INTRODUCTION:Double-J (DJ) stents find extensive use in Endourology. Nevertheless, occurrence of forgotten stents is not uncommon. This retrospective study details our encounters in handling forgotten stents and outlines the measures we have implemented to mitigate morbidity associated with DJ stents. METHODS:We conducted a retrospective analysis of hospital records of cases with Forgotten DJ stents from Jan 2021 to Jan 2025. The details reviewed included age, sex, indication for stenting, duration of the indwelling stent, presenting complaints, management, and complications. RESULTS:Of the total of 35 patients, the mean patient age was 46.8 years (14-70 years). The male-to-female ratio was 4:3 (20 males and 15 females). The mean indwelling time was 35.8 months. Flank pain was the commonest symptom (72.7%), followed by storage lower urinary tract symptoms (54.5%) and dysuria (50%). Complicated stents were noted in 17 patients (48.5%), whereas uncomplicated stents were noted in 18 patients (51.5%). All 18 "uncomplicated" stents could be removed cystoscopically, while complicated stents were removed by the combination of endourological techniques mainly, while two patients underwent laparoscopic nephrectomy in which one of them needed open cystolithotomy also. CONCLUSION:The issue of forgotten DJ stents remains a prevalent problem in developing countries, causing significant morbidity and financial burdens for patients. Stent registers and electronic stent extraction reminders helps us to minimize the incidence of forgotten stents.

Primary renal fibrosarcoma is an exceedingly rare malignant mesenchymal tumor that accounts for only 1-3% of adult renal malignancies, often mistaken for sarcomatoid renal cell carcinoma (RCC) or leiomyosarcoma due to overlapping morphology. Thus, accurate disease diagnosis is crucial for its management. We report a case of a 49-year-old female, a chronic smoker, who presented with right flank pain and progressive abdominal swelling. Clinical examination revealed a firm mass in the right abdomen, and contrast-enhanced computed tomography demonstrated a large exophytic right renal mass with areas of necrosis, infiltration of the psoas muscle, and extension of tumor thrombus into the inferior vena cava (IVC). The patient underwent right radical nephrectomy with IVC thrombectomy, and a 20 × 15 cm irregular renal mass with 2 cm IVC thrombus was excised intraoperatively. Histopathology revealed a high-grade spindle cell neoplasm with interlacing fascicles and herringbone patterns, brisk mitoses (10-12 mitotic figures per 10HPF), and 20% necrosis. Immunohistochemistry showed diffuse vimentin positivity with negative staining for epithelial, myogenic, neural, and renal lineage markers, confirming the diagnosis of high-grade primary renal fibrosarcoma. This case is notable for being the largest renal fibrosarcoma reported to date, with rare IVC extension, features typically associated with advanced RCC rather than fibrosarcoma. Despite aggressive pathology, no metastases were identified, and the patient remained recurrence-free at 6 months postoperatively, with chemotherapy reserved for recurrence or metastasis. This report emphasizes the diagnostic challenges, surgical complexity, and clinical significance of primary renal fibrosarcoma and highlights the importance of including it in the differential diagnosis of large renal masses with vascular involvement.

Objectives Nephrocalcinosis (NC) refers to the deposition of calcium salts in renal tissue, often associated with metabolic disorders like primary hyperparathyroidism, distal renal tubular acidosis (dRTA), and chronic kidney disease. On imaging, NC often mimics nephrolithiasis (NL), posing a diagnostic challenge. Hence, we chose percutaneous nephrolithotomy (PCNL) as a diagnostic and therapeutic modality to evaluate its diagnostic utility in differentiating nephrolithiasis from NC and to assess its role in stone clearance. Methods We present a prospective case series of three patients with radiologically diagnosed NC and nephrolithiasis, in whom PCNL was performed both as a diagnostic and therapeutic modality. All three patients had varying metabolic backgrounds, including type 1 dRTA and primary hyperparathyroidism. Preoperative CT showed diffuse calcifications with no clear distinction between NC and NL. PCNL allowed direct visualization, enabling distinction of calyceal stones from parenchymal deposits, followed by stone clearance. Results All three patients underwent staged PCNL procedures. Intraoperatively, most calcifications were found to be minor calyceal calculi, amenable to removal. Postoperatively, stone clearance of 85–95% was achieved in each case with significant symptomatic improvement. Mean creatinine decreased from 2.59 mg/dL preoperatively to 1.37 mg/dL postoperatively. No intraoperative or postoperative complications were noted. Conclusion PCNL serves a dual role in patients with suspected NC and nephrolithiasis by offering both diagnostic clarity and therapeutic benefit. Our findings suggest that PCNL may have a role in selected patients with suspected NC; however, larger studies are required before changes to management paradigms can be recommended.

