Pneumatic Lithoclast Research Articles

Safety and Cost-effectiveness of Mini Percutaneous Nephrolithotomy as Day Care Surgery in Paediatric Patients

Background: The increasing prevalence of urolithiasis in paediatric populations necessitates the exploration of efficient and safe treatment modalities. Mini percutaneous nephrolithotomy (PCNL), traditionally an inpatient procedure, has evolved with advancements in surgical techniques and pain management, prompting its consideration as a day care surgery. Objective: This study aims to evaluate the safety, efficacy, and cost-effectiveness of day care mini PCNL in paediatric patients with kidney stones. Methods: This prospective quasi-experimental study was conducted in a pediatric urology department. Patients aged 3 months to 14 years presenting with kidney stones were included. The procedure involved using a 16Fr mini PCNL nephroscope under general anesthesia and fluoroscopic guidance. Stone fragmentation was achieved using a pneumatic lithoclast, and fragmented stones were retrieved with wash and bifrong forceps. Inclusion criteria were stringent, considering factors like stone size, surgery duration, and patient recovery. Postoperative management included early mobilization, oral antibiotics, and analgesics. Follow-up was scheduled at 1 week and 1 month postoperatively. Data analysis employed SPSS version 20, focusing on variables like age, operative time, readmission rates, and cost comparisons. Results: The study involved 92 patients, with a gender distribution of 71.7% male and 28.3% female. The average stone size was 2.2 ± 0.7 cm, and the mean operative time was 74 ± 16 minutes. The mean hospital stay was 11 hours, with readmission rates of 6.7%. The cost savings in day care mini PCNL were significant, with an average reduction of 8000 PKR per procedure compared to inpatient care. The success rate of day care surgery was 93.7%. Conclusion: Day care mini PCNL is a viable, safe, and cost-effective treatment option for pediatric patients with kidney stones. It offers reduced hospital stay, lower costs, and high patient satisfaction without compromising on safety or treatment efficacy.

The Effectiveness of Cefazolin Prophylaxis on Infection after Transureteral Lithotripsy: A Randomized Clinical Trial

BACKGROUND: Transureteral lithotripsy (TUL) is one of the most common surgeries in urology, and many TUL procedures have been performed with antibiotics prophylaxis. The present study investigates the effect of antibiotic prophylaxis on the rate of urinary infection after TUL. METHODS: This double-blind, randomized clinical trial was conducted on 158 patients with ureteral stones, with 79 in each group: the prophylaxis cefazolin group (Group A) and the placebo group (Group B). The patients were referred to Imam Hassan Hospital in Bojnurd, Iran. The standard technique of TUL operation was performed using a pneumatic lithoclast and a semirigid 9/8/Fr ureteroscope. The bacterial isolates were identified through growth on EMB agar and blood agar. Antimicrobial sensitivity testing (AST) was carried out by disc diffusion technique. Top of Form RESULTS: According to our results, 157 patients were eligible for analysis; 79 patients in Group A and 78 patients in Group B. Flank pain and urinary complaints were the most common symptoms. Our findings indicate that cefazolin prophylaxis did not show any significant differences in preventing postoperative infection between the two groups. E. coli accounted for eight 10.1% (8/79) Group A and 9% (7/78) in Group B, respectively. The results of AST for the 15 E. coli strains revealed a high rate of antibiotic resistance against ampicillin (73.3%). CONCLUSION: Our findings indicate that prophylactic antibiotic administration does not demonstrate effectiveness in reducing the infection rate following TUL surgery. Antibiotic prophylaxis is not recommended considering the potential adverse effects, cost implications, risk of antibiotic resistance, and lack of efficacy.

Effects of administration of local aminophylline on patients undergoing ureteroscopic lithotripsy.

