Background : Urolithiasis is one of the oldest disease known to human beings and has been documented in ancient Greek. Urolithiasis continues to pose a significant health hazard, causing progressive renal impairment, if left untreated. The etiology of renal insufficiency in patients with nephrolithiasis is multifactorial and includes renal obstruction, urinary infection, frequent surgical interventions, and coexisting medical diseases. The purpose of this study is to assess the change in renal function following removal of kidney stones by Percutaneous Nephrolithotomy (PCNL) in patients with associated impaired renal function. Materials and methods : 50 Patients with renal stone disease with associated impaired renal function who were admitted and underwent PCNL in Urology department were selected as per inclusion and exclusion criteria by purposive sampling. Complete clinical evaluation including history, physical examination, relevant examinations & laboratory investigations were performed. All the patients were treated by PCNL monotherapy with Double J stenting. Mean age was 46.63±11.95 years (Age range: 24-72 years). There were 36 males (72%) & 14 females (28%) & male to female ratio was 2.57:1. Results : In this study, a significant fall in mean serum creatinine (0.5 mg%) was demonstrated following the stone removal. The creatinine value remained unchanged in 12% and improved in 84% patients. In contrast to the improvement of renal function as evident by a decline in the mean serum creatinine values, the mean Glomerular Filtration Rate (GFR) registered a small fall of 1.78 ml/min (Statistically not significant). we have observed that total 12 (24%) patients out of 50 cases experienced different sorts of complications. Conclusion: This study showed that PCNL approach to urolithiasis in patients with impaired renal function significantly improves renal functional status manifested according to the preoperative and postoperative difference of serum creatinine and 99mTc DTPA performance. JCMCTA 2019 ; 30 (2) : 70-74

Back ground: The incidence of renal calculi is rising and more patients are presenting with small renal calculi. The treatment options for renal calculi (d”2 cm) are ESWL, percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). The development of minimal invasive surgery for the treatment of renal calculus has led to an increase in success rates and, at the same time, has decreased the morbidity associated with these treatments. Objective: The study aimed to evaluate outcome of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy in the treatment of upper calyceal stone of d”2 cm in diameter. Methods: 60 Patients with radiopaque upper calyceal stone (d”2 cm) were admitted and underwent RIRS (Group A) & PCNL (Group B) in Urology department as per inclusion and exclusion criteria by purposive sampling (30 patients in each group). Complete clinical evaluation including history, physical examination, relevant examinations & laboratory investigations were performed. Result: Mean age was 37.23±11.59 years (range 18-62years) in group A and 40.10±11.49 (range 18-65 years) in group B. Mean operative time was significantly lower in group A (90.13 +/- 18.79 min) than group B (107.36 +/- 16.4 min) (p <0.05). Mean volume of irrigation fluid used during surgery, mean drop in the postoperative hemoglobin concentration, hospital stay, mean VAS score at 8 hours & 24 hours after operation were significantly lower in RIRS group than PCNL group (p< 0.05). We achieved a stone clearance of 90.00% in the RIRS group and 96.67% in the PCNL group. The difference in stone clearance in two groups was not statistically significant (p=0.30). Conclusion: The study concluded Retrograde intrarenal surgery (RIRS) in the treatment of upper calyceal stone of d”2cm in diameter is a feasible, effective and safe treatment option. Given the added morbidity in PCNL, RIRS should be considered standard therapy in these patients. Bangladesh J. Urol. 2021; 24(1): 99-104

Background: Advancements in the endoscopic armamentarium, retrograde intrarenal surgery has become a viable and attractive option for the treatment of renal stones because of its high stone-free rates (SFRs) and low morbidity. Objective: To describe our experience and outcome of RIRS for the treatment of renal stones and to assess its effectiveness and safety. Design, setting, and participants: A retrospective analysis of 60 patients who underwent RIRS for renal stones at our institute between January 2018 to December 2018 was performed. Surgical procedure: Flexible ureteroscopy and laser lithotripsy using a standardized technique with last-generation flexible ureteroscopes (Flex-Xc) using Holmium-YAG laser. Outcome measurements and statistical analysis: Clinical data were collected and intraoperative and postoperative outcomes were assessed (Ureteral access sheath placement, operation time, hospital stay, stone free rate, post-operative blood transfusion & fever, need for second session of RIRS. A descriptive statistical analysis was performed. Results and limitations: The mean overall stone size was 13±3 mm. Pre stenting done in all cases. Ureteral access sheath placement was possible in 54(90%) patients. At 1 month follow-up, the overall primary SFR was 86.67%(52 cases), the secondary SFR was 96.67%(58 cases).The mean operative time was 91.96±18.7 min. Mean hospital stay was 1.86±1.02 days. Complications were reported in 8 (13.33%) patients overall, with fever in 6 patients (10%), steinstrasse in 2(3.33%) patients need for second session RIRS in 6 patients (10%).No patient needed blood transfusion. The main limitation of the study is the retrospective nature. Conclusions: RIRS performed using a flexible ureterorenoscope marked the beginning of a new era in urology. It is safe and effective procedure and an alternative to extracorporeal shock wave lithotripsy (ESWL) and Percutaneous nephrolithotomy (PCNL) in the treatment of selected renal stones. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.3-10

Background: Percutaneous nephrolithotomy (PCNL) has gradually evolved to be one of the main endourologic treatment options for managing renal stone. For successful enctry into pelvicalyceal system can be obtained by fluoroscopy, ultrasonography and sometimes computed tomography (CT-guided) after RGP, but many are done without RGP. In this study, our objective was to compare the clinical outcomes of renal calculi management by PCNL with and without retrograde pyelography. Method: This quasi experimental study conducted on 60 cases with opaque renal calculi in lower, middle and upper calyx and lower calyx with renal pelvis. They were grouped into 2 groups purposely, one with RGP (30 patients) while other without RGP (30 patients). Result: We found no statistically significant difference between RGP and non RGP group in terms of duration of surgery (71.68 ±12.95 minutes vs 78.84±15.56 minutes), duration of radiation exposure (3.55± 1.34 min vs 3.74± 0.52 minutes) & hospital stay (3.0± 0.8 vs 2.6 ±1.0 days). Around 93.33 percent of the patients in the RGP group (n=28) were stone free, whereas in the Non-RGP group, 90% percent of the patients (n=27) were stone free. Conclusion: We can avoid RGP during PCNL in selected cases for pelvicalyceal access in the sight of no significant differences in duration of surgery, duration of radiation exposure, Hospital stay & complications in PCNL either with or without RGP. Bangladesh J. Urol. 2021; 24(1): 87-89