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IntroductionIntrauterine contraceptive devices may at times perforate and migrate to adjacent organs. Such uterine perforation usually passes unnoticed with development of potentially serious complications.Case presentationA 25-year-old woman of North Indian origin presented with an acute tender lump in the right iliac fossa. The lump was initially thought to be an appendicular lump and treated conservatively. Resolution of the lump was incomplete. On exploratory laparotomy, a hard suspicious mass was found in the anterior abdominal wall of the right iliac fossa. Wide excision and bisection of the mass revealed a copper-T embedded inside. Examination of the uterus did not show any evidence of perforation. The next day, the patient gave a history of past copper-T Intrauterine contraceptive device insertion.ConclusionsCopper-T insertion is one of the simplest contraceptive methods but its neglect with inadequate follow-up may lead to uterine perforation and extra-uterine migration. Regular self-examination for the "threads" supplemented with abdominal X-ray and/or ultrasound in the follow-up may detect copper-T migration early. To the best of our knowledge, this is the first report of intrauterine contraceptive device migration to the anterior abdominal wall of the right iliac fossa.

Abstract:The ectopic testis is frequently misdiagnosed as cryptorchidism or anorchism. We present a case of three month old male infant diagnosed as right ectopic perineal testis and right hemiscrotal hypoplasia. Ectopic testes are thought to be greater at risk of trauma, testicular torsion, subfertility and malignancy. Although definitive evidence in support of these fears in case of perineal ectopia is lacking due to its rarity and lack of long follow-up. Surgical correction of undescended testes is generally done at about 6 months of age to allow for spontaneous descent. On the other hand there is no need to delay surgery in ectopic testis because possible descent as seen in undescended testis will not occur. Yet the timing of surgery can be individualized for perineal ectopia without any unnecessary delay.

Background: Percutaneous nephrolithotomy (PCNL) has experienced remarkable development and alteration since it was first described in 1976 by Fernstorm et al. It has also experienced miniaturization of equipment, improvement in operative systems, and refining renal access methods leading to the achievement of maximum clearance of stone while causing minimal morbidity. For example, in endourological practice, when the patient is subjected to PCNL, he traditionally needs programmed inpatient admission, as part of their recovery, it is applicable as an outpatient method in properly selected cases. Objectives: We aimed at evaluating the safety and applicability of the outpatient PCNL procedure. Methods: This retrospective study was done on 210 cases of tubeless PCNL performed by a single urologist at our institute from January 2016 to January 2019. Patients’ mean age (134 males and 76 females) was 57 ± 11.8 years, and 7 patients aged 8 - 12 years. There were 71 pelvic or calyceal solitary stones, 62 non-complete staghorn stones, 17 ureteral stones, 32 renal + ureteric stones (simultaneous renal and ureteral stones) , and 28 complete staghorn stones. The average stone size was 3.5 ± 2.8 (range: 0.7 to 11.8 cm). Results: The mean operation duration was 85.0 ± 29.4 min, and the mean hospital stay was 21.7 ± 3.4 h. Out of 210 patients, 6 patients had longer stay due to high-grade fever and 3 patients due to severe pain, and also 7 patients refused discharge due to personal and social reasons. Our ambulatory PCNL rate was 97 % ( 194 out of 210). Within 72 h, 5 patients were readmitted due to high-grade fever, 3 patients due to haematuria, and 4 patients due to pain and dysuria, and all patients were discharged 2 - 4 days after conservative treatment. Thus, the readmission rate was 6.18% (12 cases were readmitted out of 194 cases). Patients showed a blood transfusion rate of 1.4 %. Also, 19 cases (9.02%) were found with post-operative fever, and no urosepsis was reported. No pulmonary complications and mortality were noted. No re-exploration was done, and no major leak was noted. The angio-embolization rate was 0.59%. We did not use HEMO-SEAL technology, cautery, or suture in the tracks. Conclusions: In conclusion, the outpatient PCNL procedure is an applicable and feasible procedure under selected criteria; however, more investigations using a larger sample size are needed.

To observe the safety and efficacy of tubeless percutaneous nephrolithotomy (PCNL). Materials and methods: Since January 2016 to 2019, 210 consecutive tubeless PCNL performed at our hospital were enrolled into this retrospective chart review. The average age of the patients (134 males and 76 females) was 57 ± 11.8 years, and 7 patients were between 8 to 12 years. The stone characteristics were 71 pelvic or calyceal solitary stones, 62 non-complete staghorn kidney stones, 17 ureteral stones, 32 kidney + ureteral stones (concomitant kidney and ureteral stones), and 28 complete staghorn stones. Mean stone size range 3. 5+2.8[range 0.7cm to 11.8 cm]. Patient's position was prone. Tract size varied from 26 F to 30 F and number of tracts varied single tract to 4 tracts. Results: The average operative time was 85.0 ± 29.4 minutes. Average hospital stay was 21.7 hrs (6 patients had longer stay due to fever) and the blood transfusion rate was 1.4%. Postoperative fever was noted in 19 (9.02%) patients, no urosepsis was noted. No Pulmonary complications and mortality noted. No re exploration was done. No major leak was noted. Angioembolisation rate 0.95%. We did not use any haemoseal ent or cautery in the tracts. Conclusion: PNT serves purpose of relook PCNL and drainage of urine if there is pyonephrosis or surgeon has doubt about PUJ competency like edema, perforation etc., but other factors like bleeding, fever, sepsis, AV aneurysm, AV fistula, pulmonary complications if puncture is in upper calyx, mortality are comparable to standard PCNL and advantage of tubeless PCNL are reduced post-operative pain which leads to lesser analgesia requirement, less apprehension as no tube is there, therefore more comfort, early discharge and indirectly less hospital expenses, early return to work. Our observation is that Tubeless PCNL is effective and safe. There is limitation of our study that our sample size is small and it is not a case-control study, therefore significance was not established.