The presence of ureteral stones can cause pain, infections of urinary tract and hydronephrosis, resulting in the loss of renal function. For two decades, Ureteroscopy and laser stone fragmentation (URSL) attained a big rise and is the first line management for large ureteric stones and renal stones up to 2 cm. The present study was conducted to assess the success rate of ureteroscopic lithotripsy in treatment of ureteric calculus after local administration of aminophylline. 100 patients having ureteric calculi <20 mm in size, aged 20-60 years were included in the study and randomly divided into Group A (n = 50) with administration of local aminophylline and Group B (n = 50) with administration of saline infusion. Ureteroscopy was performed after 5 min of administration of the solution. URSL was done using pneumatic lithoclast and/or laser. Various parameters like duration of procedure, ease of ureteral access, requirement of DJ Stent and need of further operative interventions were compared between case and control groups. The data was collected and then subjected to statistical analysis using IBM SPSS 20.0 version at significance level of p < 0.05. The mean age of study subjects having ureteral stones was found to be between 31 and 40 years of age with males being more affected. We observed less mean duration of surgery, higher success rate, easy ureteral access (p-value < 0.05) with aminophylline use than control group. The need of ureteral stent and Auxiliary procedures was significantly higher in the control than in the case group (38%). The use of aminophylline has been found to be highly useful and effective in reducing the need of stents and secondary surgery, decreased pain, and increased success rate. Thus, the use of aminophylline is recommended during URSL procedure for the successful management of ureteral calculi.

Our Experience of Semi-rigid Ureteroscopy with Pneumatic LithoClast for Impacted Upper Ureteric Calculi

Our Experience of Semi-rigid Ureteroscopy with Pneumatic LithoClast for Impacted Upper Ureteric Calculi

A comparison of suprapubic percutaneous versus transurethral approach for the treatment of vesical stone in male patients: prospective clinical trial

Abstract Background: Urolithiasis can affect all parts of the urinary tract (kidneys, ureter, urinary bladder, urethra, and even the prostate). The disease is usually symptomatic; however, a symptomatic disease can occur in some cases; vesical stones account for approximately 5% of urinary tract calculi. Objectives: In the present study, we try to compare two different techniques for endoscopic surgical treatment of vesical stone (transurethral versus percutaneous). Materials and Methods: This work involved 37 male patients with vesical stones; those patients split into two groups, the first treated by transurethral vesicolithotripsy while Group 2 (G2) treated by suprapubic vesicolithotripsy using pneumatic lithoclast system in both groups. Patients in both groups have been compared regarding operative time, stone clearance, postoperative hematuria, hospital stay, and some other parameters. Results: There was no clinical significance regarding the sizes and the number of vesical stones between the two groups of patients. The study showed the operative time was significantly shorter in G2 than in Group (G1); in addition to that postoperative hematuria was little in G2 than in G1. Stone clearance was also significantly higher in G2 than G1. Conclusion: We conclude that the suprapubic approach is better than transurethral approach for the treatment of vesical stones in male patients due to its higher efficacy and shorter operative time.

Ultraslim pneumatic lithoclast probe through single channel with dormia trapping the stone versus laser uerterolithotripsy in the treatment of ureteric stones; multicenter study

Ultraslim pneumatic lithoclast probe through single channel with dormia trapping the stone versus laser uerterolithotripsy in the treatment of ureteric stones; multicenter study

Comparative Analysis of Cystolithalopexy and Percutaneous Cystolithotripsy in Senior Pediatric Population Aged 6 to 15 Years

Background and Objectives: To compare cystolithalopexy and percutaneous cystolithotripsy in children 6 to 15 years based on complications. Methodology: The study includes 100 patients under the age of 6 to 15 years age, split into two groups called Group-A (45) and Group B. (55). Included were those patients with stones that were smaller than 20 mm in size (on average, 14 mm). Patients in Group-A received cystolithalopexy therapy utilizing a ureteroscope and a pneumatic lithoclast assisted by a Dormia basket. Patients in Group B received percutaneous cystolithotripsy therapy. Results: The age range of the 100 male pediatric patients ranged from 6 to 15 years (mean age 8 years). The average length of stay in the hospital was 2.5 days for patients in Group A and 3 to 8 days for patients in Group B. Patients in Group-A exhibited higher rates of urinary tract infections (8%) and urethral injuries (22%), residual stones (1%), enlarged bladders (2.2%), urinary retention (4.4%), and fever (13.33%). While in Group B, 18% of the members experienced urinary tract infections, 5% wound infections, 4% hematuria, 7% bladder size enlargement, and 27% fever. In each Group, urine retention was 7%. Conclusion: Pediatric male patients with vesicle calculus respond substantially better to cystolithalopexy because it requires less invasive surgery, leaves no scar, and has fewer complications. Keywords: Bladder Calculus, Comparison, Cystolithalopexy, Ureteroscope, Pneumatic Lithoclast, Dormia basket, percutaneous cystolithotripsy.

