ObjectivesTo evaluate factors contributing to bleeding after percutaneous nephrolithotomy (PCNL) and ways of managing this complication, as bleeding is a serious sequela that requires prompt management.Patients and methodsThe demographic and procedural data of 200 patients, who underwent unilateral PCNL during a 20-month period, were prospectively collected. Preoperative, operative, and postoperative details were recorded. The preoperative variables analysed included: age, sex, body mass index (BMI), the presence of hypertension, diabetes mellitus, serum creatinine, degree of hydronephrosis, previous ipsilateral open renal surgery, stone size and complexity. The operative variables analysed included: number of tracts, operative time, size of Amplatz sheath, type of anaesthesia, and complications such as calyceal and pelvic perforation.ResultsThe variables of age, sex, BMI, diabetes, hypertension, and a preoperative creatinine level of >1.4 mg/dL had no significant effect on blood loss (all P > 0.05). However, the rate of bleeding was significantly higher (P ⩽ 0.05) in patients who had a history of previous open renal surgery, intraoperative pelvicalyceal perforations, and Guy’s Stone Score (GSS) grade 3 and 4 complex stones; however, absence of hydronephrosis, larger stone size, operative time (>83 min), more than one puncture, and size of the Amplatz sheath (26–30 F) did not maintain their significance in multivariate analysis.ConclusionAccording to our present results stone complexity (GSS grade 3 and 4), history of ipsilateral renal stone surgery, and occurrence of intraoperative pelvicalyceal perforation are alarming variables for post-PCNL bleeding.

Highlights Bladder injury is an uncommon complication of cesarean delivery with an incidence ranging from 0.0016% to 0.94%. Delayed blabber rupture post CD may present with urinary ascites and elevated serum creatinine mimicking acute kidney injury. Cystography is the diagnostic imaging of choice with the reported accuracy of 85%–100%. Surgical repair is the treatment of choice for intraperitoneal bladder injury. Conservative management with intraperitoneal and urethral catheter may succeed in properly selected cases.

Background  Percutaneous nephrolithotomy is regarded as the treatment of choice for large and complex renal stones. Despite of its safety and efficacy, it remains a crucial challenge for endourologist in soiltary kidney patients Objectives  To assess the effect of percutaneous nephrolithotomy (PNL) on renal function measured by glomerular filtration rate (GFR) in solitary kidney patients Materials and Methods The records of 25 patients with age range of (18-66) years with a solitary functioning kidney that had undergone PNL from September 2015 October 2017 in Sulaymani Teaching Hospital were prospectively analyzed. Serum creatinine was measured preoperatively and 7 days postoperatively. Preoperative, operative and postoperative details were analyzed for each patient with respect to change in eGFR between pre and postoperative period. Multivariate analysis was done to find relations between variable, p-value < 0.05 was considered as significant. Results There was a significant increase in the mean postoperative eGFR in (P-value <0.001). Age, gender, BMI, DM, history of ipsilateral renal surgery, grade of hydronephrosis, stone complexity and location have no considerable impact on postoperative renal function impairment (p-value >0.05). Operative time, the number of working tracts and the size of amplatz sheath also have no impact on the deterioration of renal function. Hypertension caused a significant decrease in the postoperative eGFR (p-value 0.01) and blood loss more than average (Hb drop >1.072gm/dl) caused either stable or decrease in the postoperative eGFR (P-value 0.03). Conclusion Percutaneous nephrolithotomy is safe in solitary kidney patients and early renal function improvement is anticipated. History of hypertension and bleeding are the two blamed risk factors that cause acute postoperative renal function deterioration.

HighlightsDeep vein thrombosis (DVT) is a relatively common medical problem.Extrinsic compression with resulting obstruction of the iliac veins is recognized as a crucial cause of DVT.Different pelvic pathologies may cause compression of iliofemoral vein and cause venous thrombosis.Impacted ureteric stone has caused the left iliofemoral thrombosis in the current case.