Introduction:To compare the efficacy and safety of extended lymph node dissection (eLND) versus standard LND (sLND) in patients with bladder cancer undergoing radical cystectomy, focusing on overall survival (OS), recurrence-free survival (RFS), and complications, including symptomatic lymphoceles. Materials and Methods:A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, MEDLINE, Embase, Scopus, and Cochrane databases for randomized controlled trials (RCTs) comparing eLND and sLND. The primary outcomes were OS and RFS, while secondary outcomes included complications such as lymphoceles, sepsis, and urinary tract infections. Data were extracted independently by two authors, and the risk of bias was assessed using the Cochrane RoB 2 tool. Results:Two RCTs (Gschwend et al., 2019; Lerner et al., 2024) were included, with a total of 1,015 patients. No significant differences were observed in OS (hazard ratio [HR]: 0.95, 95% confidence interval [CI]: 0.66-1.37) or RFS (HR: 1.00, 95% CI: 0.77-1.29) between the eLND and sLND groups. However, eLND was associated with a significantly higher incidence of symptomatic lymphoceles (risk ratio: 2.21, 95% CI 1.13-4.34) and no other major complications. The risk of publication bias was high due to the limited number of included studies. Conclusion:While eLND did not show a survival benefit over sLND, it was associated with a higher risk of lymphoceles. eLND may be beneficial in patients with higher-risk disease requiring precise staging, but sLND is a viable and less morbid alternative for most patients.

INTRODUCTION:Medical expulsive therapy (MET) has been shown to be a safe and effective option for the spontaneous passage of uncomplicated ureteric stones sizing ⩽10 mm in selected cases. However, there is lack of evidence on the predictors of successful MET. Our objective was to identify parameters that can accurately predict the spontaneous passage of ureteral stones during MET. METHODS:Patients receiving MET (Tamsulosin 0.4 mg once daily (OD)) for a single unilateral ureteral calculi sizing ⩽10 mm were followed after 1 month using Non contrast Computed tomography (NCCT). Various parameters such as stone-related parameters (location, density, volume and transverse, longitudinal, and sagittal diameters), ureter-related parameters (diameter, density, and wall thickness at the stone site) and grade of hydronephrosis were evaluated on CT images and analyzed by using univariate, multivariate and receiver operating characteristic (ROC) curve analyses. RESULTS:Of 55 patients, 31 (56.4%) passed the stone successfully within 4 weeks of MET. Univariate analysis revealed these patients tended to have lower ureteric stones (p-value- 0.048), lower longitudinal (p-value- 0.024) and transverse stone diameters (p-value- 0.006), lower stone volume (p-value- 0.015) and ureteral wall thickness (UWT; p-value- 0.001). In multivariate analysis, only UWT at the stone site (p 0.036) was a significant predictor of the successful passage of calculus. The UWT cut-off was 2.1 mm with sensitivity and specificity of 83.8% and 62.5%, respectively, with an Area Under Curve (AUC) of 0.7856. CONCLUSION:The most significant predictor of successful stone passage in MET of unilateral ureteral stones was maximal UWT, with an optimal cut-off point of 2.1 mm.

Introduction: Traction on the per-urethral catheter is commonly employed after monopolar transurethral resection of the prostate (mTURP) to reduce bleeding. However, its efficacy and impact on postoperative pain remain uncertain. Further, there is limited evidence to suggest any benefit regarding post-operative blood loss. Materials and methods: In a randomized controlled trial, 62 patients undergoing mTURP were assigned to either a traction ( n = 30) or non-traction ( n = 32) group. Blood loss, postoperative pain, and analgesic requirements were assessed between January 2022 and April 2023. {(IHEC-PGR/2021/DM/M.Ch/Jan/02), CTRI Registration: CTRI/2022/01/039199.} Results: No significant differences were observed between the traction and non-traction groups regarding postoperative blood loss ( p-value- 0.632), fall in hemoglobin ( p-value- 0.719) and hematocrit ( p-value- 0.937) levels, and length of postoperative hospital stay ( p-value- 0.797). However, the traction group reported significantly higher postoperative pain scores ( p-value < 0.001) and increased analgesic requirements ( p-value < 0.001). Conclusion: The study suggests that 12-hours catheter traction after mTURP does not reduce blood loss and is associated with increased postoperative pain.

