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To assess the safety and efficacy of minimally invasive percutaneous nephrolithotomy (mPCNL) as compared to standard PCNL (sPCNL) for management of 2-3-cm renal stones in the flank-free modified supine position. Between September 2010 and December 2013, 150 patients (168 renal units) with 2-3-cm renal stones were prospectively randomized into two treatment groups; Group A (75 patients/87 renal units) treated by mPCNL and Group B (75 patients/81 renal units) treated by sPCNL. In both groups, the patients were placed in the flank-free modified supine position. In mPCNL group, the tract was dilated up to 16.5 F whereas in sPCNL group the tract was dilated up to 30 F. Both groups were compared regarding several perioperative parameters. No significant difference was recorded among both groups regarding fluoroscopy time (4.3 ± 1.3 vs 4.8 ± 2.1 min, p = 0.06), operative time (83.2 ± 17.3 vs 78.6 ± 24.4 min, p = 0.16), hospital stay (4.3 vs 4.5 days, p = 0.76), VAS score (3.2 ± 0.6 vs 3.3 ± 0.8, p = 0.36) and need for analgesia. The mean drop in hemoglobin level and the incidence of bleeding that necessitated blood transfusion were significantly lower in the mPCNL group (0.6 ± 0.1 vs 1.9 ± 1.1 g/dl, p < 0.0001 and 1.2 vs 9.8%, p = 0.03, respectively). Although the stone-free rate was higher in the sPCNL group, but this was statistically insignificant (97.1 vs 95.4%, p = 0.86). Mini-PCNL is effective for managing renal calculi with comparable operative time and stone-free rate to standard PCNL with the merit of higher safety due to lower incidence of bleeding that necessitates blood transfusion.

Objective To compare the efficacy and safety of miniature semi-rigid ureteroscopy (URS) with holmium (Ho)-yttrium-aluminium-garnet (YAG) laser lithotripsy vs shockwave lithotripsy (SWL) for treating upper urinary tract (UUT) calculi >1 cm in children. Patients and methods Children with unilateral single UUT ureteric stones of >1 cm were prospectively enrolled in this study. Patients were randomly divided into two groups: Group 1, treated with SWL; and Group 2, treated with URS (6/7.5 F) and laser lithotripsy. The patients’ characteristics, stones demographics, operative time, adjunctive procedures, stone-free rate (SFR), re-treatment rate, and complications were statistically analysed and compared. Success was defined as stone-free status (no stone residual of ≥0.3 cm) at 1 month from the initial treatment without any auxiliary procedures. Results In all, 68 patients with UUT stones met our inclusion criteria. There were no significant differences between the two groups for patient or stone demographics. In Group 1, the SFR was 26/34 (76.4%) and in Group 2 it was 33/34 (97.1%) ( P = 0.03). A total of 12 auxiliary procedures in Group 1 and two in Group 2 were needed to reach a 100% SFR ( P = 0.014). There were no significant differences between the two groups for operative times, adjunctive procedures, number of complicated cases or complications of Grade ≥III (P = 0.65, P = 0.23, P = 0.77, and P = 0.62, respectively). Conclusion Miniature semi-rigid URS with Ho-YAG laser lithotripsy for UUT ureteric stones of >1 cm in children was more effective than SWL in terms of SFR and re-treatment rate, with no significant difference in the rate or grade of complications. Abbreviations EQ: efficiency quotient; KUB: plain abdominal radiograph of the kidneys, ureters and bladder; RCT: randomised controlled trial; SFR: stone-free rate; SWL: shockwave lithotripsy; URS: ureteroscopy; US: ultrasonography/ultrasound; URS: ureteroscopy; UUT: upper urinary tract; YAG: yttrium-aluminium-garnet

ObjectiveTo assess the additive effect of sildenafil citrate to tamsulosin in the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) in men with or without erectile dysfunction (ED).Patients and methodsIn all, 150 men with untreated LUTS/BPH with or without ED were randomised to receive sildenafil 25 mg once daily (OD) or placebo OD (night time) combined with tamsulosin 0.4 mg OD (day time) for 6 months. Changes from pre-treatment scores in International Prostate Symptom Score (IPSS), IPSS-quality of life (QoL) score, maximum urinary flow rate (Qmax), and the five-item version of the International Index of Erectile Function questionnaire (IIEF-5) were assessed at 3 and 6 months. Safety profiles were assessed by physical examination and monitoring clinical adverse events.ResultsGroup A comprised of men who received tamsulosin and sildenafil (75 men), whilst those in Group B received tamsulosin and placebo (75). The IPSS was significantly improved in Group A compared to Group B, at −29.3% vs −13.7% (P = 0.039) at 3 months and −37% vs −19.6% (P = 0.043) at 6 months after treatment. Qmax significantly improved in both groups compared with before treatment (P < 0.001). The IIEF-5 scores improved more in Group A than in Group B, at 58.7% vs 11.7% at 3 months and 62.4% vs 12.4% at 6 months after treatment (both P < 0.001).ConclusionSildenafil citrate combined with tamsulosin improved LUTS, erectile function, and patient QoL more than tamsulosin monotherapy with the merit of a comparable safety profile in patients with LUTS/BPH.

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