double-J Stent Placement Research Articles

Spontaneous Rupture of Pelvicalyceal System in a Horseshoe Kidney Presenting as Acute Abdomen

Abstract Horseshoe kidney is the most common congenital renal fusion anomaly. It is more prone to complications such as pelviureteric junction obstruction and renal stones. Spontaneous rupture of the urinary collecting with urinoma has never been reported in a horseshoe kidney in literature. Spontaneous rupture of the renal pelvis is a rare event even in orthotopic kidneys and can be due to obstructing calculus. Spontaneous rupture in the horseshoe kidney can mimic acute abdominal conditions. We report a case of a 29-year-old man who presented in the emergency department with severe mid-abdominal pain. Contrast-enhanced computed tomography (CT) evaluation of the abdomen showed contrast extravasation outside the right pelvicalyceal system with pelviureteric junction obstruction in a horseshoe kidney with extensive collection in the subhepatic, subdiaphragmatic, and right pleural region. The patient underwent a double-J stent placement which was followed by complete healing of the urinary leak and underwent definitive open pyeloplasty after 3 months. Diagnosis and therapeutic challenges in this rare case are being discussed.

The effect of training given to patients who underwent ureteroscopy with double-J stent placement on anxiety before and after surgery and readiness for discharge.

Patient education is effective in reducing the level of anxiety before and after surgery and increasing the level of readiness for discharge. Patient education provided by nurses can be planned and applied individually. Therefore, this study aims to determine the effect of the education in whom a double J stent after ureteroscopy on their pre- and postoperative anxiety and levels of readiness for discharge. This research study is a randomized controlled trial with control and intervention groups, pre- and posttests. This study was conducted between November 2021 and May 2022 in a university hospital in Turkey. The patients were divided at random into two groups, control (n = 61) and intervention (n = 61). The Personal Information Form, State-Trait Anxiety Inventory (STAI-I, STAI-II), Surgery-Specific Anxiety Scale (SSAS), Readiness for Hospital Discharge Scale for Adult Patients-Short Form (RHDS/SF) and Readiness for Hospital Discharge Scale- Adult-Nurse Assesment Short Form (RN-RHDS/SF) were used to collect the data. The mean SSAS and STAI-I scores on the morning of surgery and before discharge were found to be significantly lower in the intervention group than the control group. The mean RHDS/SF and RN-RHDS/SF scores on the before discharge were found to be significantly higher in the intervention group than the control group. It was concluded that the education provided to the patients in whom a double J stent after ureteroscopy reduced pre- and postoperative anxiety and increased the level of readiness for discharge.

A forgotten double J stent with encrustation leading to pelvi-ureteric obstruction: A case report

Double J (DJ) ureteric stents are widely applied in urological operations, they maintain patient’s urinary system postoperatively, thereby accelerating recovery. Prolonged stent insertion is associated with complications. A 38-year-old woman presented with hematuria, right flank pain, and urinary tract infection. She underwent renal calculi removal 8 years ago. KUB radiograph revealed and indwelling DJ stent with vesical calculus and pyelonephritis. Ultrasound revealed a large bladder stone with mild right hydronephrosis. Computed tomographic (CT) urography revealed a DJ stent encrustation and further formation into core of the bladder stone. Cystolithotomy was performed, vesicle calculi retrieved. At 4 weeks, the patient presented with a right-side flank pain for which patient was evaluated with a contrast-enhanced CT urography which revealed a pelvi-ureteric junction obstruction with hydronephrosis. A pyeloplasty was performed and DJ stent was placed in situ, to be retrieved at 6 weeks. With improved biomaterials, design and technological improvements of DJ stents, patient’s discomfort is greatly reduced. As a result, DJ stents got left in place for a longer duration of time, and therefore high incidences of forgetfulness, retained DJ stents. Encrustation, however, is frequently encountered. Patient factors such as low education and socioeconomic status and patients living in far off rural places also contribute to forgotten indwelling stents. Authors recommend placement of DJ stents after pyeloplasty for treating pelvi-ureteric junction obstructions following long-term retained stents. Patient counseling, education, and strict follow-up should ensure a timely stent removal and improved patient safety. Effective patient counseling and awareness reduces incidences of forgotten indwelling stents and patient-related complications.

