Objective:This study aims to demonstrate a novel laparoscopic technique of tapering megaureter without disrupting the blood supply and disconnecting the ureter.Materials and Methods:Eight cases of primary obstructive megaureter in the age group of 14–22 years underwent laparoscopic extravesical ureteric reimplantation between August 2011 and July 2015 using our novel technique. Five patients had obstruction on left side and three on right side. Follow-up ultrasonography at 1 month and 3 months, voiding cystourethrogram (VCUG) at 3 months and intravenous urogram (IVU) at 6 months was obtained to assess the development of reflux and to look for adequate drainage of the obstructive ureter.Results:Average age of the patients at the time of surgery was 18.5 years. Mean operating time was 95 min. Mean blood loss of 20 ml. VCUG done after 3 months showed no reflux in all cases. IVU done after six months showed no obstruction and complete drainage of dye.Conclusion:Our technique of tapering obstructed megaureter over a preplaced ureteral dilator is time saving and also helps in preserving blood supply to lower ureter. As a result, ureteric anastomotic stricture rate is very low. It is easily reproducible in the open as well as by robotic.

INTRODUCTIONRenal calculi are the most common cause for pain in patients with urological problems and their recurrence rate is also very high to the tune of 70%.1 Various options are available for their treatment ranging from open surgery to extracorporeal shock wave lithotripsy (ESWL). For large stone burden, per cutaneous nephrolithotomy (PCNL) is the standard of care.2,3 Per cutaneous nephrolithotomy was first introduced by Fernstrom and Johansson and rapidly gained acceptance as the standard of care for removal of large and complex renal calculi. 4 Since then a lot of modifications have been introduced in the techniques and instrumentation of PCNL.In a standard PCNL, a 30Fr Amplatz sheath is placed after dilatation of the tract and calculi are retrieved after fragmentation. Either a double J (DJ) stent is placed or Ureteric catheter is retained. A nephrostomy tube is placed post procedure for haemostatic tamponade effect and to access the system in case of significant residual ABSTRACT Background: Since the time standard per cutaneous nephrolithotomy (PCNL) was introduced in 1976, it has undergone changes in techniques, instrumentation and post-operative management for better patient care. Standard PCNL involves placement of nephrostomy tube and DJ stent/ureteric catheter after stone retrieval. Now the trend is towards tubeless PCNL and totally tubeless PCNL as to minimize pain, infection and hospital stay. Our objective was to compare the outcome of standard PCNL with tubeless PCNL. Methods: This was a randomized study of patients who underwent standard PCNL and tubeless PCNL in our institute from August 2013 to August 2015 for renal calculi >2 cms. Patients with residual calculi needing further ancillary treatment and patients who had major collecting system tear were excluded from the study. A total of 257 patients who had undergone PCNL during the study period for renal calculi >2 cm were included in the study. 27 patients were excluded due to presence of residual calculi or major collecting system tear. Of these 115 underwent standard PCNL and remaining 115 tubeless PCNL. Post-operative visual analog pain score, need for analgesics, infection rate, post-operative hospital stay were analyzed. Results: No significant differences were noted in patient demographics, age, sex, stone size and stone burden. There were no significant complications seen in tubeless group as compared to standard PCNL group. Post-operative pain and hospital stay was significantly reduced in tubeless PCNL group. Conclusions: Tubeless PCNL is a relatively safe and effective modification of standard PCNL. It increases patient compliance of PCNL by reducing post-operative pain and early recovery.

We report the case of a late preterm small for gestational age baby girl presenting with deformities of both knees at birth. Diagnosis by radiologic investigation revealed bilateral knee joint dislocation and ultrasonography revealed developmental dysplasia of the hip. Concomitant treatment of the congenital dislocation of the knee with serial casting and the hip with Pavlik harness provided satisfactory results. Cases with delayed presentation or which do not respond to conservative treatment need surgery. Delay in treatment may lead to long-term instability and stiffness. Emphasis should be laid on the immediate recognition and treatment of the condition.

Laparoscopic pyeloplasty is viable standard minimally invasive alternative to open pyeloplasty for the treatment of ureteropelvic junction obstruction. Intrathoracic bleeding is an extremely rare complication after laparoscopic urological surgery, but it should be suspected and promptly diagnosed in case of worsening hemodynamic status and respiratory parameters during the intra or post-operative course. We report a case of hemothorax complicating an otherwise uneventful LP in an 18-year-old girl.