Efficacy of Pneumatic Lithoclast in Management of Different Metabolic Stones in Lower Ureter

Background: Management of ureteral calculi represents one of the complex problems in urological practice. Aim: To study the efficacy of pneumatic lithoclast as a management option for different metabolic ureteric stones. Study design: Descriptive study. Methodology: Study enrolled both male and female patients (n=60) above 12 years of age. Stone size and metabolic type was determined with determining the Hounsfield units of the stone on plain abdominal CT scan and matching them with the predetermined ranges for specific stone types. Renal transplant and cancer patients were excluded. SPSS v.26 analyzed the data. Mean±SD presented quantitative variables. Results: Calcium oxalate stones were most frequent and were observed in 32 (53.3%) patients followed by Struvite (18.3%). Almost 96.7% ureteric stones were cleared with pneumatic lithoclast. Conclusion: It was concluded that pneumatic lithoclast is an efficacious procedure in urology in clearing different metabolic stones in lower ureter thus advocates its routine use. Keywords: Pneumatic Lithotripsy, Metabolic Stones and Ureteric Stone.

To determine the outcomes of transurethral nephroscope for the treatment of large vesical stone with using pneumatic lithoclast

In this study, our aim is “to study the determine the outcomes of transurethral nephroscope for the treatment of vesical stones using pneumatic lithoclast”. Material and Methods: The detailed study was conducted in Department of Urology, Islam Medical &amp; Dental College/ Islam teaching/Central hospital Sialkot, from March 2019-March 2020 where we included 25 Male and 5 female who with vesical stones greater then 4 cm that was fragmented using the through transurethral use of a nephroscope via 26F amlplatz sheath. We took history from medical cards and conducted physical examinations, lab tests, urine culture and ultrasonagraphy of urinary tract. Then using the x-ray KUB film for stone clearance. We noted the mean age, operation time, presenting symptoms, complications and the post operative status of the stone clearane, and conducted our analysis using SPSS version 20. Result: The mean age ± SD was noted to be 48.79±12.499 years and male to female percentage being 89% to 11%. The mean stone size was 4.53±0.38 cm and mean operation time was 48.79±8.73 minutes. Thirty-one patients (31%) developed retention of urine and straining during micturition in (17%), dribbling of urine (15%) , hematuria (10%), frequent urination(10%) and abdominal pain was reported in 15% patients. Ninety-six (96%) patients achieved the stone-free status and had no complications while only 1 patient had an intravesical bleeding. Conclusion: We conclude that treatment of large stone using a nephroscope via a transurethral amplatz sheath is an effective procedure and quick too.We also noticed that the Amplatz sheath helps in pneumatic lithotripsy is indeed an effective and safe procedure to be carry out in patients with large bladder stones.

Early experience in ureteroscopy and pneumatic lithoclast in AL Hilla City

Introduction: Urological treatment of urinary calculi has changed much in the past 20 years (1). Endoscopic intra Ureteral lithotripsy has developed as the result of advances in techniques for uretroscopy and lithotripsy Aim of the study to determine the utility and the efficacy of pneumatic lithoclast in the treatment of uretric stone as early experience in AL- HillA city. Method: cross sectional study of one hundred patients with uretric stone with size ranged from (0.5-1.5 cm) and different level (upper, middle, lower Ureter 15, 20, 65 respectively) treated with uretroscopy and pneumatic lithoclast under general and spinal anesthesia. Result: About 90 patients have cleared from uretric stone within 2 weeks. The other 10patient’s not responding because Upward migration (6 patients), Ureteral perforation (4 patients). 50 patient’s need’s double j stenting at the end of the procedure because large number of fragments’ and due to hematuria. The other 50 patients not need double j stenting because small stone and easy to pass spontaneous. Conclusion: By conclusion early intervention is advisable .mid or upper ureteric stone also can deal with.

