The retrograde technique to establish a percutaneous nephrostomy tract for percutaneous nephrolithotomy is safe and effective with stone clearance and complication rates comparable to those of antegrade access.

Introduction: Distal ureteroscopy for stone extraction is a common procedure that is generally performed with spinal or general anesthesia. We retrospectively reviewed all distal ureteroscopy performed for ureteric stone extraction with conscious sedation at our institution over a 10-year period to determine its efficacy and safety. Methods: A retrospective chart review was performed of all distal ureteroscopy performed for calculus removal from 2004 to 2014. Patient characteristics, analgesic requirement, tolerability, procedure time, stone size and composition, method of stone extraction, success rate, and complications were collected. Results: Between 2004 and 2014, 314 procedures were performed. Mean age was 53.74 years, with 160 males and 154 females. A success rate of 97% and 10 (3.2%) complications were reported. Mean analgesic requirement was 189 μg of fentanyl (range: 50-400) and 2.79 mg of midazolam (range: 0-8). A total of 263 patients (83.7%) tolerated the procedure well, with only seven (2.2%) having poor tolerability. When comparing females to males, females were found to require less fentanyl (p=0.0001) and midazolam (p=0.0001). When calculi >5 mm were compared to those <5 mm, there was no statistically significant difference in success rate, procedure time, analgesic requirement, tolerability, or complications. Conclusion: Distal ureteroscopy with conscious sedation is safe and efficacious. To our knowledge, this is the first report demonstrating stones >5 mm can be safely and effectively treated with conscious sedation during this procedure. The context of our findings must be understood within the limitations of our retrospective analysis. IntroductionDistal ureteric stones are often treated with observation and/or medical expulsive therapies, extracorporeal shockwave lithotripsy (ESWL) or distal ureteroscopy under spinal or general anesthesia. ESWL and distal ureteroscopy have both been shown to be safe and effective treatments.Stone removal via ureteroscopy usually requires an operating theatre and general anesthetic, in contrast to ESWL, which is typically performed under conscious sedation. 1,2Ureteroscopy under local anesthesia was first described by Rittenberg et al in 1987. 3 Since January 1993, distal ureteroscopy under conscious sedation has been offered at our centre for the removal of distal ureteric stones. A proof of principle analysis at our centre demonstrated the feasibility and safety of this procedure. 4 Subsequent to this analysis in 2003, our centre compared ESWL and distal ureteroscopy for distal ureteric stones and found treatment success in 72% and 95% of patients, respectively.5 These results also showed men were less likely to tolerate ureteroscopy under conscious sedation compared to women.In this study, we report an updated analysis of all distal ureteroscopies under conscious sedation performed for distal ureteric stone extraction at our institution over a 10-year period to evaluate its safety and efficacy over the long term. MethodsSince 1993 our instit...

Increasing data advocates the wider use of partial nephrectomy for renal tumours amenable to this approach. We describe the initial North American use of a novel parenchymal clamp in an open and a laparoscopic partial nephrectomy. Initial results in 3 patients (2 open, 1 laparoscopic) demonstrate excellent preservation of renal function and good oncologic outcomes. Hilar dissection was avoided in all cases and the estimated blood loss was low. In our small series, we found this device to be a safe and useful adjunct to partial nephrectomy.