To evaluate the complications (using the CROES Clavien scoring system) and various factors affect... more To evaluate the complications (using the CROES Clavien scoring system) and various factors affecting them in children undergoing percutaneous nephrolithotomy (PCNL). We analysed prospectively maintained data of paediatric PCNL (patients ≤17 years) from January 2008 to December 2012. Stone complexity was defined according to validated Guy's stone score (GSS). Procedures were performed in the prone position by experienced urologists. The tract was dilated (24-30F) under fluoroscopic guidance, and an adult rigid nephroscope complemented with a cystoscope/ureteroscope were used. Complications were recorded according to the CROES-Clavien score, recently defined by the Clinical Research Office of the Endourological Society (CROES) Study Group. The study group comprised 158 procedures performed in 153 children (98 boys and 55 girls), with a mean (range) age 10.03 ± 4.51 (2-17) years. The mean (range) stone burden was 376.68 ± 265.23 (150-2400) mm(2) . The distribution of cases according to the GSS was 31% grade I, 35.4% grade II, 19% grade III, and 14.6% grade IV. The stone-free rate of PCNL monotherapy was 85.4%, which increased to 93.7% after relook PCNL/extracorporeal shock wave lithotripsy. In all, 62 children (39.2%) had operative complications; 84% were minor, i.e. Clavien grade 1/2, and managed conservatively. Stone size, GSS, tract size, number of punctures and operation duration were significantly associated with complications on univariate analysis (P < 0.05). However, on multivariate logistic regression analysis, operation duration was the only independent risk factor associated with complications (95% confidence interval: 1.013-1.065, odds ratio = 1.04; P = 0.038). Percutaneous nephrolithotomy in children using adult instruments is an effective and safe procedure for managing simple as well as complex renal calculi. Assignment of specific Clavien scores to all possible PCNL complications by the CROES PCNL Study Group have improved precision in reporting complications in a standard objective format, including the minor ones. Such models are very useful for making inter-observer comparisons to obtain clinically relevant inferences. Mean operation duration is the only independent factor affecting complications of the procedure.
• To investigate the association between overactive bladder (OAB) and C-reactive protein (CRP) in... more • To investigate the association between overactive bladder (OAB) and C-reactive protein (CRP) in a population-based sample of men and women. • Epidemiological survey of urological symptoms among men and women aged 30-79 years. A multi-stage stratified cluster design was used to randomly sample 5503 adults from the city of Boston. Analyses were conducted on 1898 men and 1854 women with available CRP levels. • The International Continence Society defines OAB as 'Urgency with or without urge incontinence, usually with frequency and nocturia.' OAB was defined as: (1) urgency, (2) urgency with frequency, and (3) urgency with frequency and nocturia. • Odds ratios (OR) and 95% confidence intervals (95% CI) of the CRP and OAB association were estimated using logistic regression. • Prevalence of OAB increased with CRP levels in both men and women. • In men, adjusted ORs (95% CI) per log(10) (CRP) levels were 1.90 (1.26-2.86) with OAB defined as urgency, 1.65 (1.06-2.58) with OAB defined as urgency and frequency, and 1.92 (1.13-3.28) with OAB defined as urgency, frequency and nocturia. • The association was more modest in women with ORs (95% CI) of 1.53 (1.07-2.18) for OAB as defined urgency, 1.51 (1.02-2.23) for OAB defined as urgency and frequency, and 1.34 (0.85-2.12) for OAB defined as urgency, frequency and nocturia. • Results show a consistent association of increasing CRP levels and OAB among both men and women. • These results support our hypothesis for the role of inflammation in the development of OAB and a possible role for anti-inflammatory agents in its treatment.
Study Type - Therapy (case series). Level of Evidence 4. What&amp... more Study Type - Therapy (case series). Level of Evidence 4. What's known on the subject? and What does the study add? This technique has been reported to have an excellent success rate in the bulbar urethra, although no data exists for its use in the penile urethra. This is the first study to report successful use of the technique in the reconstruction of penile urethral strictures. • To review our initial experience with single-stage overlapping dorsal and ventral buccal mucosa graft (BMG) urethroplasty for the reconstruction of complex anterior urethral strictures. • Among 696 urethroplasties performed at two tertiary urethroplasty centres from October 2007 to September 2010, single-stage urethral reconstruction using urethral plate incision and/or excision and overlapping dorsal and ventral BMGs was used in 36 men (5%) with complex urethral strictures (mean length 4.5 cm). • Demographic and perioperative data was tabulated and outcomes were analysed. • Stricture location was bulbar (61%), penile (19%), or both bulbar and penile (20%). • Dorsal grafts, applied only within the most severely strictured segment, measured a mean 42% of the opposing ventral graft length. • At a mean follow-up of 15.7 months, 32 of the 36 cases were successful (89%). • Repeat urethroplasty was performed in all four recurrences, three of which were successful at a mean follow-up of 16 months. • Single-stage reconstruction of focally obliterative long urethral strictures using overlapping dorsal and ventral BMGs is safe and effective.
