The objective of this study was to analyze the outcome of percutaneous nephrolithotomy (PCNL), laparoscopic and open anatrophic nephrolithotomy (AN) for management of patients with large staghorn renal stones. We analyzed the peri-operative parameters, overall treatment costs and changes in the function of the affected kidney on technetium-99 dimercaptosuccinic acid renal scintigraphy, done before the operation and before the final follow-up visit, in 45 adults who underwent PCNL (n = 16) versus laparoscopic (n = 15) versus open (n = 14) AN for large staghorn renal stones. All three groups had statistically similar preoperative characteristics, including the function of the operated kidney on renal scan. On the discharge day, the PCNL group had the lowest stone-free rate (43.75 %) compared to the laparoscopic (80 %) and open AN groups (92.85 %) (P = 0.009). After a mean follow-up period of 12.1 months, the decrease in the function of the operated kidney was greatest in the open AN group (-8.66 ± 4.97) compared to the laparoscopic AN (-6.04 ± 6.52) and PCNL group (-2.12 ± 2.77) (P = 0.003). The need for ancillary procedures to manage residual stones was greatest in the PCNL group and lowest in the open AN group. A similar trend was seen in overall treatment costs (P < 0.001). For management of large staghorn renal stones, the more invasive the procedure, the higher the one-session stone-free rate and the lower the need for ancillary procedures; however, greater renal functional loss can be anticipated. The need for ancillary procedures is a major determining factor in the overall cost of treatment, which was highest in the PCNL group.

Purpose: To assess the feasibility of the fascial interposition (FI) technique to improve the results of non-scalpel vasectomy (NSV) through a cost-effective modification. Patients and Methods: The outcome of the FI technique for NSV in 954 consecutive candidates treated by two surgeons was evaluated retrospectively. 726 (76%) of the clients had undergone NSV with FI (FI group) and for the other 228 (24%) NSV by simple ligation and excision (LE) without FI (NFI group) was performed. Demographic data, operative time and complications as well as vasectomy failures were analyzed between the two groups. Results: The two groups were age-matched and there were no significant differences between the two procedures regarding operative complications and operative time. 13 cases of vasectomy failures (5.7%) were detected after 3 months of follow-up, all in the NFI group. No vasectomy failure was recognized in the FI group. Conclusion: Combined use of FI with simple LE could be considered a simple effective method for NSV with a high success rate that allows the NSV to remain as a reliable option for contraception.

Laparoscopic approaches in cases of neovaginal foreign body are useful when the endovaginal approaches have failed, especially in transsexual patients, to prevent another major open surgery.

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