Diagnostic challenges in urethral calculi; an initial tertiary care study

Background. Kidney stone disease possesses a significant health burden not only to the family but also to the society. Sometimes, urethral stones are not expressed by typical manifestations, which can mislead clinicians in making the diagnosis. Materials and Methods. The investigation covers a period of 1 year and 6 months (Oct. 2020-Jan. 2022), carried out after obtaining the written informed consent of 22 symptomatic patients. KUB and pelvis X-ray (with or without perineal ultrasound) were performed after ethical clearance in a single center tertiary care hospital. Results. This study reveals male preponderance with no female patients, mostly in the age groups of 35-50 years (all being symptomatic). 54.54% have retention of urine and 45.45% with features of voiding lower urinary tract symptoms (LUTS); in 20% of cases, additional perineal ultrasound was performed to confirm the diagnosis. It is found that 63.63% of the stones were in the anterior part and 36.36% of the stones are in the posterior part of the urethra, 4.5% of the stones being radiolucent. Two patients were treated by meatotomy and 20 patients were treated by retrograde manipulation and fragmentation of stone by pneumatic lithoclast. Conclusions. In an extremely clinically suspicious case, an effective investigation, such as an X-ray of the pelvis and pelvis and/ or perineal ultrasound, can be used as the best diagnostic tools for urethral stones.

Comparing Holmium (Ho): YAG Laser with Pneumatic Lithoclast for Treatment Efficacy of Ureteric Stones

ABSTRACT Background: Holmium YAG (yttrium-aluminum-garnet) laser, a comparatively new technique, can clear all types and sizes of stones and is only being used in two institutes of Karachi, Pakistan. The study aimed to compare pneumatic lithoclast and holmium YAG laser, to evaluate stone-free rate (SFR), postoperative complications, operative duration, and effectiveness. Methods: This cross-sectional research included 60 patients with age 16-65 years having ureteric stones, reporting to kidney center, Urology Department, Karachi, Pakistan. CT Scan of Kidneys, Ureter, and Bladder (KUB) were used to record stone size, laterality, and location within the ureter. Patients were divided into two clusters of 30 each, group A (Ho: YAG laser) and group B (pneumatic Lithoclast) having 0.5 to 02 cm of size ureteric stones. An Independent two-sample “t” test was used to assess the difference for the continuous variables. A p-value of ≤0.05 was considered statistically significant. Results: Stone sizes distribution was 1.3±0.3cms and 1.4±0.3cms for A and B groups respectively (p=0.8). The insignificance of the p-value demonstrated no substantial divergence between both groups and stone sizes. Clearance from the proximal ureter was noted 26(84.6%) in group A and 41.7% in group B with (p&lt;0.05). A reduced lithotripsy activation period of 30.8±3.7mins was associated with stone size (p&lt;0.05). Conclusion: Holmium: YAG Laser had better stone-free rate (SFR), with 84% clearance than pneumatic. Improved and effective clearance reduces the risk of residual stones within a lesser time, required for getting back to normal life routines. Keywords: Lasers; Ureteric Stones; Ho: YAG Laser; Pneumatic Lithoclast; Kidney Stones.

CLINICAL PROFILE AND COMPARISON OF OUTCOME OF TREATMENT BY EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY AND URETERORENOSCOPY IN THE MANAGEMENT OF UPPER URETERIC CALCULI

