Omission of a nephrostomy tube after PCNL while retaining an externalized ureteral catheter for 16 to 20 hours is sufficient and safe irrespective of the stone characteristics. Shape, position, and function of the kidneys are also irrelevant with regard to tubeless PCNL.

ABSTRACT. Numerous prescription and nonprescription medications are currently available for suppression of cough, a common symptom in children. Because adverse effects and overdosage associated with the administration of cough and cold preparations in children have been reported, education of patients and parents about the lack of proven antitussive effects and the potential risks of these products is needed. INDICATIONS AND CONTRAINDICATIONSCough is a reflex response to mechanical, chemical, or inflammatory irritation of the tracheobronchial tree mediated by sensory neurons in the airways reflexly through neurons in the brainstem. Cough serves as a physiologic function to clear airways of obstructive or irritating material or to warn of noxious substances in inspired air.

PurposeTo evaluate the initial experience and outcome of photo-selective vaporization of the prostate (PVP) for benign prostatic hyperplasia (BPH) in Pakistan with the use of a 980 nm diode laser.Materials and MethodsA prospective study was performed from November 2016 to December 2017. A total of 100 patients diagnosed with bladder outlet obstruction secondary to BPH who planned for PVP were enrolled in the study. PVP was carried out with a diode laser at 980 nm (Biolitec Diode 180W laser) in a continuous wave with a 600 nm (twister) fiber. Baseline characteristics and perioperative data were compared. Postoperative outcomes were evaluated by International Prostate Symptom Score (IPSS), post void residual (PVR) and maximum urinary flow rate (Qmax) at 3 and 6 months after surgery.ResultsThe mean age was 65.82±10.42, mean prostate size was 67.35±16.42, operative time was 55.85±18.01 and total energy was 198.68±49.12 kJ. At 3 months and 6 months, significant improvements were noted (p<0.001) in IPSS 7.04±1.69 (−18.92), Qmax 19.22±4.75 mL/s (+13.09) and and PVR 18.89±5.39 mL (−112.80). Most frequent problems were burning micturition (35%) and terminal dysuria (29%). No significant difference in postoperative hemoglobin was seen in patients who were on anti-platelet drugs.ConclusionsPVP with a diode laser is a safe and effective procedure for the treatment of BPH and is also safe in patients who are on anti-platelet agents.

Ganglioneuroblastoma, neuroblastoma, and ganglioneuroma (GN) are the tumors that arise from the neural crest cells. Of these, GN has the most benign origin without metastatic potential. The most common sites of their origin are the posterior mediastinum and retroperitoneum. Although the imaging studies, including CT, are available to detect these tumors, the definitive diagnosis can only be made by histological examination. We present a case of a 40-year-old woman with a retroperitoneal GN causing longstanding, gradually increasing, uncontrolled abdominal pain due to its pressure effect on the pancreas, duodenum, and right kidney with the displacement of the inferior vena cava. An exploratory laparotomy was performed, and the mass was removed. Histopathology confirmed the benign nature of the mass (a GN). These tumors are rarely malignant and mostly asymptomatic. However, in our case, abdominal pain was affecting the patient's life. After a discussion with the patient, an elective surgical procedure was performed, and the patient was symptom-free postoperatively and able to resume her regular routine.

Since 1990, when the first laparoscopic nephrectomy was performed, there has been a dramatic increase in interest in laparoscopic procedures in urological surgeries. The aim of the study was to present our experience with the first 100 cases of laparoscopic nephrectomy at our institute, identify the difficulties encountered, and discuss how to approach the solutions. Materials and methodsThe data of all patients who underwent laparoscopic nephrectomy between May 2017 and April 2019 (n=100) were reviewed retrospectively. ResultsA total of 100 patients (49 men and 51 women), with a mean age of 34.1 ± 15.1 years, underwent laparoscopic nephrectomy. The mean operative time was 108 min (IQR, 45-240). The operative time was significantly reduced with the surgeons' experience. Of 100 cases, only four were converted to open surgery because of bleeding from the renal bed area, strong adhesions from previous surgeries, or morbid obesity. Of 100 patients, 30 were allowed intake on the same operative day while 70 were allowed on the first postoperative day. Intravenous and oral analgesics were discontinued on the second postoperative day in 81 patients. ConclusionThe learning curve in our series of cases is comparable to a very similar study with reduced operative time, reduced blood loss, and fewer complications when compared to open nephrectomy. In addition, setups with minimal previous laparoscopic units can initiate laparoscopic procedures with minimal risk to the patient.