Management of Incidentally Detected Urinary Tract Calculus in Patients Awaiting Living Donor Liver Transplantation: A Protocol-Based Approach

BackgroundUrinary tract calculi (UTC) in patients awaiting living donor liver transplant (LDLT) requires proper management due to increased risk of infections in the post-liver transplant (LT) period. Materials and MethodsA retrospective analysis of records of LDLT recipients with UTC was conducted between July 2019 and July 2023. No prisoners or paid participants were included. ResultsThirty patients (25 women and 5 men) with a mean age of 44.45 ± 9.67 years, model of end stage liver disease with sodium (MELD-Na) of 20.5 ± 12.2 were diagnosed to have a UTC during pre-LT evaluation. Twenty-five patients had renal stones, whereas five patients had ureteric calculus (22 were unilateral and 8 were bilateral calculi). Fifteen patients underwent double J (DJ)-stenting prior to LT. The mean stone size in patients who underwent DJ stenting was 13.6 (±9.83) mm vs 4.78 (±5.3) mm in whom stenting was not done. Patients with preoperative DJ stenting had a significantly reduced hospital stay (18.5 ± 2.1 days), lower mortality rates (0%), and lower rates of hematuria (6.66%) vs (23.4 ± 12.8 days, 13.33% and 13.3%, respectively). Patients with preoperative DJ stenting underwent post-transplant definitive procedure for UTC without any complications.Our Protocol for Incidentally Detected Ureteric Stones in LT Recipients:a. Proximal-ureteric calculi: Preoperative DJ stenting (2-3 days prior/ on day of LT) → LT → ESWL/URS 2-3 weeks later → DJ stent removal after 2-3 weeks.b. Distal-ureteric calculi: Preoperative DJ stenting ± URS (2-3 days prior/ day of LT) → LT → DJ stent removal after 2-3 weeks.Our protocol for incidentally detected renal stones in LT recipients:a. Stone size (< 5 mm) and nonobstructive calculi with no active UTI:No surgical intervention → Liver transplant under antibiotics cover → medical management of stone.b. Multiple calculi sized < 5 mm or single stone 5-10 mm:DJ stent placement → LT → ESWL/RIRS after 4-6 weeks → DJ stent removal after 3 weeks.c. Single stone size > 10 mm or multiple calculi > 5 mm:DJ stent placement → LT → RIRS/PCNL after 4-6 weeks→DJ stent removal after 3-4 weeks. ConclusionA systemic minimally invasive approach is needed for pre-LT management of UTC for better patient outcomes.

Transvaginal double-layer parallel in-situ suturing for early complex vesicovaginal fistula repair: Case report.

Complex vesicovaginal fistulas (VVFs) with large defects pose significant surgical challenges. Traditional repair methods often require extensive tissue separation and multilayer suturing, risking local blood supply and healing. This study introduces a novel modified transvaginal repair technique that simplifies the procedure while preserving tissue vascularity. It employs double-layer parallel in situ suturing for early repair of complex VVF. A 50-year-old woman was admitted with continuous vaginal urine leakage for 4 days following trauma. Speculum examination revealed a 3-cm longitudinal oval laceration at the 11 o'clock position in the dorsal lithotomy site, with continuous fluid leakage through the fistula. Self-inflicted complex VVF. The patient underwent prophylactic placement of bilateral double-J stents and continuous catheterization, followed by surgical repair using a modified transvaginal technique involving double-layer parallel in situ suturing. Postoperative evaluations showed successful healing with no urinary leakage. The vaginal sutures were removed on day 24, and follow-up at 1 year confirmed no recurrence of the fistula or lower urinary tract symptoms, significantly improving the patient's quality of life. The modified transvaginal repair technique using double-layer parallel in situ suturing is a simple and effective approach for early repair of complex VVF, highlighting its potential for broader clinical application. Future studies with larger cohorts are needed to validate these findings.

