Background Varicocele is an abnormal dilation and tortuosity of the internal spermatic veins within the pampiniform plexus of the spermatic cord. Varicocele is associated with progressive testicular damage and infertility. Azoospermia is associated with a varicocele in approximately 4–14% cases. For men with azoospermia or severe oligoasthenospermia, varicocele repair may result in modest improvement in semen quality which may have a significant advantage on couple’s fertility options. The aim of the study was to evaluate the role of microsurgical varicocelectomy in the men of non-obstructive azoospermia (NOA) with clinical varicocele. Methods This was a retrospective study conducted between August 2012 and January 2017, a backward review of 104 patients with the diagnosis of infertility and NOA with palpable varicocele that underwent microsurgical varicocelectomy at our institution was performed. In addition, microdissection testicular sperm extraction (MDTESE) results of these post-varicoceletomy patients were compared with the patients of NOA without varicocele. Results A total of 104 patients underwent varicocelectomy; out of these, 19 patients (18.26%) had sperm on sperm analysis post-operatively. Two of them had spontaneous pregnancy (10.5%), and 3 had children by intracytoplasmic sperm injection (15.78%). Out of the 85 patients who had MDTESE, 29 patients (34.11%) had sperms in their testis. The fertilization rate was 89.65%. Sperm retrieval rate (SRR) in NOA men with varicocele was 34.11% which was higher from those who had NOA without varicocele (24.03%). Live birth rate was 31.03% in NOA men who had varicocelectomy which was more in comparison to NOA men without varicocele (24%). Conclusions In NOA men with varicocele microsurgical varicocelectomy may have favourable effects which results in recovery of motile sperms in the post-operative ejaculate and also on spontaneous or assisted pregnancies, but it appears that this effect was more remarkable on MDTESE results when following successful intracytoplasmic sperm injection. Importantly, Sperm retrieval rate, pregnancy rate and subsequent live birth rate were higher in these patients in comparison to patients affected by NOA alone. In patients with NOA and coexisting varicocele, varicocelectomy can be considered to be essential to the overall reproductive outcome in these patients.
pyrexia, incomplete stone removal, pleural injury, and adjacent organ injury. 2 After completion of stone removal, usually, a nephrostomy tube is placed which helps in tamponade of bleeding, drainage of urine, tract recovery, and a guide for second look nephroscopy if needed. 3,4 In various studies, the usage of small caliber nephrostomy tubes were found to be equivalent to large nephrostomy tubes. 5-7 Apart from the above-mentioned ABSTRACT Background: In the current era of minimally invasive interventions, the mainstay of treatment of renal stones larger than 2 cm is percutaneous nephrolithotomy (PCNL). PCNL underwent various evolutionary changes minimizing morbidity to the patients. We prospectively compared the outcome of tubeless PCNL (without nephrostomy drainage tube) to reduce the pain and discomfort caused by tube with standard PCNL in the treatment of renal stones. Methods: In this randomized control trial (RCT), we divided patients satisfying the inclusion criteria of consenting for trial, single access puncture, less than 3 stones each less than 3 cm, operative duration of less than 2 hours into two groups, standard PCNL (group 1) and tubeless PCNL (group 2) with 25 patients each. Randomization and group assignment were done after complete clearance of renal stones. Results: Patient"s age, gender, sides of stone and stone size were comparable between two groups (standard versus tubeless PCNL). Postoperative hemoglobin drop, bleeding, pyrexia, urine leak, and blood transfusion requirement did not show a statistically significant difference between the two groups. Analgesic requirement (190 mg versus 80 mg of tramadol), operative duration (49.80 min versus 38.60 min), postoperative pain score (6/10 versus 3.64/10-visual analog scale) and duration of hospital stay (68.48 hours versus 41.12 hours) showed statistically significant difference favoring tubeless PCNL. Conclusions: Tubeless PCNL may be a safe, acceptable and effective modality of treatment for renal calculi in carefully selected patients comparing standard PCNL resulting in less operative duration, lower postoperative pain, reduced analgesic requirement and shorter hospital stay.Cite this article as: Kamalakshi MM, Ramasamy V, Sadasivan D, Raveendran S, Paramasivam S, Ganapathy V. Comparison of standard and tubeless percutaneous nephrolithotomy for renal calculi: a prospective randomized control trial. Int J Clin Trials 2019;6(4):185-90.
Retrograde intrarenal surgery (RIRS) has been increasingly used as an effective treatment modality for treatment of stones in anatomically abnormal kidneys. A challenging RIRS in a 27-year-old man, done for a 1 cm calculus in a pelvic ectopic kidney is being presented here in order to highlight the technical difficulties encountered, safety and outcome of RIRS for pelvic ectopic kidneys. A 27-year-old man presented with the chief complaints of left sided flank pain of one year duration. He was discovered to have a left pelvic ectopic kidney 7 years back and later discovered to have a calculus within it 1 year back. He had a history of an attempted rigid ureteroscopy 2 months back at another hospital where they were unable to reach the stone, so they placed a Double J stent over a guidewire. The patient was worked up and taken up for surgery at our institution. Intraoperatively there was a kink at the PUJ, below which the access sheath was placed under C arm guidance and with the flexiscope, the kink was negotiated to reach the stone. Holmium laser was used to disintegrate the stone and DJ stent was placed. Post operatively patient was stable and discharged on day 2. RIRS is a safe and effective modality for the treatment of calculi in pelvic kidneys as seen, technical difficulties like kinks can be overcome by flexiscopy.
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