Massive hemorrhage after PCNL when angioembolization failed or was not feasible due to any reason could be controlled by partial nephrectomy or renorrhaphy with the same principles as that used for surgical exploration in patients with high grade renal trauma.

ObjectiveTo evaluate the accuracy of ultrasonography (US) in measuring the urinary tract stone using non-contrast computed tomography (NCCT) as the standard reference.Patients and methodsA total of 184 patients suspected with urolithiasis who had undergone NCCT and US radiologic investigation from 2015 to 2017 were enrolled in this study. The sensitivity, specificity, and stone size measured in US were validated by NCCT. Data of the stone size in US were classified into four groups (0–3.5, 3.6–5, 5.1–10, >10 mm) and then compared with NCCT data.ResultsIn 184 patients, NCCT detected 276 (97.2%) stones, while US could identify 213 (75.5%) stones. Overall sensitivity and specificity of US were 75.4% and 16.7%, respectively. Detection rate of mid and distal ureteral stone was lower than that at other locations. The detection rate increased with the stone size. About 73% concordance was obtained for the stone size measured by US and NCCT (Pearson’s correlation coefficient was 0.841). Factors such as the stone size, amount of hydronephrosis, and weight affected the detection rate of the urinary tract stone using US (P<0.001, P=0.02, and P=0.01, respectively).ConclusionThe stone size obtained by US was almost the same as that detected by NCCT; however, US is a limited imaging modality in detecting urinary tract stone, especially when used by an inexperienced radiologist, and in the case of smaller stone size, increased weight, and low grade of hydronephrosis.

Background: Miniaturization of endoscopic instruments in percutaneous nephrolithotomy (PCNL) allowed less invasive procedures with low complication rates, especially in children. This study was conducted to evaluate the safety and efficacy of ultrasonography-guided (USG) versus fluoroscopy-guided (FG) mini-PCNL in children.Materials and methods: This is a retrospective comparative study conducted from June 2015 to June 2020. The sample included 70 children (35 pateints underwent USG mini-PCNL and 35 pateints underwent FG mini-PCNL). They were compared mainly by the patients’ demographic characteristics, procedural information, and post-treatment outcomes. In the USG mini-PCNL group, puncturing was performed using a 3.5 MHz US probe, whereas fluoroscopy was utilized in the FG mini- PCNL group. Results: Both groups were comparable in terms of gender, previous history of failed ESWL, and hydronephrosis grade. The mean stone burden was 15.94 ± 3.69 mm and 19.20 ± 7.41 mm in USG and FG groups, respectively (p = 0.024). The stonefree rate (SFR) was 97.1% in the USG group and 94.3% in the FG group, which was not statistically significant (p = 0.16). Mean operative time in the USG group and FG group was 69.00 ± 13.33 minutes and 63.48 ± 16.90 minutes, respectively. Four (11.4%) patients in the FG group required blood transfusions to restore the hemodynamic state (p = 0.039). Fever was detected in 4 (11.4%) patients in the USG group and 15 (31.4%) patients in the FG group (p = 0.041). Conclusions: In children, mini PCNL under USG is safe and as effective as fluoroscopy.

Circumcision is one of the important public surgeries performed globally. It is a popular non-therapeutic procedure that can be performed by people of various abilities and skills, ranging from trained medical practitioners to non-specialists, depending on their cultural and social backgrounds. Consequently, this surgery may cause varying types and frequencies of complications. Glans amputation and death due to severe bleeding, as a complication of this procedure, are rare, and the patients are left with morbidity and life-long complications. Here, we describe two cases of catastrophic complications due to ritual circumcision (one penile glans amputation and one death).

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