Novel Stanley Stent Symptom Status Score (s5 score) for predicting ureteral stent-related symptoms

Background It is a known fact that endourological procedures frequently require placement of double J (DJ) ureteral stent. These patients can have stent-related symptoms (SRS) after DJ stent placement which can be distressing with increased morbidity. Though intraoperative and postoperative factors for SRS have been studied, research work is deficient in preoperative prediction of these symptoms which is the need of the hour. Thus, we aim to find out the factors which can lead to SRS after ureteroscopic lithotripsy (URSL) surgeries. Further, we aim to establish a scoring system which will help us predict the possibility of SRS and take necessary actions to minimise them.Materials and methodsOur study includes 150 URSL cases with DJ stenting where we correlated various factors with the presence of SRS. Information regarding preoperative, intraoperative and postoperative factors which may lead to SRS were noted down. All patients completed Ureteral Stent Symptom Questionnaire (USSQ) to evaluate the symptoms at 1 and 3 weeks after stent placement and 1 week after removal of the stent. The statistical data were evaluated using SPSS 24 Statistics.ResultsIn our study, we found that SRS correlated statistically with factors namely body mass index (BMI) > 25 kg/m2, loin pain, stone size > 1 cm, haematuria, bilateral stone disease, incomplete distal curl, distal end crossing midline and these could predict the occurrence of SRS. Based on the significant preoperative factors, we constructed the Stanley Stent Symptom Status Score (S5 Score) which predicts the possibility of developing SRS.ConclusionThorough understanding of factors which can lead to SRS can help us take steps to reduce the morbidity related with this frequent procedure. Stanley Stent Symptom Status Score (S5 Score) predicts the occurrence of these symptoms preoperatively. This score is first of its kind which will pave the way for deeper understanding and prediction of these symptoms preoperatively.

The safety and efficacy of through-and-through wire technique for ureteral Double-J stent placement.

To evaluate the efficacy and safety of the through-and-through wire (TTW) technique for antegrade ureteral Double-J stent placement after failure of either antegrade or retrograde ureteral stent placement. This retrospective study analyzed the medical records of consecutive patients who underwent Double-J stent placement with the TTW technique at Asan Medical Center and Gil Medical Center between January 2016 and February 2023. Patient histories, reasons for employing the TTW technique, TTW pathways, and complications were reviewed. Eight patients were included in the study. The reasons for using the TTW technique were failure to advance a larger-diameter catheter, balloon catheter, or Double-J stent passing over the guidewire beyond the stricture (6/8, 75.0%); failure to negotiate the stricture with a guidewire (1/8, 12.5%); and guidewire passing through a ureteropelvic junction defect (1/8, 12.5%). TTW was applied either between a percutaneous nephrostomy (PCN) and the urethral orifice (n=4), between a PCN and an ileostomy pouch (n=3), or between a left and right PCN (n = 1). Urologic assistance was required for retrograde ureteral cannulation in one male patient (12.5%). Subsequently, balloon dilation and/or Double-J stent placement were performed in all eight patients, resulting in 100% technical success. No major or minor complications occurred. The TTW technique was safe and effective in the undertaking of PCN and antegrade Double-J stent placement in patients for whom either antegrade or retrograde access had failed.

Primary pyeloplasty for uretero-pelvic obstruction in the USA adult population with or without double-J indwelling ureteral stents. Insurance claims data on contemporary time to removal trends, perioperative complications, health care costs, and re-intervention rates.

Using a large population-based dataset, we primarily sought to compare postoperative complications, health-care expenditures, and re-intervention rates between patients diagnosed with ureteropelvic junction obstruction (UPJO) undergoing stented vs. non-stented pyeloplasty. The secondary objective was to investigate factors that influence the timing of DJ stent removal. Patients ≥18 years old with UPJO treated with primary open or minimally-invasive pyeloplasty were identified using the Merative™ Marketscan® Databases between 2007-2021. Multivariable modeling was implemented to investigate the association between Double-J (DJ) stent placement and post-pyeloplasty complications, hospital costs, and re-intervention rates and the role of the perioperative predictors on time to DJ stent removal. Subgroup analyses stratified by ureteral stenting duration were additionally performed. Out of 4872 patients who underwent primary pyeloplasty, 4154 (85.3%) had DJ placement. Postoperative complications were rare (N.=218, 4.47%) and not associated with ureteral stenting (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.55-1.12). The median cost for in-hospital charges was $21,775, with DJ stent placement independently increasing the median aggregate amount (OR: 1.29, 95% CI: 1.09-1.53). Overall, re-interventions were performed in 21.18% of patients, with DJ stenting found to be protective (OR: 0.79, 95% CI: 0.66-0.96). Higher Charlson Comorbidity Index, longer hospital stay, and open surgical approach were independent predictors for prolonged DJ stenting time to removal. Our study suggests that patients undergoing stent-less pyeloplasty did have a higher rate of secondary procedures, but not higher complications when compared to those undergoing stented procedures. Concurrently, the non-stented approach is associated with decreased health-care expenditures, despite the increased rates of secondary procedures.

