Purpose: To assess the safety and efficacy of self-removing antegrade tethered stents after percutaneous nephrolithotomy (PNL) during the COVID-19 pandemic. Materials and Methods: Instead of routine placement of double-J stent which requires endoscopic removal, a tethered antegrade stent after tubeless PNL as an exit strategy followed by self-removal can obviate the need of early postoperative revisit. A prospective observational study in a university teaching hospital was conducted during the lockdown period from May 2021–June 2021 with the use of antegrade tethered stent in 30 patients and we studied the complications associated with it. Results: The average stone size among the patients was 2.4 cm (1.2–4.9). Postoperative visual analog scale (VAS) till the time of stent removal was 30.8 + 4.4 mm while the VAS at stent removal was 26.6 + 3.8 mm. None of the patients had urine leak or hemorrhage from the site of percutaneous access after self-removal of stent. Two (6.66 percent) patients had grade I and grade II modified Clavien–Dindo complication. The mean score of satisfaction with life scale (SWLS) Questionnaire was 31 (34–27). The present study demonstrates that tubeless PNL with antegrade tethered stent has the advantages of avoiding hospital visits for stent removal during COVID-19. Conclusion: The use of an antegrade threaded stent is safe, culminating in minimal morbidity and patient distress, and greater overall patient satisfaction.

Percutaneous nephrolithotomy (PNL) has long been considered the bench-mark intervention for complicated urinary stones and has undergone important advancements since it was first described. Given the proven safety and efficacy of PNL, simultaneous bilateral PNL has been attempted for bilateral renal calculi to cut down on total procedure costs. To further cut down on operative time, concurrent bilateral synchronous PNL (BS-PNL) has been performed involving two surgeons, each operating concurrently on one renal unit. We performed a retrospective study to evaluate the safety and efficacy of BS-PNL in patients who consented for the procedure. Mean operative time taken from percutaneous access to skin closure was 78 min which was lower than that taken during the single surgeon approach for simultaneous bilateral PNL. Two (12%) out of 16 renal units required multiple punctures for stone clearance. Sheath size varied between 26Fr to 30Fr depending on the stone burden. Mean duration of hospital stay was 2 days. Fourteen (88%) out of 16 renal units had complete stone clearance. Fifteen (94%) out of 16 renal units had a double J stent placed for drainage. Only two patients had complications in the form of postoperative fever. In the background of already proven safety and efficacy of SB-PNL, the concurrent two surgeon approach appears to be feasible and safe with additional advantage of reduced operative time. However, the number of patients in this series were limited and a bigger and preferably multi-institutional study would be required before we can come to a definitive conclusion.

Urinary bladder paraganglioma (UBP) are rare neuroendocrine tumors with variable biological behavior. High index of suspicion in the preoperative evaluation would enable the clinician to formulate appropriate management of the rare tumors. Clinical and pathological data of seven cases evaluated and treated as per a devised protocol for suspected bladder paraganglioma from 2008 to 2019 was retrospectively reviewed. Among the seven cases, UBP’s were predominantly seen in middle aged men. Most of these presented with storage symptoms (85.71%; n=7) and gross painless hematuria (42.85%; n=3). Three patients were hypertensives and post-micturition syncope was seen in two patients. Among the seven patients two patients had functionally active tumors confirmed by elevated urinary and serum markers for catecholamine excess. Functional tumors, nonfunctional tumors involving uretero-vesical junction or broad based polypoidal tumor were considered for partial cystectomy. Other small nonfunctional tumors underwent trans-urethral resection of bladder tumour (TURBT). Follow up protocol included repeat ultrasound, check cystoscopy and completion TURBT at one month and annually thereafter. Repeat urinary catecholamines at 1 month was done in functional UBP. Cystoscopic examination of a bladder lesion which are solid, sessile and predominantly intramural, a prior to a definitive planned surgery may differentiate UBP from urothelial cancer. Most of the non-functional UPB are diagnosed by histopathological examination.  In symptomatic cases, functional evaluation with biochemical estimation of catecholamine excess allow better treatment planning and avoiding intraoperative hemodynamic instability. Due to high recurrence rate life-long follow-up despite complete excision is strongly recommended.