Posterior tibial nerve stimulation can be a viable treatment option in some patients with refractory monosymptomatic nocturnal enuresis. However, deterioration in some responders with time suggests the need for maintenance protocols.

Abstract:Background: Intracorporeal lithotripsy modalities and stone removal devices have been created to facilitate endoscopic management of ureteral stones. These devices, along with improved techniques, have resulted in stone-free rates greater than 95% with low morbidity. However, problems remain that preclude consistent 100% stone-free rates with endoscopic treatment of ureteral calculi. Retrograde migration during ureteroscopic procedures remains a significant problem. Objectives: The aim of this study was to compare the Stone Cone device and instillation of lubricating lidocaine jelly as two methods to prevent retrograde stone migration during ureteroscopic lithotripsy. Patients and methods: This study included patients suffering from ureteral stones that were treated with intracorporeal lithotripsy using the pneumatic Lithoclast. These patients were divided into two groups. In group I, the Stone Cone device was used, while in group II, lidocaine jelly 2% concentration was used.Results: This study included 40 patients with a mean age of 38.6±9.3 years (20 patients in each group). There was no significant difference between the groups with regards to stone site, size or state of the upper urinary tract by excretory urography. The pneumatic Lithoclast allowed successful fragmentation of all calculi into small fragments. Upward stone migration did not occur in patients in the Stone Cone group, while in the lidocaine jelly group it occurred in three patients (15%). The operative time in the Stone Cone group ranged between 30 and 55 minutes (mean, 41.8±5.3), while in the lidocaine jelly group it ranged between 40 and 71 minutes (mean, 51.4±3.4), and this difference was statistically significant (p < 0.05). Conclusion: The Stone Cone is safe and efficient in preventing proximal stone migration during ureteroscopic pneumatic lithotripsy. It maintained continuous ureteral access and demonstrated a statistically significant advantage over the lidocaine jelly in terms of proximal stone migration, operative time, and the need for auxiliary procedures.

Background: Percutaneous Nephrolithotomy (PCNL) is the preferred technique for treating large stones >2cm in diameter within the kidney, placement of a percutaneous nephrostomy tube for hemostasis, drainage and for second look has been an integral part of the standard PCNL procedure, however the procedure has been modified to tubeless PCNL to decrease hospital stay and analgesic use duration. Many studies advice for the use of adjuvant local hemostatic sealants to decrease both bleeding and extravasation.Objective: Evaluation of local hemostatic sealants used in tubeless PCNL.Methods: One hundred and fifty patients with renal stone 2-3cm in diameter who were enrolled for PCNL were divided into five equal groups; groups from 1 to 4 had tubeless PCNL.We used Gelatin matrix hemostatic sealant (Surgiflo), collagen sponge coated with thrombin and fibrinogen (Tachosil), oxidized cellulose (Surgicel), gelatin sponge (Gelfoam) in the 1 st , 2 nd , 3 rd and 4 th respectively while in the 5 th group standard PCNL was done.We compared the groups regarding demographic data, stone site and size, intraoperative time, estimated blood loss (Hematocrit value drop in % before and after PCNL), postoperative pain, analgesic duration, length of hospital stay, complications, and cost.Results: Between the five groups, no significant difference concerns the demographic data stone size and site, intraoperative time, estimated blood loss and complications and a significant difference concerning the cost, hospital stay, visual pain analogue scale and analgesic use duration. Conclusion:The use of local hemostatic sealants is safe and to be considered for cases who underwent tubeless PCNL. There were no significant differences among the four sealants used in the present study as regard applicability, safety and overall complications post-operatively.However the Tachosil material is found to be costy when compared to the other materials.