Ex Vivo Porcine Model for Ureteral Stent Placement Training

Realistic simulation models for interventional radiology procedures are limited, including for placement of double-J ureteral stents (DJSs). Using a porcine kidney and empty saline bag (bladder), an ex vivo model aiming to improve operators’ knowledge and confidence in performing a DJS procedure was developed. Six faculty (J.W., J.L.) and 14 trainees (C.B.O.) successfully operated on the model. Mean results for faculty versus trainees were as follows: 2.2 (SD ± 1.5) versus 2.4 (SD ± 1.5) puncture attempts to access the collecting system (P = .78), 14.5 minutes (SD ± 4.8) versus 15.1 minutes (SD ± 6.0) for insertion time (P = .84), 7.3 minutes (SD ± 2.8) versus 10.3 minutes (SD ± 2.6) for exchange time (P = .04), 8.48 minutes (SD ± 2.0) versus 8.01 minutes (SD ± 2.6) for fluoroscopy time (P = .70), and 5.7 mGy (SD ± 1.6) versus 5.4 mGy (SD ± 2.0) for absorbed air kerma (P = .77). Self-assessed knowledge and confidence with DJS placement increased for all participants following model use.

Success rate and complications of performing elective ureteroscopy in

The aim of this study was to compare the outcomes, success rate, and complications of performing elective ureteroscopy at different times: <1 week from renal colic initiation (early) and more than 1 week from renal colic initiation (late) in patients with ureteral stone larger than 6 mm. This comparative observational study was conducted on 338 consecutive patients. Patients were evaluated in two groups: patients who underwent ureteroscopy in <1 week (A) and patients who underwent ureteroscopy in more than 1 week (B) from renal colic initiation. Helical unenhanced computed tomography was used to assess the size, location, and hardness of stone for all patients. Operation success was defined as complete clearance of stone with no stone residue (stone free) at 2-week postoperative ultrasonography with no need to further interventions. Operation data were collected using medical records, and postoperative complications were investigated at 2 weeks postoperative follow-up visits. Group A included 165 patients and Group B included 173 patients. The overall mean stone size was 8.60 ± 1.12 mm: for Group A 9.13 ± 0.94 mm and for Group B 8.10 ± 1.04 mm (P < 0.001). Stone residues were found in 11 patients: 9 in Group A (5.4%) and 2 in Group B (1.1%) (P = 0.026). Nine patients needed repeated ureteroscopy: 8 (4.8%) in Group A and 1 (0.6%) in Group B (P = 0.015). A double-J stent was used for 85 (51.5%) patients in Group A and 66 (38.2%) patients in Group B (P = 0.016). Major intraoperative complications did not happen in any patients. Fifty-three (32.1%) patients in Group A and 28 (16.2%) patients in Group B suffered from postoperative complications (P = 0.001). Our study revealed that performing elective ureteroscopy with an interval of more than 1 week from the onset of renal colic in combination with medical treatments was associated with less need for double-J stent placement, less need for repeated ureteroscopy, and fewer postoperative complications compared to performing elective ureteroscopy in <1 week from the renal colic onset in nonemergent patients with ureteral stone larger than 6 mm. Although the rate of ureteroscopy failure was higher among the patients who underwent ureteroscopy in <1 week from their renal colic initiation, there was no statistically significant relationship between performing ureteroscopy in <1 week and an increased risk for ureteroscopy failure.

BK Viremia and Viruria Does Not Depend on the Type of Double-J Stent Used During Kidney Transplantation.

BK virus is a major cause of chronic renal allograft failure.Transplant ureteral stent use has been reported as a risk factorfor BK virus infection. Recently, the use of a new type of ureteral stent (Magnetic Black Star) was reported in kidney transplant recipients. The aim ofthis preliminary report was to compare BK virus viremia and viruria occurrence depending on the type of double-J stent (standard versus Magnetic Black Star). We included all kidney transplants performed in our center from January to December 2022. Each case had double-J stent placement. Indwelling stents were either a 6- or 7-Fr standard double-J stent or a 6-Fr Magnetic Black Star double-J stent. The type of double-J stent was chosen according to the surgeon's preference. A standard BK virus screening protocol was followed during the study period, which consisted of routine polymerase chain reaction examination of plasma and urine samples during monthly follow-ups. We assessed 120 patients without missing data: 92 patients received standard double-J stents and 28 patients received Magnetic Black Star stents. Patients were mostly male in the standard group (70.7%) versus the Magnetic Black Star group (42.9%) (P = .01). ABO- and HLA-incompatible transplant rates were similar in both groups. BK viremia occurrence and BK viruria occurrence were similar between groups at 1 month, 3 months, and 6 months. This preliminary study showed no differences concerning BKvirus infection depending on the type of double-J stents used during kidney transplant.

