ali eslahi

Patients who have nephrolithiasis and are candidates for operation may have symptomatic or asymptomatic bacteriuria, which should be treated before any surgical intervention. We evaluated our patients for the prevalence of bacteriuria before surgical intervention.

Between March 2020 and March 2022, a total of 832 patients (489 men and 343 women) with a mean age of 38.4 years, who were candidates for renal stone surgery, were evaluated by tests, including complete blood count, urine analysis, and preoperative culture. In this study, we recorded the bacteriuria (symptomatic or asymptomatic).

Of 832 patients, 594 had the first episode of stone formation and 238 had recurrent diseases. Of these, 784 patients were scheduled for percutaneous nephrolithotomy and 48 patients for open nephrolithotomy. Overall, in the preoperative urine analysis test, 56 cases of bacteriuria were reported, of which 22 cases had positive urine cultures. Of the positive culture cases, 14 were recurrent and 8 were patients who had kidney stones for the first time. The most common microorganism was Escherichia coli (n=15), followed by Klebsiella (n=4), Proteus (n=2), and Pseudomonas (n=1). Only 8 of these patients had symptoms and the rest were asymptomatic. All of these patients received a course of oral antibiotics before the operation.

Bacteriuria is a common finding in patients with nephrolithiasis that seems to be more common in recurrent diseases; therefore, urine culture and appropriate treatment are mandatory before any intervention to prevent serious complications, such as infection, sepsis, and mortality.

Renal colic is one of the common causes of abdominal pain in pregnant women. The present study aimed to evaluate the outcome of renal colic during pregnancy in our referral center.

From March 2015 to March 2020, a total of 228 pregnant patients were referred to the emergency unit with renal colic. Most of them were managed conservatively; nonetheless, some of them were complicated and needed more procedures.

Of 228 patients, 179 patients had only microscopic hematuria and mild hydronephrosis with small or no stone in ultrasonography. They responded to conservative management and were discharged. Moreover, 26 patients had ureteral stones smaller than 6 mm that were passed with medical therapy. A number of 11 patients were in the third trimester with ureteral stone and/or renal stone for which percutaneous nephrostomy was applied. In addition, 12 patients who had large distal ureteric stones underwent ureteroscopy and stent insertion. A number of 24 patients that were in the first or second trimester had an internal stent (15 patients) or nephrostomy (9 patients) until the delivery of their fetus. Finally, three patients in the second trimester did not tolerate/accept complicated stent or nephrostomy, so they had intractable colic. After explaining all the possible complications and obtaining written informed consent, they were scheduled for urgent percutaneous nephrolithotomy with ultrasonographic guidance in a flank position.

Renal colic in pregnancy is common and mostly managed conservatively; however, in some cases, the patients may need nephrostomy tube insertion, ureteroscopy, and stent insertion. Extracorporeal shock wave lithotripsy is contraindicated, and percutaneous nephrolithotomy is not recommended as the first opinion in pregnancy unless in an urgent situation.

Urolithiasis during pregnancy poses risks for mother and the fetus with specific challenges in diagnosis and management. We report our experience with urgent percutaneous nephrolithotomy (PCNL) in seven pregnant patients with symptomatic renal stone in early pregnancy.
Seven pregnant patients with symptomatic renal stones were reviewed. The technique comprised PCNL with complete access under guide of ultrasonography in prone position under general anesthesia using pneumatic lithoclast for stone fragmentation.
There was no significant residual fragment of stone in the operated kidneys. The patients discharged without complications and delivered their babies healthy.
PCNL should not be considered as the first therapeutic method in the first trimester of pregnancy, unless in urgent situations such as symptomatic renal pelvic stone with moderate to severe hydronephrosis in patients who do not tolerate or are complicated by nephrostomy or internal stent. However, this procedure could be technically demanding and should be done in centers with enough experience and equipment in percutaneous nephrolithotomy.

The study aimed to compare tubeless, totally tubeless, and standard percutaneous nephrolithotomy (PNL) in a tertiary center with selected patient population.
Between September 2013 and March 2015, percutaneous nephrolithotomy was performed on 216 patients in our center. Patients without massive bleeding, calyceal perforation, and residual fragments smaller than 4 mm were enrolled in this study. The patients were divided into 3 groups. In the first group (n = 68), we placed nephrostomy and kept ureteral catheter for 24 hours (the standard group). In second the group (n = 69), no nephrostomy was inserted and ureteral catheter was removed in the operation room (the totally tubeless group) and in the third group (n = 79), no nephrostomy catheter was placed but antegrade DJ stent was inserted intraoperatively (the tubeless group). Three groups were compared with respect to age, analgesic requirement, BMI, length of stay, pain, and stone size.
No significant differences were found in the mean stone size, operation time, transfusion rates, and hemoglobin level change between the groups. However, hospitalization time, the amount of narcotic usage, and pain were significantly lower in the second group compared to the other groups (P