• To establish whether it is safe to manage minimally symptomatic and asymptomatic pelvi-ureteric... more • To establish whether it is safe to manage minimally symptomatic and asymptomatic pelvi-ureteric junction obstruction (PUJO) conservatively. • In all, 50 patients with PUJO diagnosed with dynamic renography, and monitored with at least two renograms. • In all, 19 patients were totally asymptomatic, while 31 patients had minimal symptoms at time of diagnosis. • The mean follow-up was 53 months. • During the course of follow-up 10 of the 50 patients deteriorated. • All patients who had asymptomatic renographic deterioration, deteriorated within 2 years of diagnosis. • Eight of the 10 patients that deteriorated needed pyeloplasty and two nephrectomy. • Conservative management of patients with minimally symptomatic and asymptomatic PUJO is safe. • Discharging patients could be considered at 2 years from diagnosis, if they remain renographically stable and asymptomatic or minimally symptomatic.
• To evaluate the long-term outcomes of patients undergoing observation of asymptomatic renal cal... more • To evaluate the long-term outcomes of patients undergoing observation of asymptomatic renal calculi. • This is a retrospective review of 50 patients with 85 stones undergoing observation with annual imaging from January 2005 to December 2009. • The incidences of spontaneous stone passage, stone progression and intervention were evaluated and assessed for statistical difference according to initial size and location of stone. • Percutaneous nephrolithotomy, shock wave lithotripsy and ureteroscopy were performed when patients developed complications from the stones. • Patients were followed up for a mean of 46 months. Sixteen percent had bilateral stones and 38% had multiple stones. • The average stone size was 5.7 mm and 31%, 26% and 43% of the stones were located in the upper, middle and lower pole respectively. • Overall incidences of spontaneous passage, progression and intervention were 20%, 45.9% and 7.1% respectively. • Stones measuring 5 mm or less were significantly more likely to pass (P= 0.006). • There was no significant difference in the incidence of passage according to the initial location of the stone (P= 0.092). There was no significant difference in intervention or progression according to the initial size (P= 0.477 and 0.282 respectively) or location of stone (P= 0.068 and 0.787 respectively). • Patients with asymptomatic renal stones may be managed conservatively in view of low risk of intervention (7.1%). • Annual imaging should be performed as half of these stones will progress in size.
WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Use of balloon dilatat... more WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Use of balloon dilatation leads to less blood transfusion rates than metallic dilators. Plasma vaporization leads to less blood loss than balloon dilatation in this study. The study evaluates a novel technique for the creation of a nephrostomy tract for PCNL. Compared with other techniques, plasma vaporization is a safer procedure that causes lesser blood loss, requires a shorter hospital stay, causes less radiation exposure, and enables easier nephrostomy tract creation for PCNL. To evaluate the efficacy and safety of plasma vaporization for tract creation in percutaneous nephrolithotomy (PCNL). In this randomized prospective trial we enrolled 65 patients and assigned each to one of two groups: 33 patients were randomly scheduled to undergo plasma vaporization and 32 were scheduled to undergo balloon dilatation for tract creation. A bipolar resectoscope mounted with a plasma vaporization button electrode or a traditional balloon dilator were used to create the nephrostomy tract. The mean blood loss, mean length of hospital stay and mean operating time, stone-free rates and postoperative complications in the two groups were compared using the t-test or chi-squared test (Fisher's exact test). The plasma vaporization group had a significantly lower mean (SD) decrease in haematocrit level (3.5 [2.8]% vs 6.6 [3.3]%; P = 0.02) and a shorter mean (SD) hospital stay (2.6 [1.2] days vs 5.3 [3.4] days; P = 0.0). There were no significant differences in the operating time, stone-free rate or cases of postoperative fever between the two groups. The plasma vaporization technique is safe, leads to less blood loss than the other techniques, and is a simple solution for creating the nephrostomy tract for PCNL.