Comparison Efficacy between Percutaneous Nephrostomy and Double J Stent in Management of Obstructive Uropathy

Background: The prevalence of urolithiasis and associated acute kidney injury (AKI) has seen a notable increase in recent decades, particularly in developing countries such as Pakistan, which falls within the "stone forming belt" region. This rise has underscored the need for effective management strategies for obstructive uropathy, a potentially reversible condition if timely intervention is provided. However, the literature reveals a divergence in treatment approaches between different regions and among healthcare professionals, with no universally recommended treatment for relieving the obstructed system. Objective: This study aimed to evaluate and compare the efficacy of percutaneous nephrostomy (PCN) versus Double J stent (DJS) in the management of obstructive uropathy secondary to urolithiasis in patients with elevated serum creatinine levels. Methods: Conducted as a randomized controlled trial at the Jinnah Postgraduate Medical Center Karachi from January 2023 to December 2023, the study included patients aged 20 to 50 years with obstructive uropathy secondary to urolithiasis and serum creatinine above or equal to 2.0 mg/dL. Exclusion criteria encompassed obstructive uropathy due to bladder outlet obstruction, uncontrolled coagulopathy, and lack of consent. Participants were randomized into two groups for either PCN or DJS placement, with pre-operative and post-procedure serum creatinine and urea levels measured at multiple intervals. Data analysis was performed using SPSS version 25. Results: The study enrolled 30 patients in the PCN group and 30 in the DJS group. Efficacy rates for PCN and DJS were 93.3% (28 out of 30) and 76.7% (23 out of 30), respectively. Stratified analysis revealed no statistically significant differences in efficacy based on age, gender, or duration of illness, although a trend favoring PCN was observed in patients over 40 years and those treated within 5-10 days of illness onset. Conclusion: While both PCN and DJS are effective interventions for obstructive uropathy secondary to urolithiasis, PCN showed a non-significantly higher overall efficacy. These findings suggest a potential preference for PCN in certain patient subsets, though further research with larger sample sizes and multi-center trials is needed to substantiate these observations.

Development of the self-management scale for urolithiasis patients with indwelling double-J tube

PurposeTo develop a specific self-management scale applicable to patients with indwelling double-J tube in urolithiasis, and to test its reliability and validity.MethodsThe construction and validation of our scale involved three stages. First, an initial version of the questionnaire was formed through literature analysis, group discussions, semi-structured interviews, and the Delphi method. Second, a pre-survey was conducted with 20 urolithiasis patients with indwelling double-J stent placement to test their understanding of the initial questionnaire items and its acceptability. Finally, a formal survey of 234 patients with indwelling double-J tube for urolithiasis was conducted, and the scale was tested for reliability and validity.ResultsAfter the three stages, a specific self-management scale for urolithiasis patients with indwelling double-J tube was developed, consisting of 30 items across five dimensions with a cumulative contribution rate of 52.541%. The content validity index for item level ranged from 0.8 to 1, and the content validity index for the questionnaire level was 0.93. The correlation between each item and its dimension was > 0.4. The Cronbach’s alpha coefficient for the overall questionnaire was 0.910, and the Cronbach’s alpha coefficients for each dimension ranged from 0.672 to 0.865. The split-half reliability of the overall questionnaire was 0.864, and the split-half reliabilities for each dimension ranged from 0.659 to 0.827. The test–retest reliability of the overall questionnaire was 0.840, and the test–retest reliabilities for each dimension ranged from 0.674 to 0.818.ConclusionThe specific self-management scale for urolithiasis patients with indwelling double-J tube has good reliability and validity, and it is a reliable and effective tool for evaluating and assessing the self-management level of patients with indwelling double-J tube in urolithiasis.