Objective: Urinary calculi are the third most common affliction of the urinary tract, exceeded only by urinary tract infections and pathologic conditions of the prostate. This study was carried out to assess the safety, efficacy, and compare structural and functional outcome after treating the patients of the upper ureteric calculus with Extracorporeal Shock Wave Lithotripsy (ESWL) and Ureterorenoscopy (URS).&#x0D; Methods: A prospective study was conducted on patients with the upper ureteric stone of size 0.5–1.5 cm. A total of 50 patients were included in the study by means of systematic random sampling so as to get 25 patients in each category of ESWL and URS for the treatment of their upper ureteric calculi.&#x0D; Results: The age ranged from 15 years to 55 years. There were 36 males and 14 females in the study of 50 patients, 43 (86%) presented with pain, followed by 4 (8%) presented with hematuria. Twenty-eight (56%) of the patients had stone in the range of 0.5–1.0 cm, and 22 (44%) of the patients had stone in the range of 1.0–1.5 cm. Sixteen (32%) patients had stone within 2 cm of the pelvi-ureteric junction, and 13 (26%) had stone within 2 cm of the sacroiliac joint. Twenty-one (42%) patients had stone in between these two. Of the 50, 25 patients (50%) underwent shock wave lithotripsy, 25 patients (50%) underwent URS. In the ESWL group, 21 (84%) patients were stone-free after single sitting of ESWL. Four patients (16%) who required Re ESWL, after repeat ESWL two became stone-free however 2 (8%) patient of 1.0–1.5 cm category required secondary procedure, that is, URS and became stone free. To achieve stone-free 1.24 procedure was required per patients. Of the 25 patients in the ESWL group, 2 (8%) patient (one steinstrass case and one poor fragmentation case) required secondary procedure. They underwent URS. Both the patient belonged to 1.0–1.5 cm group. URS was done using semirigid ureteroscope using pneumatic Lithoclast. In our study, two patients of each 0.5–1.0 cm and 1.0–1.5 cm category did not become stone free. These four patients were subjected to ESWL and became stone free.&#x0D; Conclusion: The management of the ureteral stone should be decided on individual basis, based on stone size, location, symptoms, obstruction, and the availability of the instruments. For stones of 0.5–1.0 cm, ESWL is the treatment of choice for the upper ureteric stones, with very low Re- ESWL (1.12 sittings) without any requirement of ancilliary procedure. URS may be used for the upper ureteric stones but requirement of ancilliary procedure is high 11.11%. For stones between 1.1 cm and 1.5 cm, ESWL is the preferred modality of treatment for the upper ureteric stones.

A COMPARISON BETWEEN TRANSURETHRAL CYSTOLITHOCLASTY AND VESICOLITHOTOMY IN PEDIATRIC MALE PATIENTS

ABSTRACT&#x0D; BACKGROUND &amp; OBJECTIVE: To compare transurethral cystolithoclasty with ureteroscope over open vesicolithotomy in pediatric male patients.&#x0D; METHODOLOGY: Study comprises of hundred pediatric male patients, divided into two equal groups of 50 each, labeled as Group-A and Group-B. All the patients having stones less than 20mm size (average 14mm) were included. Group-A patients were treated with transurethral cystolithoclasty by using ureteroscope and pneumatic lithoclast assisted with the help of Dormia basket. Group-B patients were treated with open vesicolithotomy.RESULTS: All hundred male pediatric patients were between the ages of 1-15 years (mean age 8 years). Hospital stay was 2-3 days (average 2.5 days) in Group-A patients and 3-5 days (average 4 days) in Group-B patients. In Group-A3 (6%) patients had urinary tract infection, 1(2%) had urethral injury and 2(4%) had residual stone post-operatively. While Group-B4 (8%) suffered from urinary tract infection, 1(2%) had wound infection, 1(2%) had hematuria, and 2(4%) had fever. Retention of urine was 1(2%) in each Group.&#x0D; CONCLUSION: Transurethral cystolithoclasty is a much better way of treating vesical calculus in pediatric male patients because it is a procedure with short hospital stay, minimal invasion, no scar and less complication. KEYWORDS: Bladder Calculus, Comparison, Cystolithoclasty, Ureteroscope, Pneumatic Lithoclast, Dormia basket, Vesicolithotomy.

Comparison of three different endoscopic approaches in the treatment of bladder calculi.

BackgroundThis study compared the following three endoscopic techniques used to treat bladder stones: transurethral cystoscope used with a pneumatic lithoclast or nephroscope used with a pneumatic lithoclast and nephroscope used with an ultrasonic lithoclast. MethodsBetween January 2013 and May 2016, 107 patients with bladder stones underwent endoscopic treatment. Patients were classified into three groups based on the endoscopic techniques and energy modalities used in each group as: group 1 (transurethral stone removal using a cystoscope with pneumatic lithoclast), group 2 (transurethral stone removal using a nephroscope with pneumatic lithoclast), and group 3 (transurethral stone removal using a nephroscope with ultrasonic lithoclast). Baseline and perioperative data were retrospectively compared between three groups. ResultsNo statistically significant intergroup differences were observed in age, sex ratio, and stone size. A statistically significant intergroup difference was observed in the operation time—group 1, 71.3±46.6 min; group 2, 33.0±13.7 min; and group 3, 24.6±8.0 min. All patients showed complete stone clearance. The number of urethral entries was higher in group 1 than in the other groups. Significant complications did not occur in any patient. ConclusionNephroscopy scores over cystoscopy for the removal of bladder stones with respect to operation time. Ultrasonic lithoclast is a safe and efficacious modality that scores over a pneumatic lithoclast with respect to the operation time.