Background and objective Prostate biopsy, conducted frequently through the transrectal route, is associated with significant risks of infectious complications. This study aimed to compare the efficacy of various strategies to reduce these complications, using a network meta-analysis approach. Methods Our study included randomized controlled trials (RCTs) identified from PubMed/MEDLINE, Embase, and the Cochrane database as of March 1, 2024. We included studies that involved adults undergoing transrectal or transperineal prostate biopsy with either standard empirical antibiotic prophylaxis or alternative interventions. The primary outcomes were assessment of sepsis, fever, urinary tract infections (UTIs), and readmissions. The study was registered with PROSPERO (CRD42024532225). Key findings and limitations Our search yielded 28 RCTs eligible for analysis, encompassing a total of 10 179 participants. Rectal cleansing had the highest rankogram score to reduce infectious complications such as sepsis (odds ratio 0.40, 95% confidence interval [0.28–0.58]; rankogram, p score = 0.917), followed by transperineal biopsy (p score = 0.496). The overall analysis also highlighted a lower incidence of UTIs and readmissions with this method. Heterogeneity among studies was minimal (I2 < 50% for all outcomes). Conclusions and clinical implications Rectal cleansing might be the most effective strategy to reduce infectious complications following transrectal prostate biopsy and could be more effective than rectal culture–based antibiotic prophylaxis and transperineal biopsy. Given the indirect nature of our comparisons, further RCTs are needed to determine the safest approach for prostate biopsy, particularly between transperineal biopsy and transrectal biopsy with rectal cleansing or rectal culture–based antibiotic prophylaxis. Patient summary In this review, we analyzed different techniques to reduce infectious complications after a prostate biopsy. We found that rectal cleansing prior to performing a transrectal prostate biopsy reduced infectious complications and might be the most effective strategy. We conclude that either transperineal or transrectal prostate biopsies are acceptable approaches, albeit with rectal cleansing or rectal culture–based antibiotic prophylaxis, respectively.

Background: Inguinal hernia repair is one of the most common operations performed in general surgery. Lichtenstein mesh hernioplasty is a commonly practiced technique for open inguinal hernia repair. Out of many other complications postoperatively, chronic groin pain is one of the patients' most common postoperative complaints. There is no direct evidence to explain the cause of post-mesh hernioplasty pain. Only a few studies have been done to judge the effect of suture material used for mesh fixation on chronic groin pain. Aims and objectives: To compare the postoperative groin pain level in mesh hernioplasty using nonabsorbable versus absorbable sutures for mesh fixation at predetermined intervals using a visual analog scale (VAS) score. Methods: A prospective, single-center, non-randomized, observational study was conducted. All patients per inclusion and exclusion criteria of inguinal hernia planned for surgery were admitted electively on the day of surgery and were operated on in minor OT under local anesthesia for open mesh hernioplasty. The VAS score assessed the postoperative pain level. Results: This observational study was done to look for any difference in postoperative chronic groin pain after mesh fixation with either nonabsorbable, prolene sutures (PS) or absorbable vicryl sutures (VS). One hundred and ten patients fulfilling the department of general surgery inclusion criteria were admitted to the study. In our study, postoperatively, the incidence of chronic groin pain was assessed and followed up to six months. After six months, 25%of patients had pain. Of this 25%, the majority (70%) of patients had mild pain, 15% had moderate pain, and 15% had severe pain. There was no statistically significant difference between the two groups of mesh fixation by nonabsorbable versus absorbable sutures. Conclusion: Inguinal hernia is one of the most typical conditions seen in general surgery clinics with male predominance. Definitive management of inguinal hernia is surgery. There is no difference in postoperative chronic groin pain with either type of suture material i.e., nonabsorbable or absorbable (prolene vs vicryl) sutures. To conclude, fixation material for mesh does not influence chronic inguinodynia. However, further studies are required for the same.