Efficacy of combined phytotherapy (NefroBest® and UroBest®) in female patients with urolithiasis and preoperative drainage of upper urinary tract before ureteroscopy

Introduction. In most cases, double-J stent placement is the initial method of drainage in patients with urolithiasis. Until ureteroscopic intervention, most patients report «stent-related symptoms» that reduce the quality of life.Objective. To improve the results of treatment in female patients with urinary stone disease (USD) and preoperative drainage of the upper urinary tract using double-J stent by assessing the effect of the NefroBest® and UroBest® complexes on the prevention of the development of «stent-related symptoms» and inflammatory processes.Materials &amp; methods. The study group included 90 female patients with USD, who were performed ureteroscopic interventions with preoperative stent placement from March to September 2023 in the Yudin City Clinical Hospital. Patients were divided into two groups: the main group 1 (n = 30) — patients who received phytotherapy with NefroBest® (30 days) and UroBest® (7 days) complexes after placement of an internal ureteral stent; the control group 2 (n = 60) — patients who did not receive specific therapy postoperatively.Results. According to the USSQ, in group 1 the median score due to urinary symptoms was 22 points, and in group 2 — 28 points (p = 0.001), when assessing symptoms associated with pain — 12 and 18 points (p &lt; 0.001), general health — 17 points both and work performance — 9 and 11 points, respectively. Among patients in group 1, stonefree rate was observed in 90.0%, and among patients in group 2 — in 93.3%. In group 1, antibacterial therapy in the postoperative period was in 37.0% of patients, and in group 2 – among 53.0%.Conclusion. The co-use of the NefroBest® and UroBest® complexes in female patients with USD and preoperative drainage of the upper urinary tract using double-J stent can reduce the severity of symptoms associated with urination and pain, and postoperatively resulted in a lower incidence of infectious-inflammatory complications.

Stent-ception: implementation of soft double-J stents in the ureteric Memokath-051&lt;sup&gt;TM&lt;/sup&gt; in bilateral ureteric stricture post radiotherapy for advanced prostate cancer

Narrowing of ureter can be due to malignant or benign causes. Temporary double-J (DJ) stents, various metallic stent designs, or definitive corrective surgery can be the options management for ureteric stricture. As an alternative from DJ stents, Memokath-051TM (MMK-051TM) can be inserted in strictured ureters post radiotherapy for advanced prostate cancer patients. We present a case of an advanced prostate cancer which bilateral DJ Stents placed within MMK-051TM. A 76-year-old man with underlying hormone sensitive advanced prostate cancer completed radiotherapy. Post radiotherapy he developed bilateral ureteric strictures and bilateral DJ stents inserted. He had to underwent multiple change of stents due to blockage. Patient had MMK-051TM inserted, however complicated with blockage due to encrustation. Improvisation method done by putting the bilateral DJ stents within the MMK-051TM. Patient had no more blockage of MMK-051TM after the placement of DJ stents within it. However, patient succumbed to death a year after the last procedure. Our case report highlighted encrustation of metallic ureteric stents and a novel approach to overcome this problem. Introduction of additional DJ stents not only reduced the incidence of MMK-051TM blockage but also improved the quality of life of the patient.

Comparison of the One-Step Prone Split-Leg Position to the Traditional Prone Position for Percutaneous Nephrolithotomy: A Single-Center Retrospective Study.

To evaluate the one-step prone split-leg position compared to the traditional prone position for percutaneous nephrolithotomy (PCNL). This study retrospectively analyzed the clinical data for 102 patients with upper urinary tract calculi who underwent PCNL at our hospital from April 2019 to December 2022. All PCNL procedures were performed by the same senior urologist. According to different surgical positions, the patients were divided into a one-step prone split-leg position group (observation group, n = 39) and a traditional bladder lithotomy position followed by prone position group (control group, n = 63). Then, the two groups were compared regarding the time of catheter insertion and channel establishment, channel size, time required for double-J stent placement, total operative time, postoperative hospital stay, stone removal rate, secondary operation rate and postoperative complications. There was no significant difference in the preoperative baseline characteristics of the patients between the two groups (all P > .05). Patients in the observation group had shorter total operative times, higher stone removal rates (76.9% [30/39] vs. 57.1% [36/63], P = .042), and lower secondary operation rates (10.3% [4/39] vs. 28.6% [18/63], P = .029) than those in the control group. There were no significant differences in the time of working channel establishment, channel size, postoperative hospital stay, or postoperative complications between the two groups (all P > .05). The one-step prone split-leg position is a safe and reliable surgical posture for treating upper urinary calculi in PCNL patients. It can not only shorten the overall operation time of PCNL but also improve the stone removal rate of the operation, thus reducing the secondary operation rate of multiple renal stones.

