ObjectivesTo evaluate the possible role of silodosin (a highly selective α1A-adrenoceptor antagonist) in facilitating the passage of distal ureteric stones (DUS) in children, as the role of α-blockers as medical expulsive therapy is well known in adults.Patients and methodsIn all, 40 paediatric patients (27 boys and 13 girls) diagnosed with unilateral, single, radiopaque DUS of <10 mm were included in the study. Their mean (SD, range) age was 8.1 (2.7, 5–17) years. The patients were randomly divided into two groups: Group A, received silodosin 4 mg as a single bedtime dose; and Group B, received placebo as a single bedtime dose. Ibuprofen was prescribed to both groups on-demand for pain episode relief. Patients were followed up biweekly for 4 weeks. The stone expulsion time and rate, pain episodes, analgesic use, and any adverse effects were recorded.ResultsThe mean (SD) stone size in Group A was 6.6 (1.7) mm and in Group B was 6.7 (1.4) mm (P = 0.4). Two patients were lost to follow-up (one from each group), and one patient in Group A refused to complete the study. The stone-free rate at end of the 4-week treatment period was 88.8% in Group A vs 73.6% in Group B (P = 0.4). The mean (SD) stone expulsion time was 7.0 (4.3) vs 10.4 (4.7) days in groups A and B, respectively (P = 0.02). The mean (SD) number of pain episodes requiring ibuprofen was 2.3 (1.4) vs 4.7 (2.6) episodes in groups A and B, respectively (P < 0.001). Adverse effects (headache and dizziness) were recorded in three patients (16.7%) in Group A, which were mild and none of them discontinued treatment, whilst no adverse effects were recorded in Group B.ConclusionsThe data in the present study show that silodosin can be safely used in the treatment of DUS in children for decreasing time to stone expulsion, pain episodes, and analgesic requirement.

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Real-time virtual sonography (RVS) is a diagnostic imaging support system that can be synchronized with real-time ultrasonography in conjunction with computed tomography (CT) using a magnetic navigation system. The application of RVS for percutaneous nephrolithotomy has not yet been reported. This study aimed to examine the effect of RVS-guided renal access during endoscopic combined intrarenal surgery (ECIRS) for large renal calculi.METHODS: We retrospectively evaluated 12 patients with large renal calculi (35.1 AE 3.3 mm) who underwent ECIRS in our center between April 2014 and January 2015. The Digital Imaging and Communication in Medicine volume data from preoperative CT performed in the prone position were loaded in the RVS unit. The operation was performed as follows: 1) All of the patients were oriented in the prone split-leg position to allow for retrograde and antegrade access; 2) One urologist performed retrograde intrarenal surgery by using a Holmium-YAG laser with a ureteroscope through a ureteral access sheath, while the other performed renal puncture using the RVS system (Figure ); and 3) After inserting the percutaneous tract, each urologist worked simultaneously to fragment the renal calculi.RESULTS: All of the procedures were successfully performed using a single tract. The mean number of renal punctures until gaining renal access through the calyx, which provides the best access to the calculus, was 1.6. The mean surgical duration was 107.0 AE 10.5 minutes, and the mean length of hospital stay was 5.3 AE0.5 days. The mean decrease in hemoglobin level was 0.76 AE 0.15 g/dL. Complete stone clearance after a single ECIRS treatment session was achieved in 7 patients (87.5%). None of the patients required a blood transfusion and had a Clavien grade ! 2.CONCLUSIONS: RVS-guided renal access improved the precision of the calyceal puncture, which decreased the incidence of bleeding complications and improved the stone clearance rates during ECIRS. This is the first report to evaluate the efficacy of the RVS system for renal access.

Objective: Endourological treatment is associated with a risk of postoperative febrile urinary tract infections and sepsis. The aim of this study was to review the reported rate of infectious complications in relation to the type and modality of the endourologic procedure. Methods: This systematic review was conducted in accordance with the PRISMA guidelines. Two electronic databases (PubMed and EMBASE) were searched. Out of 243 articles retrieved we included 49 studies after full-text evaluation. Results: Random-effects meta-analysis demonstrated that retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) were associated with not significantly different odds of getting fever (OR = 1.54, 95% CI: 0.99 to 2.39; p = 0.06) or sepsis (OR = 1.52, 95% CI: 0.37 to 6.20, p = 0.56). The odds of getting fever were not significantly different for mini PCNL compared to standard PCNL (OR = 1.11, 95% CI: 0.85 to 1.44; p = 0.45) and for tubeless PCNL compared to standard PCNL (OR = 1.34 95% CI: 0.61 to 2.91, p = 0.47). However, the odds for fever after PCNL with suctioning sheath were lower than the corresponding odds for standard PCNL (OR = 0.37, 95% CI: 0.20 to 0.70, p = 0.002). The odds of getting fever after PCNL with perioperative prophylaxis were not different from the corresponding odds after PCNL with perioperative prophylaxis plus a short oral antibiotic course (before or after the procedure) (OR = 1.31, 95% CI: 0.71 to 2.39, p = 0.38). Conclusions: The type of endourological procedure does not appear to be decisive in the onset of infectious complications, although the prevention of high intrarenal pressure during the procedure could be crucial in defining the risk of infectious complications.   on behalf of U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai

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