WHAT&... more WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: In a recent rtMRI study, we were able to show that, during initiation of voiding, there was both funnelling of the bladder neck and simultaneous contraction of the ventral prostate. We presumed that the vertical contraction of the ventral prostate contributes to the initiation of successful micturition. The question remained as to whether this shortening of the ventral prostate is predominantly caused by contractile elements in the organ itself, or by surrounding contractile elements of the pelvic floor. In our study we provide insight in to anatomical changes, and biometric and functional analysis of the prostate during micturition. A sagittal contraction of the ventral prostate and the longitudinal smooth muscle elements at the onset of voiding, which can be observed on MRI, is likely to shorten and open up the prostatic urethra. To investigate if in vitro contractile strength of the prostate and the prostatic urethra might correlate with the shortening of the ventral prostate seen on real-time magnetic resonance imaging (rtMRI). Micturition is a complex process that includes anatomical and neurological interactions for successful voiding. Recently we described on rtMRI that vertical contraction of the ventral prostate precedes initiation of male micturition and may contribute to the funnelling of the bladder neck. In all, 10 patients undergoing radical prostatectomy (RP) were enrolled. Approval was obtained from all patients and by the local Ethics Committee. Preoperative rtMRI during voiding was performed as described before in eight patients undergoing RP, measuring the difference of the cranio-caudal distance of the ventral prostate (VP). To roughly estimate the amount of force required to deform the prostate in a vertical direction as seen on rtMRI, we uniaxially compressed the organ immediately after surgery by the same distance, assuming incompressibility and isotropy of prostatic tissue. A muscle strip (3 × 3 mm) from the ventral prostate, dorsal prostate and prostatic urethra was obtained after pathological evaluation. Contraction was elicited by electrical-field stimulation (EFS: 0.1 ms pulses at 2, 4, 8, 16, 32 and 64 Hz for 4 s). There was a mean cranio-caudal contraction of the ventral prostate by 7.6 mm at the onset of micturition on rtMRI (P = 0.002). The mean (sd) contractile force of strips elicited by EFS at 32 Hz was 1472.44 (706.88) mN for the ventral prostate, 1044.24 (894.66) mN for the dorsal prostate, and 639.10 (785.06) mN for the prostatic urethra (P = 0.02). Extrapolating these values to the whole organ diameter, we calculated comparable force as observed in compression experiments. Our functional and biometric in vitro analyses of prostate tissue showed sufficient contractile strength of the ventral prostate to induce a shortening of the organ as seen on rtMRI. There was significant higher contractile strength in the ventral prostate than in the dorsal prostate or the proximal urethra. The consistency of in vivo and in vitro results underlines the significance of the ventral prostate for the initiation of normal micturition.
To review our experience of retroperitoneoscopic ureterolithotomy (RPUL) and to compare the resul... more To review our experience of retroperitoneoscopic ureterolithotomy (RPUL) and to compare the results with those from open surgery. Between March 1994 and mid-December 2000, 55 patients with large (mean 2.1 cm) upper and mid-ureteric calculi, and with normal renal values, underwent RPUL. In 22 patients, earlier attempts with extracorporeal shock wave lithotripsy and ureteroscopy had failed. These patients were compared with 26 (mean stone size 2.4 cm) who underwent open ureterolithotomy during the same period. The two groups had similar distributions for age, sex, stone size and stone location; most stones were calcium-based. The mean operative duration and blood loss for RPUL and open surgery were 108.8 and 98.8 min, and 58.5 and 50.5 mL, respectively (not significant). The mean analgesic (pethidine) requirement and hospital stay for RPUL and open surgery were 41.1 and 96.9 mg, and 3.3 and 4.8 days, respectively (P<0.001). The duration of convalescence was significantly less after RPUL than open surgery (1.8 weeks vs 3.1). There were 10 conversions, which occurred early in the series, and one significant complication amongst patients who underwent RPUL. RPUL is comparable with open surgery for operative duration and blood loss, but the laparoscopic procedure has significant advantages over open surgery for analgesia, hospital stay, recuperation and cosmesis. RPUL is a viable alternative for large upper and mid-ureteric calculi and in those patients where a previous attempt at endourological management has failed. However, the technique requires significant training and experience before good results can be obtained.
... Single step access into the pelvicalyceal system using the webb target dilator for PCNL and c... more ... Single step access into the pelvicalyceal system using the webb target dilator for PCNL and comparison with sequential dilatation technique Apul Goel, Monish Aron, Rajiv Goel, NP Gupta, AK Hemal, PN Dogra, Amlesh Seth Department of Urology, All India Institute of Medical ...
