A 58-year-old gentleman presented with right side ureteric colic for six months duration. He had undergone an extended pyelolithotomy for a pelviureteric junction calculus 10 years back and he had defaulted follow up. His X-ray KUB revealed a large renal calculus with a calcified feeding tube, along with a large bladder calculus with encrustation of the tube in the bladder. Cystolitholapaxy was performed for the bladder calculus, and percutaneous nephrolithotomy was performed and the renal calculus along with the calcified feeding tube was removed. At the end of the procedure, the patient was left with only a single incision of 2cm length.

We identified 42 cases (17 supine and 25 prone), all with an ASA grade of 1-3. Operating times were on average 107.5 min (supine) and 101.8 min (prone). Average hospital stay was 4.5 and 5.1 nights respectively. There were three post operative complications in the supine cohort and five in the prone. Seven supine patients had ureteric stents inserted compared to two prone. Overall, 15/17 (88%) supine and 22/25 (88%) prone cases had complete clearance at fluoroscopic and nephroscopic (rigid and flexible) assessment. Conclusion:In this single centre, single surgeon audit, we have demonstrated equivalence in most of the parameters studied since introducing a significant modification of our PCNL technique. In our opinion, the advantages of the supine technique make it preferable going forward, while we intend to maintain the capability to perform either approach.

225age analgesic requirement in the post-operative period was 47.2 mg morphine equivalent and 162 mg diclofenac equivalent respectively. 11.8% developed post-operative pyrexia which settled with antibiotics. Compared to the BAUS outcome, this series had a higher percentage of staghorn stones and higher stone clearance rates. 75.8% were rendered stone free, while the rest had ancillary procedures (ESWL/flexible ureterorenoscopy). Discussion: 'Tubeless PCNL' or 'nephrostomy free PCNL' is a safe procedure associated with reduced morbidity and shorter hospital stay when compared to standard PCNL. The analgesic requirements are also diminished with this technique.

1478 mm 2 , CT scan diameter from 3 to 48 mm and volume from 14.15 to 36760 mm 3 . Smaller stones trended towards prolate ellipsoid (rugbyball shaped), stones between 8 and 15 mm towards oblate ellipsoids (disc shaped) and stones over 15 mm towards scalene ellipsoids. Stone maximal diameter and surface area on plain film were well correlated and estimated stone volume with similar precision. Conclusion:The average shape of renal stones changes with maximal diameter. No single equation for estimating stone volume can be recommended. As maximal diameter changes, there is poor correlation with stone volume. We recommend that research looking at stone clearance rates should use CT reconstructed stone volumes.

Renal cell cancer (RCC) represents 2-3% of all cancers with male predominance affecting old age. Risk factors include smoking, obesity, hypertension and genetic factors. Presentation can vary from non-visible hematuria to symptoms from metastatic disease to bones, lung, brain and lymph nodes. Only 6-10% presents with classical presentation of loin pain, loin mass and hematuria (3). We presents a case of a patient who had non-visible hematuria later progressing to metastatic renal cell carcinoma.