Outcome, Efficacy and Safety of Ureteroscopic Pneumatic Lithotripsy In Management of Lower and Mid Ureteric Calculi

OBJECTIVE: To determine the efficacy and safety of pneumatic lithotripsy in the treatment of mid and lower ureteric calculi.DESIGN: prospective study.DURATION: From 2014 to 2015SETTING: Department of Urology, AL-Diwaniya teaching Hospital.PATIENTS &amp; METHODS:Over a period of one year,one hundred (100) patients of ureteric stones were treated with pneumatic lithoclast. Twenty five (25) Stones were located in mid ureter, Seventy five (75) stones were located in lower ureter . Success rate was defined as symptom free, no residual stones larger than 2mm. General anesthesia was given to all patients.RESULTS:Over all success rate was 90%. Success rate in middle and lower ureteric stones were 82%, 92% respectively. Completely fragmented stones cleared spontaneously within two weeks in 95% of cases and all patients were free of stones one month after the procedure. In six (6) patients stone was migrated, later on submitted for ESWL and successful. Complications were encountered in 11% of cases and were managed conservatively.Hospital stay was 24 to 48 hours.CONCLUSION:Pneumatic lithotripsy is reliable, highly effective rapid, safe and cost effective treatment modality for ureteric stones with negligible incidence of complications.

COMPARATIVE STUDY OF LITHOTRIPSY AND MINIPERC IN 11 TO 18 MM IMPACTED PUJ CALCULI

Background: Impacted PUJ calculi are well known entity. Nephrolithiasis is a common disorder that accounts for significant cost, morbidity, and loss of work. Over last 3 decades considerable advances have been made in the management of kidney stone disease, still there is no single universally accepted and uniformly effective modality of treatment in medium size of impacted PUJ calculi. Aim: To study the efficacy of lithotripsy and MINIPERC in 11mm to 18mm impacted PUJ calculi. Methodology: The patients with impacted PUJ calculi of size 11 to 18mm of both sexes of all age group varying form 18-60 years, on consecutive sampling method total 84 patients were included. All patients underwent basic lab investigations, USG, IVU and investigations for fitness purpose. Group 1: All procedures were tubeless. We used 15 Fr Richard Wolf nephroscope for the procedure. 16 to 20 Fr Amplatz sheath was used depending upon situation. Fragmentation was performed using pneumatic lithoclast or holmium Laser depending upon stone size and characteristics. Group 2: Underwent DJ stenting under subarachnoid block or short GA depending upon situation. On the next day they were subjected for lithotripsy on Dorniel alpha machine under USG guidance, 3000 shocks were given in each sitting. One to three such sittings were given. Post operatively ultrasonography and X-ray KUB was done in all the patients and stents were removed after assuring complete clearance. Patients with absence of stone or presence of stone less than 4 mm on USG or x-ray KUB were declared as completely cleared. Results: Average hospital stay was 48 hours in miniperc group and it was 30 hours in DJ with ESWL group. Clearance rate was 100 % in Miniperc group and it was 85.71 % in DJ with ESWL group. Five patients (11.9%) in DJ lithotripsy group required another procedure. (Two needed miniperc and three needed URS). Two(4.76 %) patients in miniperc group had fever in post op period but nobody suffered major sepsis. Conclusion: Miniperc fulfils many criteria if we see results and complications. Although bigger sized multicentric study and long term follow up is needed.

