Percutaneous Holmium Laser Fulguration of Calyceal Diverticula

Introduction. Calyceal diverticular stones are uncommon findings that represent a challenge in their treatment, due to the technical difficulty in accessing the diverticulum, and the high risk of their recurrence. Current percutaneous technique for calyceal diverticular stones involves establishing a renal access, clearing the stone, and fulguration of the diverticular lining with a roller-ball cautery electrode using hypotonic irrigation solution such as sterile water or glycine solution which may be associated with the absorption of hypotonic fluids with its inherent electrolyte disturbances. Case Report. In this paper, we present for the first time percutaneous holmium laser fulguration of calyceal diverticula in 2 patients using normal saline. Their immediate postoperative sodium was unchanged and their follow-up imaging showed absence of stones. Both patients remain asymptomatic at 30 months post-operatively. Conclusion. This demonstrates that holmium laser is a safe alternative method to fulgurate the calyceal diverticulum after clearing the stone percutaneously

Does Imaging Modality Used for Percutaneous Renal Access Make a Difference? A Matched Case Analysis

Objective: To assess perioperative outcomes of percutaneous nephrolithotomy (PCNL) using ultrasound or fluoroscopic guidance for percutaneous access. Methods: A prospectively collected international Clinical Research Office of the Endourological Society (CROES) database containing 5806 patients treated with PCNL was used for the study. Patients were divided into two groups based on the methods of percutaneous access: ultrasound versus fluoroscopy. Patient characteristics, operative data, and postoperative outcomes were compared. Results: Percutaneous access was obtained using ultrasound guidance only in 453 patients (13.7%) and fluoroscopic guidance only in 2853 patients (86.3%). Comparisons were performed on a matched sample with 453 patients in each group. Frequency and pattern of Clavien complications did not differ between groups (p = 0.333). However, postoperative hemorrhage and transfusions were significantly higher in the fluoroscopy group: 6.0 v 13.1% (p = 0.001) and 3.8 v 11.1% (p = 0.001), respectively. The mean access sheath size was significantly greater in the fluoroscopy group (22.6 v 29.5F; p = 27F) and multiple punctures. Prospective randomized trials are needed to clarify this issue

[4] Learning curve of percutaneous renal access on a virtual reality simulator: Pilot study

Objectives: To assess the learning curve of percutaneous renal access (PCA) using the PERC Mentor™ simulator. Methods: Urology postgraduate trainees (PGTs) from postgraduate years (PGY) 4 and 5 were recruited. Participants received educational demonstration on how to perform the PCA using the ‘bull’s eye’ technique before being asked to perform task five on the PERC Mentor simulator, where they had to correctly puncture the middle calyx over a stone in a left kidney model. All participants were assessed objectively by the PERC Mentor simulator and subjectively by the validated Percutaneous Nephrolithotomy-Global Rating Scale (PCNL-GRS) tool. The learning curve of PCA was considered with plateauing in PCNL-GRS score, operative and fluoroscopy times, and absence of complications. Results: Four urology PGTs (three PGY-4 and one PGY-5), with median (range) age of 30 (27.8–32.3) years and without prior PCNL experience, participated in this study. Most of the participants were male (three of the four). Participants had previously performed a median of 100 cystoscopies, 50 TURBT, and 27.5 TURP prior to this study. The PGTs performed a total of 68 PCA procedures, with mean (SD) operative time of 159.8 (16) s, mean (SD) fluoroscopy time of 93.9 (11.3) s, mean (SD) number of attempts to puncture the pelvi-calyceal system (PCS) of 1.3 (0.1), mean (SD) PCS perforation of 0.68 (0.2), mean (SD) vascular injury of 0.3 (0.08), and mean (SD) PCNL-GRS score of 21.8 (0.6). Plateauing of the curve was achieved after 14 trials in terms of the PCNL-GRS score, the operative and fluoroscopy times, and PCS perforations. Conclusion: Based on these results, we think that a minimum of 15 PCA procedures are needed on the PERC Mentor to obtain the early part of the learning curve for PCA before starting practicing in the operating room

Structure and function of the adult rat vas deferens

Four aspects of the function of the vas deferens were examined by light microscope immunocytochemistry of Bouin-fixed, paraffin-embedded material. First, the expression of aquaporin-1 by endothelial cells of the vascular channels in the lamina propria of the distal region, suggested water transport from the lumen of the vas deferens via the dilated intercellular spaces to underlying vascular channels, the function of which may be to concentrate sperm. Second, the expression of 3beta-hydroxysteroid dehydrogenase by principal cells was indicative of steroid synthesis. Third, the ability of the vas deferens to create a special environment for protecting spermatozoa in the lumen was investigated using anti-glutathione S-transferase (GST) antibodies. Both principal and basal cells showed varying degrees of GST expression in the different regions of the cauda and vas deferens, suggesting a complex, changing environment of substrates to which epithelial cells and sperm are subjected. Fourth, the epithelial cells lining the cauda epididymidis and vas deferens were investigated for their secretory and endocytic functions. (Abstract shortened by UMI.

Shock wave lithotripsy in patients requiring anticoagulation or antiplatelet agents

Extracorporeal shockwave lithotripsy (SWL) remains the only truly minimally invasive procedure for the treatment of upper tract nephrolithiasis. Recently, there has been a recent rise in the patients on antiplatelet agents. Therefore, the aim of the present study is to review the literature available regarding SWL in these high-risk patients requiring anti-coagulation therapy. Alternative therapies to SWL are also presented

Adult Bilateral Ureteroceles Presenting with Lower Urinary Tract Symptoms and Acute Urinary Retention

Ureterocele is a well-known pathologic entity in the pediatric urology population but remains a diagnostic and treatment challenge in the adult population. Adult ureteroceles remain a diagnostic challenge for the adult urologist. Its prevalence is estimated between 1/500 and 1/4000 patients with a wide variety of clinical presentations. We present the case of a 30-year-old female patient who presented with severe lower urinary tract symptoms (LUTS) and acute urinary retention secondary to prolapsing bilateral single-system orthotopic ureteroceles. She was successfully treated with transurethral unroofing of her bilateral ureteroceles and she is currently asymptomatic. This case represents the first reported case of bilateral ureteroceles presenting with severe LUTS and subsequent urinary retention from the prolapse of one of the ureteroceles. We provide a review of the most recent case series of adult ureteroceles and their outcomes. Transurethral unroofing of the ureterocele is a safe and minimally invasive approach for this disease