To evaluate the complications (using the CROES Clavien scoring system) and various factors affect... more To evaluate the complications (using the CROES Clavien scoring system) and various factors affecting them in children undergoing percutaneous nephrolithotomy (PCNL). We analysed prospectively maintained data of paediatric PCNL (patients ≤17 years) from January 2008 to December 2012. Stone complexity was defined according to validated Guy's stone score (GSS). Procedures were performed in the prone position by experienced urologists. The tract was dilated (24-30F) under fluoroscopic guidance, and an adult rigid nephroscope complemented with a cystoscope/ureteroscope were used. Complications were recorded according to the CROES-Clavien score, recently defined by the Clinical Research Office of the Endourological Society (CROES) Study Group. The study group comprised 158 procedures performed in 153 children (98 boys and 55 girls), with a mean (range) age 10.03 ± 4.51 (2-17) years. The mean (range) stone burden was 376.68 ± 265.23 (150-2400) mm(2) . The distribution of cases according to the GSS was 31% grade I, 35.4% grade II, 19% grade III, and 14.6% grade IV. The stone-free rate of PCNL monotherapy was 85.4%, which increased to 93.7% after relook PCNL/extracorporeal shock wave lithotripsy. In all, 62 children (39.2%) had operative complications; 84% were minor, i.e. Clavien grade 1/2, and managed conservatively. Stone size, GSS, tract size, number of punctures and operation duration were significantly associated with complications on univariate analysis (P < 0.05). However, on multivariate logistic regression analysis, operation duration was the only independent risk factor associated with complications (95% confidence interval: 1.013-1.065, odds ratio = 1.04; P = 0.038). Percutaneous nephrolithotomy in children using adult instruments is an effective and safe procedure for managing simple as well as complex renal calculi. Assignment of specific Clavien scores to all possible PCNL complications by the CROES PCNL Study Group have improved precision in reporting complications in a standard objective format, including the minor ones. Such models are very useful for making inter-observer comparisons to obtain clinically relevant inferences. Mean operation duration is the only independent factor affecting complications of the procedure.
• To investigate the association between overactive bladder (OAB) and C-reactive protein (CRP) in... more • To investigate the association between overactive bladder (OAB) and C-reactive protein (CRP) in a population-based sample of men and women. • Epidemiological survey of urological symptoms among men and women aged 30-79 years. A multi-stage stratified cluster design was used to randomly sample 5503 adults from the city of Boston. Analyses were conducted on 1898 men and 1854 women with available CRP levels. • The International Continence Society defines OAB as 'Urgency with or without urge incontinence, usually with frequency and nocturia.' OAB was defined as: (1) urgency, (2) urgency with frequency, and (3) urgency with frequency and nocturia. • Odds ratios (OR) and 95% confidence intervals (95% CI) of the CRP and OAB association were estimated using logistic regression. • Prevalence of OAB increased with CRP levels in both men and women. • In men, adjusted ORs (95% CI) per log(10) (CRP) levels were 1.90 (1.26-2.86) with OAB defined as urgency, 1.65 (1.06-2.58) with OAB defined as urgency and frequency, and 1.92 (1.13-3.28) with OAB defined as urgency, frequency and nocturia. • The association was more modest in women with ORs (95% CI) of 1.53 (1.07-2.18) for OAB as defined urgency, 1.51 (1.02-2.23) for OAB defined as urgency and frequency, and 1.34 (0.85-2.12) for OAB defined as urgency, frequency and nocturia. • Results show a consistent association of increasing CRP levels and OAB among both men and women. • These results support our hypothesis for the role of inflammation in the development of OAB and a possible role for anti-inflammatory agents in its treatment.
Study Type - Therapy (case series). Level of Evidence 4. What&amp... more Study Type - Therapy (case series). Level of Evidence 4. What's known on the subject? and What does the study add? This technique has been reported to have an excellent success rate in the bulbar urethra, although no data exists for its use in the penile urethra. This is the first study to report successful use of the technique in the reconstruction of penile urethral strictures. • To review our initial experience with single-stage overlapping dorsal and ventral buccal mucosa graft (BMG) urethroplasty for the reconstruction of complex anterior urethral strictures. • Among 696 urethroplasties performed at two tertiary urethroplasty centres from October 2007 to September 2010, single-stage urethral reconstruction using urethral plate incision and/or excision and overlapping dorsal and ventral BMGs was used in 36 men (5%) with complex urethral strictures (mean length 4.5 cm). • Demographic and perioperative data was tabulated and outcomes were analysed. • Stricture location was bulbar (61%), penile (19%), or both bulbar and penile (20%). • Dorsal grafts, applied only within the most severely strictured segment, measured a mean 42% of the opposing ventral graft length. • At a mean follow-up of 15.7 months, 32 of the 36 cases were successful (89%). • Repeat urethroplasty was performed in all four recurrences, three of which were successful at a mean follow-up of 16 months. • Single-stage reconstruction of focally obliterative long urethral strictures using overlapping dorsal and ventral BMGs is safe and effective.
