Background and Purpose:Ideal treatment modality for patients with large impacted proximal ureteral stone remains controversial. We compared laparoscopic transperitoneal ureterolithotomy (Lap-TPUL) and semirigid ureteroscopy for large proximal ureteric stones to evaluate their efficacy and safety.Patients and Methods:From November 2012 to December 2014, we enrolled 122 patients with large (≥1.5 cm) proximal ureteral stone in the study. Patients were randomly divided into two groups: Group A (60 patients), retrograde ureteroscopic lithotripsy using a semirigid ureteroscope; Group B (62 patients), transperitoneal LU (Lap-TPUL).Results:The overall stone-free rate was 71.6% and 93.5% for Group A and Group B respectively (P = 0.008). Auxiliary procedure rate was higher in Group A than in Group B (27.3% vs. 5.6%). The complication rate was 11.2% in Group B versus 25% in Group A. Mean procedure time was higher in laparoscopy group as compared to ureterorenoscopy (URS) groups (84.07 ± 16.80 vs. 62.82 ± 12.71 min). Hospital stay was 4.16 ± 0.67 days in laparoscopy group and 1.18 ± 0.38 days in URS group (P < 0.0001).Conclusion:Laparoscopic transperitoneal ureterolithotomy is a minimally invasive, safe and effective treatment modality and should be recommended to all patients of impacted large proximal stones, which are not amenable to URS or extracorporeal shock-wave lithotripsy or as a primary modality of choice especially if patient is otherwise candidate for open surgery.

Objective:We conducted a study to detect, quantify and compare irrigation fluid absorption in transurethral resection of the prostate (TURP) and Holmium laser enucleation of the prostate (HoLEP), using BEC.Materials and Methods:The study included 50 patients of lower urinary tract symptoms, secondary to benign enlargement of prostate. The patients were nonrandomly allocated to undergo TURP and HoLEP. Twenty-six patients underwent TURP and the remaining 24 underwent HoLEP. Sterile water tagged with 1% ethanol w/v was used for irrigation. Absorption was detected and quantified every 10min by BEC levels. Data was analyzed using standard nomograms.Results:In HoLEP, 14/24 had no fluid absorption. The remaining 10/24 showed fluid absorption ranging from 95 ml to 300 ml. In TURP, all had fluid absorption ranging from 250-980 ml. Three TURP patients developed overt symptoms, while none did in the HoLEP group.Conclusions:Fluid absorption observed in our study in the HoLEP group was lower than in the TURP group.

Introduction:Uroflowmetry is the objective method of measuring rate of urine flow. Nomograms are required to observe the change in flow rates at different voided volumes (VVs) and the use of which overcomes the limitation of referencing flow rates to any single VV. The purpose of the present study was to construct the Indian uroflow nomogram for adult healthy males between 15-40 years of age.Methods:A total of 1000 healthy males between 15 and 40 years of age were included in the study. Exclusion criteria were any urinary symptoms or urological intervention. Parameters analyzed statistically were age, peak flow rate (Qmax), average flow rate (Qavg), and VV. A nomogram was drawn for the fitted regression model.Results:The mean age was 27.26 ± 6.71 years. The mean Qmax, Qavg, and VV were 24.32 ± 3.50 ml/s, 9.45 ± 2.55 ml/s, and 420.93 ± 97.89 ml, respectively. The correlation between flow rates and VV was statistically significant, indicating that the higher the VV, the higher the flow rates. A negative significant correlation of Qmax with age was seen in our study. We observed a decline of Qmax by 1 ml/s/decade. The relationship of Qmax with VV is in linear progression up to 600 ml, and then it becomes a plateau and with higher VV it declined.Conclusion:Qmax exhibits significant correlation with VV and age. A nomogram was constructed to attain normal reference values of flow rate over different VVs.

Purpose:To review our success in PCNL for managing large horse shoe kidney stones as primary treatment.Method:Between 2012 and 2016, a total of 23patients (24 renal units) underwent percutaneous renal surgery for stone dieses in horseshoe kidneys. Indications were HSK with stone more than 1 cm in size and failed ESWL.Results:Mean age was 35.60 ± 10.10 years out of which 18 were males and 5 females. One patient had stone in both kidneys. Mean stone size was 22.03 ± 10.33 mm. Access site was upper calyceal and subcostal in all patients. In 2 patients an extra middle calyceal puncture were used for total clearance (8.69%). Mean operation time was 67.22 ± 7.63 minutes. One patient with staghorn stone was converted to open surgery because of inaccessibility of the stone and complexity of the renal calyceal system. Post operatively, 2 renal units with residual stone more than 8mm were cleared with ESWL. Complete clearance was achieved in 21 renal units with PCNL (87.50%). There was no significant intra operative complication. Post operatively 2 patients developed fever which was treated conservatively(clavien grade I).Conclusion:PCNL can be recommended as first line of management in the treatment of horseshoe kidneys with large stone burden considering its higher clearance rate and minimal complications.

Aim:The aim of this study is to compare the outcomes of miniaturized percutaneous nephrolithotomy (mini-perc) and retrograde intrarenal surgery (RIRS) in management of renal stones with a diameter <15 mm.Materials and Methods:This was an open-label prospective study that included a total of 80 cases underwent mini-perc (n = 40) and RIRS (n = 40) between July 2014 and August 2017. The primary outcome objective was stone-free rate, retreatment rate, complications, hospital stay, operative time, and reduction in hemoglobin level. Data were analyzed using SPSS version 16.0 Software.Results:Overall, 80 patients were enrolled in this study. The mean age was 40.12 and 38.20 years, and the mean stone size was 1.15 and 1.30 cm in mini-perc and RIRS group, respectively. Majority of the study participants were males. Overall, mini-perc and RIRS had stone clearance rates of 100% and 95.4%, respectively. Two patients required retreatment in RIRS group. The duration of hospital stay and the rate of complication was similar in both the groups. Operative duration was more in RIRS group. Decrease in hemoglobin level was more in mini-perc group.Conclusions:Results demonstrated that both modalities were associated with high stone clearance rates with minimal complications. RIRS was associated with less reduction in hemoglobin and could be used as standard treatment modality for small renal calculi.