Background: Anatomical abnormalities in kyphoscoliosis [KS] is a huge challenge in patient positioning for robotic prostatectomy. The narrow pelvis limits the range of movement of the robotic instruments' and port placing could be an issue. Second, carful preoperative assessment prior to administration of anesthesia and pneumoperitoneum in robot-assisted radical prostatectomy [RRP] is crucial to reduce peri-operative cardio-pulmonary complications.The Case: We report a successful use of robot in a patient with sever kyphoscoliosis for radical prostatectomy. He was a 58 years old male, overweight, with KS and history of cardiac stenting, bilateral total hip replacement. He had prostatic carcinoma. He is on antihypertensive medications, statins and bronchodilator inhalers. Auscultation revealed bronchovascular breathing with left base inspiratory crepitation. He was Mallampati score III [difficult intubation], recurrent chest infection, and severe restriction of respiratory function. The management had been performed under general anesthesia, in the supine-Trendelenburg-Lithotomy position before engaging the robot. The operative intervention showed stability of the patient except an episode of hypertension [an hour after starting surgery]. The total operative time [3 hours, 50 minutes]; the patient then transferred to intensive treatment unit for the next 12 hours. Postoperatively, backache is absent, drain removed 24 hours later; patient discharged after 48 hours, and catheter removed 10 days later. Histological examination showed adenocarcinoma of prostate, 35% of the gland with negative surgical margin. Conclusion:We confirmed that, robotic assisted radical prostatectomy could be handled in Kyphoscoliosis, Ankylosing Spondylitis with satisfactory outcome, irrespective of both technical and anaesthetic difficulties.

Background: Synchronous bilateral urothelial tumors of the upper urinary tract are extremely rare. However, their treatment is a real challenge for urologists. Patient with low grade superficial urinary bladder tumor can be treated by endoscopic procedures. But they need to be put onto a surveillance program for superficial bladder cancer. In the case of high grade, invasive or large volume or multifocal tumors, radical bilateral nephroureterectomy with cystoprostatectomy is considered the standard of care. Here, We present a case of multifoci high grade tumor of bilateral renal pelvis and ureters in a patient with history of high grade superficial bladder cancer who was treated endoscopically for thirteen years. Most recently, bladder growth recurred aggressively and widely over the last six months and this was treated by singlestage Simultaneous Open Radical Bilateral Nephroureterectomy and Cystoprostatectomy. Our aim was not only to present the operative technique but also to show that the procedure is safe and effective modality of treatment. The open approach was preferred due to its advantage of shorter operative time. In addition, the decision was based on team consultation [Patients, Surgeon and Anesthetist]. The outcome was satisfactory and safe. Thus, the one setting [simultaneous] open approach is considered safe and effective. However, we do not against laparoscopic approach, but we encourage individualization [case by case] of the procedure for each patient according his clinical situation and after counselling of all members of the team.

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Background: Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for large renal calculi. The primary goal of treatment is absolute clearance of stone. The incidence of residual stones after PCNL ranges from 10% to 60% and may be higher in radiolucent stones. Aim of work:Our objective was to assess the effectiveness of using ultrasound during PCNL in patients with radiolucent stones in reducing the incidence of residual fragments postoperatively. Patients and Methods:This was a single-center prospective study over a 6 year period. We identified 86 patients undergoing PCNL with radiolucent stones. Ultrasound was used in conjunction with traditional fluoroscopy to identify residual fragments. Each patient had a first-day postoperative computed tomography to assess for residual fragments. The sensitivity of ultrasound with fluoroscopy was compared to clinically or radiologically [CT] detected residual fragments.Results: Our overall stone clearance rate was 82.6% [as evidenced by postoperative CT]. The sensitivity of intraoperative ultrasound, when compared to postoperative CT, was 95.8%, specificity 40.0%, the positive predictive value 88.3%, and negative predictive value 66.7% Conclusions: The use of intraoperative ultrasound during PCNL for radiolucent stones may help in the reduction of postoperative imaging. However, future studies are recommended.