Fluorescence guidance during robotic resection of bladder wall endometriosis: case report and technique.

The application of indocyanine green (ICG) has recently been reported to aid in the resection of endometriosis in the bladder wall and/or involving the ureters. A symptomatic 41-year-old patient with dysmenorrhea and pollakisuria was referred to our tertiary center. Imaging revealed a 1.5-2cm intramural endometriotic nodule in the posterior bladder wall. She was planned for robotic resection of the endometriotic nodule, under ICG guidance, together with a hysterectomy. After placement of double-J ureteral stents and clamping the bladder, perforation of the bladder mucosa could be avoided whilst performing a circumferential resection of the nodule. By clamping the bladder catheter after instillation of ICG, both the bladder wall thickness and ureters could be visualized with near-infrared imaging during robotic resection of the endometriotic nodule and hysterectomy. With the surgical approach described here, endometriotic nodules/tissue can be removed precisely with enlarged vision at the robot console, safely, and completely without damaging adjacent tissues.

Combined endoscopic approaches in management of complicated forgotten double J stent: A case report

Forgotten Double J (DJ) ureteric stent with encrustation is a source of morbidity and unrequired admission. It is prevalent due to a lack of patient education and follow-up in third-world countries like Nepal. A case is reported of 30 years gentleman who had underwent right pyelolithotomy for large staghorn calculus and placement of DJ stent after surgery. The patient presented with encrusted, retained DJ stent which was managed with endoscopic combined intrarenal surgery with retrieval of the forgotten DJ stent.

Abdominal pregnancy secondary to uterine horn pregnancy: a case report

BackgroundPregnancy begins with a fertilized ovum that normally attaches to the uterine endometrium. However, an ectopic pregnancy can occur when a fertilized egg implants and grows outside the uterine cavity. Tubal ectopic pregnancy is the most common type (over 95%), with ovarian, abdominal, cervical, broad ligament, and uterine cornual pregnancy being less common. As more cases of ectopic pregnancy are diagnosed and treated in the early stages, the survival rate and fertility retention significantly improve. However, complications of abdominal pregnancy can sometimes be life-threatening and have severe consequences.Case presentationWe present a case of intraperitoneal ectopic pregnancy with fetal survival. Ultrasound and magnetic resonance imaging showed a right cornual pregnancy with a secondary abdominal pregnancy. In September 2021, we performed an emergency laparotomy, along with additional procedures such as transurethral ureteroscopy, double J-stent placement, abdominal fetal removal, placentectomy, repair of the right uterine horn, and pelvic adhesiolysis, in the 29th week of pregnancy. During laparotomy, we diagnosed abdominal pregnancy secondary to a rudimentary uterine horn. The mother and her baby were discharged eight days and 41 days, respectively, after surgery.ConclusionsAbdominal pregnancy is a rare condition. The variable nature of ectopic pregnancy can cause delays in timely diagnosis, resulting in increased morbidity and mortality, especially in areas with inadequate medical and social services. A high index of suspicion, coupled with appropriate imaging studies, can help facilitate its diagnosis in any suspected case.

Efficacy Evaluation of Smartphone-based Stent Tracking Application in Follow-up Patients with Ureteral Stents: A Prospective Study

Objective: Our objective was to determine how effectively our smartphone app improved follow-up compliance in ureteral stent patients. Materials and Methods: Two groups of patients who underwent double-j stent placement were compared. For the traditional program (i), retrospective data from January 2021 to June 2021 was collected. We randomly selected 72 patients from the overall 121 patient data. For the smartphone-based stent tracking program (ii), a smartphone application was used from July 2022 to January 2023 to track 72 patients. Result: The rate of poor compliance in group (ii) (4.2%), was significantly lower (p=0.004) than the rate of poor compliance in group (i) (19.4%). Differences in diagnosis between the two groups were not found to be related to the compliance rates. Surprisingly, kidney transplant patients in both groups had perfect compliance. Conclusion: Smartphone-based stent tracking application increased patient compliance to appointments in patients who underwent double-j stent placement. This study is a demonstration of how technology can assist patients to better health care and can prevent complications.