Objective: Supracostal access is avoided for fear of potential intrathoracic complications and subcostal approach is favored as it carries minimal or no risk of intrathoracic complication. The aim of this study was to evaluate safety and efficacy of supracostal approach for percutaneous renal surgery. Material and methods: A total of 60 cases were enrolled and studied prospectively in this study. The patients had upper (n=10), and lower (n=12) calyceal, pelvic (n=12), proximal ureteral (n=14) stones, and pelviureteric junction obstruction (n=12). All the punctures were made by urologist under fluoroscopy. Results: All the punctures were made between 11 th and 12 th ribs (supra-12 th); none of the punctures was made above 11 th rib. The overall complication rate in our study was 26.7%. Four patients (6.7%) had pleural rupture and all the four presented with hydrothorax. The other complications included intraoperative hemorrhage in 1 (1.7%), and pelvic perforation in 1 patient (1.7%), Amplatz sheath migration/loss of tract was detected in 1 (1.7%), postoperative fever in 2 (3.3%), prolonged hematuria in 3 (5%) and residual disease in 4 (6.7%) patients Conclusion: Supracostal approach should be used whenever indicated which was found to be both effective and safe as far as intrathoracic and other complications are concerned.

Background: Benign Prostatic Hyperplasia (BPH) is one of the most common urological diseases seen in aging men. Surgical treatment is recommended for patients unresponsive to medical therapy or those who have developed BPH-related complications. Enucleation procedure distinguished itself as a successful treatment option in large BPH patients, mimics open prostate enucleation, characterized by good surgical efficiency, reduced complications, faster postoperative recovery, similar prostatic tissue ablation capabilities and satisfactory follow-up results compared with the open technique. Objectives: To assess the safety and efficacy of transurethral enucleation of prostate. Methods: Patients aged above 45 years with symptoms of bladder outlet obstruction due to BPH, with maximal urinary flow rate (Qmax) of <15 ml/s, failure to relieve symptoms by medications or acute urinary retention failing at least one trial without catheter or recurrent gross hematuria due to prostatomegaly or upper urinary tract changes due to bladder outlet obstruction due to BPH and patient willing to undergo Transurethral Resection of the Prostate (TUEP) were included in this study. Results: In our study patients aged between 55-90 years were enrolled. Most common presenting complaints were frequency and acute urinary retention. Mean preoperative prostate size was 102.9 ± 10.90g with a range of 84-126 g. Mean operative time was 86.71 ± 5.24 minutes. The mean postoperative ID catheter was 2.1+1.63 days. Postoperative uroflowmetry and International Prostate Symptom Score (IPSS) improved significantly. Conclusion: TUEP represents a promising endoscopic approach in large Benign Prostate Enlargement (BPE) cases, mimics conventional open method of enucleation of the prostate while having all the advantages of a minimally invasive surgery.

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Background: Percutaneous nephrolithotomy (PCNL) is an important surgical method for managing renal stones of any size. Anomalous kidneys pose additional technical challenge to the operating surgeon to perform PCNL in these anatomically abnormal kidneys especially if the stone load is large. The aim of this study is to present the efficacy and limitations of PCNL in managing stones >2 cm in size in anomalous kidneys.Methods: This was a retrospective single centre study of PCNL in anomalous kidneys with stones >2 cm in size.Results: 30 patients of kidney stones >2 cm underwent PCNL. Our series of patients included 19 (63.32%) cases of horseshoe kidneys, 9 (30%) malrotated kidneys, 1 (3.34%) pelvic and 1 (3.34%) crossed fused ectopia. We achieved complete stone clearance in 26 (86.67%) patients. Presence of staghorn calculus was the most important statistically significant factor limiting complete clearance.Conclusion: PCNL is an effective procedure for management of patients with large stones in anomalous kidneys. Appropriate preoperative evaluation especially imaging, appropriate selection of cases and most importantly excellent technical expertise is needed to achieve high stone clearance rates with minimal morbidity.

Background: Percutaneous nephrolithotomy (PCNL) is one of the 1st line treatment options for managing renal stones. Miniaturization of this technique has been developed to decrease the morbidity of this technique without compromising the results. Mini PCNL (mPCNL) involves the use of small calibre sheath and nephroscope to tackle renal stones of small to moderate size. The aim of this study is to present the efficacy and technical advantages of mPCNL in managing renal stones.Methods: This was a retrospective single centre study of mPCNL in managing renal stones. Results: From July 2015 to July 2020 192 mPCNL procedures were done at our centre in 175 patients. The median number of stones was 1(1-3) and the average size of calculus was 18.5 mm (6-35) mm. Mean operative time in our study was 46 (35-92) minutes. Fever developed in 15 (7.8%) patients which was managed by parenteral antibiotics, none of our patients required ICU admission. Haemothorax developed in 2 (1%) patients and both of them were managed by tube thoracostomy. We achieved complete clearance in 183 (95.3%) cases. In 9 (4.7%) patients residual calculi were manged by flexible ureteroscopy at 1 month.  Conclusions: mPCNL is an effective procedure for management of patients with renal stones with the advantages of less blood loss, short hospital stay and excellent stone clearance rate.