Second look PCNL for residual renal calculi: experience in Hospital Universiti Kebangsaan Malaysia

BACKGROUND Presence of residual calculi post PCNL is not rare. Due to the presence of residual calculi, patientm ight be subjectedt o a repeatP CNL under generala naesthesiaw hich is not without the risk of increased morbidity. Second look PCNL might reduce the chanceo f a repeatP CNL and subsequentlyre ducet he risk of morbidityto the patient. AIM To audit retrospectivelyt he outcomeo f secondl ook PCNL in our centerf rom January 2003 to October 2005. MATERIALAND METHOD 33 patients underwent second look PCNL for residual stone in our center from January 2003 to October 2005.The records of each patient were traced and the data analysed. The stone clearance. tolerability of procedure, complications and operation time were the variables and outcome studied. RESULT Out of 33 patients, 4 achieved complete clearance, 8 almost complete clearance, and 13 partial clearancew hile only 4 patientsh ad unsuccessfusl econdl ook operation due to technical difficulties. In another 4 patients, the KUB x-rays were doubtful and second look operation confirmed the absence of stone in the pelvicalyceal system. There were no complications and the procedure well tolerated by all the patients. CONCLUSION Due to its advantagesa nd low morbidity, secondl ook PCNL shouldb e an alternative method of treatment for residual stones whenever indicated

Ruptured testicular abscess: a rare complication of epididymo-orchitis

Epididymo-orchitis is a medical condition characterised by inflammation of epididymis and testis which is a common urological diagnosis encountered by healthcare professionals. Misdiagnosis and under treatment can lead to poor outcome such as infarction and abscess formation. We presented a 33-year-old man, with no known medical illness, presented with one-week history of left testicular pain, swelling and fever. He was commenced on Amoxicillin by his general practitioner. Physical examination showed left swollen and tender testis and normal right testis. Investigations showed an elevated white cell count (WCC) 41.3x103 /L and colour doppler ultrasound (USG) testes showed left epididymo-orhitis. He was admitted and treated with IV Unasyn® (Ampicillin+Sulbactam) for 5 days. His symptoms improved, and he discharged home well with one week oral Unasyn®. He represented 2 weeks later with worsening left scrotal swelling and pain. Clinical examination found a swollen, tender and erythematous scrotum with 1x1cm defect in the left scrotum with purulent discharge. He underwent operation incision and drainage of left scrotum and left orchidectomy. Post-operatively he recovered well. Histopathology reported as epididimoorchitis with abscess, necrosis and perforation. As a conclusion, testicular rupture and abscess formation secondary to epididymo-orchitis is an uncommon reported complication. Immediate recognition and treatment is crucial as a delayed diagnosis can lead to sepsis and infertility