Efficacy of silodosin on the outcome of semi-rigid ureteroscopy for the management of large distal ureteric stones: blinded randomised trial

ObjectiveTo evaluate the efficacy of silodosin therapy, as a new α-adrenergic receptor (α-AR) blocker, on the success rate of semi-rigid ureteroscopy (URS) for the management of large distal ureteric stones. Patients and methodsThis prospective study recruited 127 adult patients with single distal ureteric stone of ≥1 cm. The patients were randomly allocated to two groups: the first group included 62 patients who received silodosin (8 mg) for 10 days before URS (Silodosin group), whilst the second group included 65 patients who received placebo, in the form of multivitamins, for 10 days before URS (Placebo group). All patients underwent URS and a pneumatic lithoclast was used for stone fragmentation. ResultsThe mean (SD) operative time was shorter in the Silodosin group compared with the Placebo group, at 41.61 (4.67) vs 46.85 (4.6) min, respectively. Furthermore, advancing the ureteroscope to access the stone failed in a statistically significant number of patients in the Placebo group compared with the Silodosin group (13 vs two, respectively). The complication rate was significantly higher in the Placebo group compared with the Silodosin group (20% vs 6.4%, P = 0.036). Additionally, the need for postoperative analgesia was significantly lower in the Silodosin group compared with the Placebo group (8.1% vs 26.2%, P = 0.009). ConclusionSilodosin therapy prior to URS management of large distal ureteric stones seems to be associated with better advancing of the ureteroscope to access the stone, shorter procedure time, higher stone-free rate, lower incidence of complications, and lesser need for postoperative analgesia.

Simultaneous antegrade and retrograde endoscopic surgery for benign prostatic hyperplasia with vesical calculi – A single-centre experience

ObjectiveTo describe the effectiveness and safety of our novel technique of simultaneous percutaneous cystolithotripsy with transurethral resection of prostate (TURP) for patients with benign prostatic hyperplasia (BPH) complicated with large vesical calculi. Patients and methodsThis was a retrospective analysis of 25 patients who underwent simultaneous percutaneous cystolithotripsy with TURP between January 2012 and January 2016. Technique: A 28-F Amplatz sheath was inserted percutaneously into the bladder after sequential dilatation under cystoscopic guidance. Percutaneous cystolithotripsy using a nephroscope and pneumatic lithoclast was then performed simultaneously along with monopolar TURP. Preoperative parameters reviewed included: patient’s symptoms, International Prostate Symptom Score, uroflowmetry pattern, prostate volume, and stone burden on ultrasonography of the abdomen and pelvis. Postoperative parameters analysed included: duration of irrigation, time until catheter removal, length of hospital stay, and complications. ResultsThe mean age of the patients was 67.8 years. The mean prostate size was 62.28 mL and the mean stone burden was 3.18 cm. The mean operating time was 54.2 min. The mean time until catheter removal was 3.2 days. ConclusionSimultaneous percutaneous cystolithotripsy with TURP in patients with BPH with large bladder calculi is safe and feasible.

Comparison of ureteroscopic pneumatic lithotripsy and extracorporeal shock wave lithotripsy for the management of proximal ureteral stones: A single center experience.

To evaluate and compare the effectiveness of ureteroscopic (URS) pneumatic lithotripsy versus extracorporeal shock wave lithotripsy (ESWL) in the management of the proximal ureteral stones in terms of stone- free rates, complications and costs involved. We included 200 patients in Group 1 who underwent ESWL and 200 patients in Group 2 who underwent URS intervention. We used Modulith SL X lithotripter 3rd generation Storz medical for ESWL group while Swiss pneumatic lithoclast was used to break the stone in the URS group. Stone-free status was defined as stone fragment of less than 4 mm on follow- up kidney ureter and bladder X-ray after 3 months of procedure. SPSS version 16 was used for statistical analysis. The mean age in ESWL and URS groups were 39.21±13.36, and 43.13±13.65 years respectively. Mean stone size was 10.47±3.7 mm (ESWL) and 13.6±6.6 mm (URS). Stone- free rate after single procedure was (125/200 patients) 62.5% for ESWL and (168/200 patients) 84% for URS group (p=0.001). Complications included post procedure sepsis in 3 (1.5%) patient of ESWL, while 7 (3.5%) patients of URS groups. Steinstrasse was seen in 4 (2%) patients of ESWL group. No mortality was seen in both groups. Mean costs for ESWL were US $320±50 while US $1100±150 for URS group (p=0.001). The stone-free rates after single procedure were significantly higher for the URS group while the complication rates were comparable in both groups. Treatment costs were significantly lower for the ESWL group.