subjects and Methods: From January 2011 to June 2016, 425 tubeless PCNLs were performed at our hospital. All patients underwent a single-stage procedure with a metal dilator. Of the 425 patients, 93 had stone sizes ≥5 cm (mean: 7.77 cm, Group 1) and 332 patients had stone sizes &lt;5 cm (mean: 2.75 cm, Group 2). Data analysis was performed using Statistical Package for the Social Sciences, V. 21.0. Numerical variables were compared by independent-samples t-test. Categorical variables were compared by Chi-square or Fisher's exact test as appropriate. P &lt; 0.05 was deemed statistically significant. Results: The duration of surgery was longer in Group 1 than in Group 2 (93.6 vs. 70.4 min, P &lt; 0.001). There were no significant differences between the two groups in the incidence of postoperative fever (8% vs. 7%) or sepsis (both 1%). In addition, no significant difference was observed in the length of postoperative hospital stays (3.05 vs. 3.2 days) although the transfusion rate was higher in Group 1 (6/93 vs. 4/332, P = 0.003). No other major complications or conversion to open surgery occurred in either group. Conclusions: Tubeless PCNL performed in patients with stones ≥5 cm in size has a reasonable and acceptably higher transfusion rate, with no other associated major complications.

Seldinger technique in repair of the parotid duct

Injuries to the parotid ducts are difficult to locate, assess, and repair, and traditionally, solid metal dilators and soft plastic tubes have had only limited success. We describe the Seldinger technique with a central venous catheter, which makes repair easier.

Intravesical migration of female urethral dilator: a case report of a new urologic emergency in the era of e-commerce

BackgroundThe introduction of foreign bodies in the female urethra for auto-erotic stimulation or in case of psychiatric disorders is not uncommon. The occurrence of intravesical migration of these objects makes it necessary to remove it shortly after insertion, since after long term permanence complications are likely to occurr.Case presentationA 47-year-old white female was referred at our Urology department for migration inside the bladder of a metallic urethral dilator used for sexual stimulation. An ultrasound study and an X-ray plate of the pelvis clearly visualized the presence of an object shaped like a rifle bullet located in the bladder. Twenty-four hours later, the patient reported its spontaneous emission through the urethra during micturition. This was confirmed by US and X-ray imaging.ConclusionsThe retrieval of foreign objects introduced through body orifices with purpose of sexual gratification is a known urological expertise. Curiously, in the case reported, the patient was able to manipulate the object thus facilitating its correct orientation and passage outside the bladder during micturition. To the best of our knowledge this is the first case of documented spontaneous emission through the urethra of a sizable intravesical foreign body. Sexual gratification in females though the insertion of urethral dilators is a growing practice, as demonstrated by the broad proposal of such instruments on the web. Therefore, the occurrence of accidental intravesical displacement of such kind of foreign body is increasingly likely, and the Urologists must be aware of this possibility.