OBJECTIVE To determine the impact of radical local treatment (RLT) on overall survival (OS) and other survival outcomes in patients with OligoMetastatic Prostate Cancer (OMPC).METHODS We performed a meta-analysis of randomized controlled trials (RCTs) published in the MEDLINE and CENTRAL databases until May 2023. We included RCTs that randomized patients to RLT (either radical prostatectomy [RP] or external beam radiotherapy [EBRT]) and standard of care and reported on OMPC. Our primary objective was to analyze OS with a minimum median follow-up of 4 years (PROSPERO-CRD42023422736).RESULTS We analyzed 3 RCTs, presenting data across 5 papers. OS was significantly higher in the RLT group (HR -0.643, 95%CI 0.514-0.8, P-value < .001). The data on EBRT was drawn from 520 patients and that of RP was from 85. The post-hoc power analysis showed 81% power to detect a difference of 10% with an alpha error of 0.01. Pooled prevalence of grade 3-4 bowel and bladder toxicity was 4.5%. Health-Related Quality of Life was similar in both groups (mean difference -1.54, 95%CI - 0.625 - 3.705, P-value .163). The risk of bias as per the RoB2 tool was low for all domains and overall bias. As per GRADE criteria, the certainty of evidence was high.CONCLUSION Our meta-analysis underscores the evidence-based significance of RLT, particularly emphasizing the benefits of EBRT in patients with OMPC. However, the findings should be interpreted with caution due to the limited number of studies and the relatively small sample sizes, especially in the RP subgroup. Future investigations in OMPC should consider incorporating EBRT in their standard treatment approach.(c) 2023 Elsevier Inc. All rights reserved.

Abstract Introduction: Medical expulsive therapy (MET) is a safe and effective option for the spontaneous passage of uncomplicated ureteric stones sizing ≤ 10 mm. Our objective was to identify parameters that can accurately predict the spontaneous passage of ureteral stones during MET. Methods Patients receiving MET (tamsulosin 0.4mg od) for a single unilateral ureteral calculi sizing ≤ 10 mm were followed up to 1 month. The potential parameters, stone related (location, density, volume and transverse, longitudinal, sagittal diameters), ureter related (diameter, density, and wall thickness at the stone site) and hydronephrosis grade were evaluated on CT images and analyzed by using univariate, multivariate and receiver operating characteristic (ROC) curve analyses. Results Of fifty-five patients, 31 (56.4%) passed the stone successfully within 4 weeks of MET. Univariate analysis revealed these patients tended to have lower ureteric stones (p 0.048), lower longitudinal (p 0.024) and transverse stone diameters (p 0.006), lower stone volume (p 0.015) and ureteral wall thickness (p 0.001). In multivariate analysis, the only variable with significant independent predictive value on successful stone passage (SP) was the maximal ureteral wall thickness (UWT) at stone site (p 0.036). Sagittal stone diameter, ureteral diameter, ureteral & stone densities were found to be insignificant. The UWT cut off was 2.1mm with sensitivity and specificity of 83.8% and 62.5% respectively. Conclusion The most significant predictor of successful stone passage in MET of unilateral ureteral stones is the maximal UWT, with an optimal cut-off point of 2.1mm.

Tuberous sclerosis complex (TSC) affects approximately one to two million people worldwide. Nowadays renal lesions are the leading cause of death in Angiomyolipoma (AML) related to tuberous sclerosis. The new role of Everolimus (mTOR Inhibitor) has come in patients of Large AML with TSC in the last decade. A 13 year boy with sporadic tuberous sclerosis, large multiple bilateral angiomyolipomas, and associated symptoms (Adenoma Sebecium, Shagreen patches, Tubers in brain) was treated with Everolimus for 5 years. Pre and Post treatment subjective and objective parameters were evaluated for ten years. In the initial first year there was a 34 percent reduction noted in the size of renal lesions and vascularity. The patient's Hemoglobin raised from 8.4 to 13 gmdl, along with improvement in performance and seizures episodes. Similarly, skin lesions, including adenoma sebeceum were reduced markedly. Thereafter no significant improvement was reported in renal lesions with therapy, so the drug was stopped at age of 18 years but a very slow progression of renal lesions was noted after omitting everolimus. In the year 2019, he underwent right sided nephrectomy for pyonephrosis. Presently he is having intermittent episodes of seizures with borderline left renal functions. Everolimus is the first line therapy for bilateral large AML. Everolimus reduces renal lesions size significantly, apart from seizures control for a longer duration.