• To establish whether it is safe to manage minimally symptomatic and asymptomatic pelvi-ureteric... more • To establish whether it is safe to manage minimally symptomatic and asymptomatic pelvi-ureteric junction obstruction (PUJO) conservatively. • In all, 50 patients with PUJO diagnosed with dynamic renography, and monitored with at least two renograms. • In all, 19 patients were totally asymptomatic, while 31 patients had minimal symptoms at time of diagnosis. • The mean follow-up was 53 months. • During the course of follow-up 10 of the 50 patients deteriorated. • All patients who had asymptomatic renographic deterioration, deteriorated within 2 years of diagnosis. • Eight of the 10 patients that deteriorated needed pyeloplasty and two nephrectomy. • Conservative management of patients with minimally symptomatic and asymptomatic PUJO is safe. • Discharging patients could be considered at 2 years from diagnosis, if they remain renographically stable and asymptomatic or minimally symptomatic.
• To evaluate the long-term outcomes of patients undergoing observation of asymptomatic renal cal... more • To evaluate the long-term outcomes of patients undergoing observation of asymptomatic renal calculi. • This is a retrospective review of 50 patients with 85 stones undergoing observation with annual imaging from January 2005 to December 2009. • The incidences of spontaneous stone passage, stone progression and intervention were evaluated and assessed for statistical difference according to initial size and location of stone. • Percutaneous nephrolithotomy, shock wave lithotripsy and ureteroscopy were performed when patients developed complications from the stones. • Patients were followed up for a mean of 46 months. Sixteen percent had bilateral stones and 38% had multiple stones. • The average stone size was 5.7 mm and 31%, 26% and 43% of the stones were located in the upper, middle and lower pole respectively. • Overall incidences of spontaneous passage, progression and intervention were 20%, 45.9% and 7.1% respectively. • Stones measuring 5 mm or less were significantly more likely to pass (P= 0.006). • There was no significant difference in the incidence of passage according to the initial location of the stone (P= 0.092). There was no significant difference in intervention or progression according to the initial size (P= 0.477 and 0.282 respectively) or location of stone (P= 0.068 and 0.787 respectively). • Patients with asymptomatic renal stones may be managed conservatively in view of low risk of intervention (7.1%). • Annual imaging should be performed as half of these stones will progress in size.
WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Use of balloon dilatat... more WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Use of balloon dilatation leads to less blood transfusion rates than metallic dilators. Plasma vaporization leads to less blood loss than balloon dilatation in this study. The study evaluates a novel technique for the creation of a nephrostomy tract for PCNL. Compared with other techniques, plasma vaporization is a safer procedure that causes lesser blood loss, requires a shorter hospital stay, causes less radiation exposure, and enables easier nephrostomy tract creation for PCNL. To evaluate the efficacy and safety of plasma vaporization for tract creation in percutaneous nephrolithotomy (PCNL). In this randomized prospective trial we enrolled 65 patients and assigned each to one of two groups: 33 patients were randomly scheduled to undergo plasma vaporization and 32 were scheduled to undergo balloon dilatation for tract creation. A bipolar resectoscope mounted with a plasma vaporization button electrode or a traditional balloon dilator were used to create the nephrostomy tract. The mean blood loss, mean length of hospital stay and mean operating time, stone-free rates and postoperative complications in the two groups were compared using the t-test or chi-squared test (Fisher's exact test). The plasma vaporization group had a significantly lower mean (SD) decrease in haematocrit level (3.5 [2.8]% vs 6.6 [3.3]%; P = 0.02) and a shorter mean (SD) hospital stay (2.6 [1.2] days vs 5.3 [3.4] days; P = 0.0). There were no significant differences in the operating time, stone-free rate or cases of postoperative fever between the two groups. The plasma vaporization technique is safe, leads to less blood loss than the other techniques, and is a simple solution for creating the nephrostomy tract for PCNL.
