This study confirmed that PKEP is a safe, easy to learn, and durable technique suitable for any prostate sizes.

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Background To assess awareness of ionizing radiation safety measures among Egyptian Urology Trainees and Urologists and see the effect of radiation safety courses on the adoption of these measures. Methods This Internet-based survey was conducted via https://www.surveymonkey.com/ after approval by the Egyptian Urological Association (EUA). It was sent to all EUA members via email during December 2019. Participation was voluntary and questions included participants’ demographics such as age, gender, years of experience, level of training and type of practice. Other questions assessed some domains such as whether the participant had radiation safety courses, and the extent to which she/he is adopting these measures during daily practice. Results A total of 142 Egyptian urology trainees and urologists responded to this electronic survey. The mean hours of fluoroscopy-guided endourologic procedures per week were 4.3 ± 2.1 h, and only 23% reported that they always wear protective lead aprons. In terms of the thyroid shield, X-ray protective gloves, eye googles, a total of 70% and 89% and 89% reported that they never wore it, respectively. The ALARA principle was known by only 24% of respondents. About 94% denied receiving any radiation safety courses. Participants who received radiation safety course reported significantly shorter FT during URS (p = 0.04), PCNL (p = 0.03) and JJ insertion (p = 0.04) and were significantly more compliant (p = 0.02). In addition, the number of years of experience (< 5y,5-10y,10-15y, > 15y) and the current job level (resident, specialist, consultant, professor) was significantly associated with higher compliance with lead aprons (p = 0.006, p < 0.001, respectively). On regression analysis, previous radiation safety awareness courses were the only predictor of good compliance with radiation safety measures (OR = 2 ± 0.73, p = 0.009). Conclusion There was a lack of awareness and implementation of radiation safety measures among all participants. Receiving radiation safety courses was the only predictor of good compliance with radiation safety measures.

To determine the efficacy and safety of trajectory infiltration with 1:150 000 Norepinephrine (NE) in reducing blood loss during percutaneous nephrolithotomy (PCNL). Materials and methods: This is a prospective randomized double-blinded placebocontrolled trial. In all, 140 consecutive patients underwent PCNL for the management of large renal calculi. They were randomly assigned (1:1) to one of either study groups, the NE-PCNL group (70 patients whose PCNL-trajectory was infiltrated by NE) or the Placebo group (saline PCNL) (70 patients whose PCNL tracts were infiltrated by normal saline). Procedure-related blood loss (the primary outcome) was assessed and statistically analyzed. Also, all other procedure-related events and complications were recorded and compared. Results: The median blood loss was 378 ml (IQR: 252-504) in the NE-PCNL group versus 592 ml (IQR: 378-756) in the S-PCNL group (p < 0.0001). In addition, Hemoglobin and Hematocrit deficits were lower in NE-PCNL (p < 0.05). Patients who were randomized to the NE-PCNL group had a higher immediate stone-free rate (SFR) (80%) compared with those of the S-PCNL group (70%) (p = 0.034). However, no statistical differences were found in the final SFR. The reported overall complications between the 2 groups were similar (p > 0.05). Indeed, bleeding-related complications were 1 (1.4%) versus 10 (14.3%) for NE-PCNL and S-PCNL, respectively (p = 0.009). Conclusions: Trajectory infiltration of PCNL tracts by NE was found to be effective and safe in mitigation of PCNL-related blood loss. This step is a timeless and cost-effective as NE is readily available in surgical theaters and of very low cost.

2019) Modified tubeless minimally invasive percutaneous nephrolithotomy for management of renal stones in children: A single-centre experience, Arab ABSTRACT Objectives: To evaluate the safety, effectiveness and morbidity, as well as the usefulness of a modified supine mini-percutaneous nephrolithotomy (PCNL) for managing renal stones in children.Patients and methods: We studied 50 children, from September 2017 to September 2018, who were aged 4-16 years with a single renal pelvic or calyceal stone of <2 cm. We used a 9-F short ureteroscope through a 16-F metal access sheath with an alternative approach that allows a second percutaneous procedure using the same tract. If a residual stone was present, we recovered the track back through the exteriorised ureteric catheter at the flank. Results: Of all 50 patients, 48 (96%) underwent the modified supine mini-PCNL technique, which produced a primary stone-free rate of 80% that increased to 100% after treating the residual stones by a second look. The mean operative and fluoroscopic times were 89.10 and 7.68 min, respectively. One case (2%) had significant bleeding and one case (2%) had pelvic perforation; and a nephrostomy tube was inserted in both cases. The mean haemoglobin drop was 0.91 g/dL (P < 0.001). The mean hospital stay was 1.42 days and the mean pain score was 2.08, the pain score was 5 in the two cases in which a nephrostomy tube was inserted. Conclusion: The modified supine mini-PCNL is a safe and effective method for managing renal stones in children, with less postoperative pain and discomfort, less analgesic requirement, and provides access back for a second look.Abbreviations: ESWL: extracorporeal shockwave lithotripsy; Hb: haemoglobin: PCNL: percutaneous nephrolithotomy; SFR: stone-free rate ARTICLE HISTORY