Objective: Preliminary study to assess the feasibility and safety of percutaneous nephrolithotomy (PCNL) as an ambulatory procedure. Patients and Methods: Between February 2011 and September 2012, 84 patients with renal calculi fulfilling the inclusion criteria were admitted to the Urology Department of Benha University Hospitals for PCNL. All patients were subjected to a full medical history, clinical, laboratory and radiological examinations. Tubeless PCNLs were done in the supine position, and an antegrade double-J stent was inserted. Operative time and intraoperative complications were recorded. Postoperatively, the hematocrit value, postoperative pain and analgesics, need of blood transfusion, stone-free rate, and length of hospital stay were recorded. Stable patients that could be safely discharged within 24 hours after surgery were considered ambulatory. Results: All cases of tubeless PCNL were successfully done and no cases converted to open surgery. The overall stone-free rate was 91.7%, the mean postoperative pain score measured by the visual analog scale was 4.4 ± 1.2, the mean overall hematocrit deficit was 4.8 ± 2.2% and the mean hospital stay was 33.4 ± 17.5 hours. Ambulatory PCNL was accomplished in 60 out of 84 patients (71.4%) and double-J stents were removed 7-10 days postoperatively. In the non-ambulatory cases, double-J stents were removed after auxillary procedures were done according to each case. Conclusion: PCNL can be safely done on an ambulatory basis under strict criteria, but further studies are needed to confirm and expand these findings.

Most cervico-mediastinal goiters are situated in the anterior mediastinal compartment, but according to the literature, 10–15 percent of them are located in the posterior mediastinum. Although most anterior mediastinal goiters can be removed by using the transcervical approach, cervico-mediastinal goiters in the posterior mediastinal may require additional extracervical incisions. We report the case of a huge cervico-mediastinal goiter extending from the neck retrotracheally to the posterior mediastinum. Surgical removal is the treatment of choice in such cases. We performed an operation using a transcervical and right posterolateral thoracotomy approach. Histopathological examination confirmed the diagnosis of a large toxic goiter. The patient recovered well and was discharged in one week. While most retrosternal goiters can be resected through a transcervical approach, those extending beyond the aortic arch are better dealt with by either sternotomy or thoracotomy. This report describes the use of transcervical and posterolateral thoracotomy with an excellent postoperative result.