WHAT&... more WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: In a recent rtMRI study, we were able to show that, during initiation of voiding, there was both funnelling of the bladder neck and simultaneous contraction of the ventral prostate. We presumed that the vertical contraction of the ventral prostate contributes to the initiation of successful micturition. The question remained as to whether this shortening of the ventral prostate is predominantly caused by contractile elements in the organ itself, or by surrounding contractile elements of the pelvic floor. In our study we provide insight in to anatomical changes, and biometric and functional analysis of the prostate during micturition. A sagittal contraction of the ventral prostate and the longitudinal smooth muscle elements at the onset of voiding, which can be observed on MRI, is likely to shorten and open up the prostatic urethra. To investigate if in vitro contractile strength of the prostate and the prostatic urethra might correlate with the shortening of the ventral prostate seen on real-time magnetic resonance imaging (rtMRI). Micturition is a complex process that includes anatomical and neurological interactions for successful voiding. Recently we described on rtMRI that vertical contraction of the ventral prostate precedes initiation of male micturition and may contribute to the funnelling of the bladder neck. In all, 10 patients undergoing radical prostatectomy (RP) were enrolled. Approval was obtained from all patients and by the local Ethics Committee. Preoperative rtMRI during voiding was performed as described before in eight patients undergoing RP, measuring the difference of the cranio-caudal distance of the ventral prostate (VP). To roughly estimate the amount of force required to deform the prostate in a vertical direction as seen on rtMRI, we uniaxially compressed the organ immediately after surgery by the same distance, assuming incompressibility and isotropy of prostatic tissue. A muscle strip (3 × 3 mm) from the ventral prostate, dorsal prostate and prostatic urethra was obtained after pathological evaluation. Contraction was elicited by electrical-field stimulation (EFS: 0.1 ms pulses at 2, 4, 8, 16, 32 and 64 Hz for 4 s). There was a mean cranio-caudal contraction of the ventral prostate by 7.6 mm at the onset of micturition on rtMRI (P = 0.002). The mean (sd) contractile force of strips elicited by EFS at 32 Hz was 1472.44 (706.88) mN for the ventral prostate, 1044.24 (894.66) mN for the dorsal prostate, and 639.10 (785.06) mN for the prostatic urethra (P = 0.02). Extrapolating these values to the whole organ diameter, we calculated comparable force as observed in compression experiments. Our functional and biometric in vitro analyses of prostate tissue showed sufficient contractile strength of the ventral prostate to induce a shortening of the organ as seen on rtMRI. There was significant higher contractile strength in the ventral prostate than in the dorsal prostate or the proximal urethra. The consistency of in vivo and in vitro results underlines the significance of the ventral prostate for the initiation of normal micturition.
To review our experience of retroperitoneoscopic ureterolithotomy (RPUL) and to compare the resul... more To review our experience of retroperitoneoscopic ureterolithotomy (RPUL) and to compare the results with those from open surgery. Between March 1994 and mid-December 2000, 55 patients with large (mean 2.1 cm) upper and mid-ureteric calculi, and with normal renal values, underwent RPUL. In 22 patients, earlier attempts with extracorporeal shock wave lithotripsy and ureteroscopy had failed. These patients were compared with 26 (mean stone size 2.4 cm) who underwent open ureterolithotomy during the same period. The two groups had similar distributions for age, sex, stone size and stone location; most stones were calcium-based. The mean operative duration and blood loss for RPUL and open surgery were 108.8 and 98.8 min, and 58.5 and 50.5 mL, respectively (not significant). The mean analgesic (pethidine) requirement and hospital stay for RPUL and open surgery were 41.1 and 96.9 mg, and 3.3 and 4.8 days, respectively (P<0.001). The duration of convalescence was significantly less after RPUL than open surgery (1.8 weeks vs 3.1). There were 10 conversions, which occurred early in the series, and one significant complication amongst patients who underwent RPUL. RPUL is comparable with open surgery for operative duration and blood loss, but the laparoscopic procedure has significant advantages over open surgery for analgesia, hospital stay, recuperation and cosmesis. RPUL is a viable alternative for large upper and mid-ureteric calculi and in those patients where a previous attempt at endourological management has failed. However, the technique requires significant training and experience before good results can be obtained.
... Single step access into the pelvicalyceal system using the webb target dilator for PCNL and c... more ... Single step access into the pelvicalyceal system using the webb target dilator for PCNL and comparison with sequential dilatation technique Apul Goel, Monish Aron, Rajiv Goel, NP Gupta, AK Hemal, PN Dogra, Amlesh Seth Department of Urology, All India Institute of Medical ...
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