Background: Lymphocele formation is the most common identifiable surgical complication of renal transplant recipients, which often requires surgical deroofing. In this retrospective study, we are determining the efficacy of laparoscopic deroofing surgery in the management of post-renal transplant lymphocele. Aims and Objectives: This study aims to determine the efficacy of laparoscopic deroofing surgery in the management of post-renal transplant lymphocele. Materials and Methods: All patients who underwent surgical deroofing for post-renal transplant lymphocele at the Institute of Kidney DISEASE and Research Center, Ahmedabad, India, between January 2016 and October 2019 were included in the study and retrospectively reviewed. Information about symptomatology, clinical features, radiological findings, preoperative drainage, ultrasound-guided percutaneous nephrostomy (PCN) diversion, intraoperative, post-operative findings, and complications were retrieved and analyzed. Results: Among the 1138 open renal transplant recipients, 28 patients developed symptomatic lymphocele (incidence 2.5%). The mean interval to develop these lymphoceles was 8 weeks (3 weeks–4 months). All 28 patients underwent laparoscopic lymphatic deroofing surgery. There were no conversions to open surgery. Overrunning of cut edges was performed in six and omentopexy in two patients, rest of the 20 patients only deroofing of lymphocele was performed. Graft PCN was placed before surgery in four patients and in two patients, percutaneous drain was placed into the lymphocele. The mean operative time was 80 min. The mean hospital stay was 3.5 days. In one case, there was an injury to the ureter intraoperatively which was repaired over a DJ stent laparoscopically. There was one case with recurrence who had a prior history of continuous ambulatory peritoneal dialysis. He was explored and perivascular lymphatics were tied and omental packing was performed. Conclusion: Laparoscopic deroofing of symptomatic lymphoceles following renal transplantation appears to be safe and effective, because it has minimal post-operative morbidity, rapid convalescence, and low recurrence rate. Laparoscopy should be considered the first-line treatment for symptomatic lymphoceles.

Background: Emphysematous pyelonephritis (EPN) is a serious suppurative infection of renal and extrarenal tissues. Most of them end up in nephrectomy, either in an emergency setting or delayed, which is increasingly favored. Laparoscopic nephrectomy is difficult in the post-EPN state due to dense adhesion around the kidney. Aims and Objectives: In this study, we want to check the feasibility of laparoscopic nephrectomy in EPN kidneys. To the best of our knowledge, our series is the single largest series as of today with 10 cases of laparoscopic nephrectomies in EPN kidneys. Materials and Methods: All patients of EPN who underwent laparoscopic nephrectomy at Institute of Kidney Diseases and Research Centre, Ahmedabad, between December 2017 and October 2019 were taken as study subjects and retrospectively reviewed. Patients in whom conservative management was successful were excluded from the study. All patients were diverted initially, either ultrasound/computed tomography-guided percutaneous nephrostomy (PCN) insertion or double J stenting, with or without PCN along with antibiotics and supportive therapy. Delayed transperitoneal laparoscopic nephrectomies were performed for poorly functioning EPN kidneys in follow-up renal scans. Results: A total of 10 patients underwent nephrectomy in this period. The male-to-female ratio was 3:7. As per Huang and Tseng’s EPN classification, one patient had Class 2, four patients had Class 3a, and five patients had Class 3b EPN disease. Mean operative time was 192 min and mean blood loss was 206 ml. Two cases had intraoperative complications managed laparoscopically. No conversion to open nephrectomy or mortality was seen. The drain was placed for a mean period of 3.1 days. The mean hospital stay was 4.8 days. Conclusion: Laparoscopy is safe and feasible for nephrectomy in EPN kidneys. Experience with laparoscopy and operating on pyelonephritis cases is important to reduce complications and extend the advantages of laparoscopy in these groups of patients. An increase in class does not increase the degree of difficulty during laparoscopy.