We showed that totally ultrasound-guided complete supine PCNL is safe and feasible even in reoperative patients. It has certain advantages such as elimination of X-ray exposure to the surgeon and staff of the operating room, avoidance of contrast material administration, identification of all the tissue between the skin and kidney, and the energy expenditure of the surgeon and other staff of the operating room is decreased as it is not necessary to wear a lead shield.

Introduction and Hypothesis:To compare complications and outcomes of complete supine percutaneous nephrolithotomy (csPCNL) with ultrasound guided and fluoroscopically guided procedure.Materials and Methods:In this randomized clinical trial study from January 2009 to September 2010, 26 of 51 patients with renal stones underwent csPCNL with ultrasonographic guidance in all steps of the procedure (group A), and the other 25 patients underwent standard fluoroscopically guided csPCNL (group B). All of the patients underwent PCNL in the complete supine position. Statistical analysis was performed with SPSS16 software.Results:Mean BMI was 28.14 in group A and 26.31 in group B (p=0.30). The mean stone burden was 26.48 and 30.44 in groups A and B, respectively (p=0.20). The stone free rate was 88.5% in group A and 75.5% in group B, that was no significant (p=0.16). Overall 2 patients (7.7%) in group A and 6 patients (24%) in group B had complications (p=0.11). Mean operative time in group A was 88.46 minutes, and in group B it was 79.58 minutes (p=0.39). Mean hospital stay was 69.70 and 61.79 hours in group A and B, respectively (p=0.22). There was no visceral injury in groups.Conclusions:This randomized study showed that totally ultrasonic had the same outcomes of fluoroscopically csPCNL. Ultrasonography can be an alternative rather than fluoroscopy in PCNL. We believe that more randomized studies are needed to allow endourologists to use sonography rather than fluoroscopy in order to avoid exposition to radiation.

To determine the effects of previous stone surgery on the results of complete supine percutaneous nephrolithotomy (csPCNL), we reviewed 81 patients undergoing csPCNL at our center between March 2008 and March 2009. The principal aim in our study was whether prior renal surgery affects the outcome of PCNL. The results of the study were analyzed using SPSS 11 software. Our patients were divided to in two groups. Group 1 consisted of patients with a previous history of renal stone surgery and group 2 consisted of patients without history of renal surgery. Mean operative time in group 1 was 98.75 ± 56.31 min, and in group 2 99.71 ± 45.9 min (p = 0.93). Bleeding requiring transfusion occurred in four (14.2%) patients in group 1, and in eight (15.09%) patients in group 2 (p = 0.826). Fever was detected in no patients in group 1, and in four (7.5%) patients in group 2 (p = 0.136). Postoperative hematoma was seen in one (3.5%) patient in group 1 and in no patient in group 2 (p = 0.166). Other major complications including extravasations, sepsis, pleural effusion, pelvis perforation, and visceral organ trauma were not seen in any groups. This is the first experience of csPCNL in patients with and without a previous history of renal surgery. We found that there was no difference in results between the two groups that underwent complete supine PCNL. So csPCNL in patients with a history of stone surgery can be safe and effective. csPCNL offers the potential advantages of less patient handling, easier access to the urethra, easier possibility of changing spinal or regional anesthesia to general anesthesia if needed, better airway control and less hazard, especially for patients with compromised cardiopulmonary function, morbid obesity, or those who require a prolonged procedure and easier access to upper calyx. Its popularity is still minimal in the field of urology as a whole, because of fear of colon injury and a lack of training in this position in educational centers.

Intraprostatic injection of Botulinum-A may be an effective and safe treatment for symptomatic BPH in selected patients whose medical treatment has faced failure and are poor surgical candidates. Transurethral method could be selected as a preferable technique of injection.

Study Type – Therapy (RCT) Level of Evidence 1b What's known on the subject? and What does the study add? Results of our study showed that intravenous papaverine hydrochloride plus suppository sodium diclofenac were more effective than diclofenac sodium suppository alone in the treatment of acute renal colic. Therefore, intravenous papaverine hydrochloride may be a beneficial supplemental therapy to relieve renal colic pain, particularly in combination with NSAIDs. OBJECTIVE To assess the efficacy of papaverine hydrochloride combined with a diclofenac sodium suppository to relieve renal colic compared with diclofenac suppository monotherapy, as the effect of phosphodiesterase inhibitors on ureteric muscles might reduce the pain of renal colic. PATIENTS AND METHODS A prospective, double‐blind clinical study was performed. In all, 550 patients aged 17–55 years with acute renal colic were randomised to two groups. Patients in one group (group A) received a diclofenac suppository (100 mg) plus saline 0.9% (placebo) and the other group (group B) received a diclofenac suppository (100 mg) plus intravenous (i.v.) papaverine hydrochloride (1.5 mg/kg up to120 mg). Pain intensity was assessed using a visual analogue scale (VAS) at 0, 20 and 40 min after treatment. Further analgesia was provided at the patients' request (25 mg pethidine intramuscularly). RESULTS Baseline characteristics (sex, age, past history of similar pains) were similar in the two groups. There were significant differences in VAS pain scores between 0 and 20 min and 0 and 40 min in both groups (P < 0.001). At the end of study, 71.1% of patients in group A and 90.9% of patients in group B reported pain relief and did not require pethidine, respectively. Significantly more patients in group A required further analgesia. CONCLUSIONS According to our results, i.v. papaverine hydrochloride plus a diclofenac suppository were more effective than the diclofenac suppository alone for treating acute renal colic. Therefore, i.v. papaverine hydrochloride is a beneficial supplemental therapy to relieve renal colic pain, particularly combined with non‐steroidal anti‐inflammatory drugs.

BMI, stone burden, imaging for access, and calix for access were effective parameters on operative time in complete supine PCNL. Groups of BMI, previous stone surgery and SWL, number of tracts, and tubeless approach had no effect on operative time.

Abbreviations and Acronyms5HT = 5-hydroxytryptamine IELT = intravaginal ejaculation latency time IIEF-5 = International Index of Erectile Function PE = premature ejaculation SJW = St. John's wort SSRI = selective serotonin reuptake inhibitors ABSTRACT

The renal UP percutaneous access can be performed using several techniques. The superior calix was accessible in csPCNL with the renal displacement technique (lung inflation) subcostally while intrathoracic complications may be avoided. UP puncture in csPCNL with this technique was associated with minimal morbidity and avoids the need for a supracostal puncture, and the stone-free rate appeared to be more.