Objective To assess the ef®cacy and safety of the retrograde ureteropyeloscopic holmium laser for treating renal stones that are too large to treat with extracorporeal shock wave lithotripsy (ESWL). Patients and methods Thirty patients (22 men and eight women, mean age 43 years, range 18±62) with a renal stone burden of >2 cm were selected for laser treatment. The stones were in the renal pelvis in 16 patients, lower calyx in ®ve, middle calyx in two, upper calyx in one and multiple pelvic and calyceal in six. Lithotripsy was undertaken using a holmium laser through 550 mm and 200 mm laser ®bres passed through a semi-rigid ®bre-optic long ureteroscope or the actively de¯ectable¯exible ureteropyeloscope, respectively. Success was de®ned as total fragmentation of the stone to <2 mm in diameter and/or clear imaging on renal ultrasonography and plain ®lms within the 3-month follow-up. Patients in whom the treatment failed received either alternative therapy or complementary ESWL.Results Endoscopic access and complete stone fragmentation was achieved in 23 of the 30 patients (77%). The treatment failed in seven patients because of poor visualization, the initial presence of stones in, or migration of their large fragments to, an inaccessible calyx. There were no major intraoperative complications. Minor complications after treatment included haematuria that persisted for 2 days in one patient and high-grade fever in two patients; all were treated conservatively. Conclusion Large renal calculi that are not amenable to ESWL monotherapy can be safely and effectively treated with a retrograde endoscopic technique that seems to compete well with the more invasive percutaneous or open surgical manoeuvres.

Study Type – Therapy (case series)Level of Evidence 4What's known on the subject? and What does the study add?The minimally invasive percutaneous nephrolitholapaxy (MIP) has shown high efficacy and safety for the management of small renal stones. It was initially developed to overcome a gap between the minimally invasive extracorporeal shockwave lithotripsy and invasive conventional percutaneous nephrolitholapaxy (PCNL) in the management of low stone burden but there is debate as to whether the MIP is also effective for larger stones.The present study shows the high efficacy and safety of MIP, which is comparable to conventional PCNL in the treatment of stones of >20 mm, including complex staghorn stones.OBJECTIVE To evaluate the safety and efficacy of minimally invasive percutaneous nephrolitholapaxy (MIP) in the management of large and complex renal calculi. PATIENTS AND METHODS From January 2007 to March 2011, 73 patients with 83 renal units with large renal stones (>20 mm in diameter) were retrospectively evaluated. Stones were classified into simple (isolated renal pelvis or isolated calyceal stones) or complex (partial or complete staghorn stones, renal pelvis stones with accompanying calyceal stones). Stone‐free rate, complications according to the modified Clavien system, decrease in haemoglobin, creatinine level, operative duration and hospital stay were compared for simple and complex renal calculi. RESULTS The mean (sd) stone size was 36.7 (23.37) mm and mean operative duration was 99.2 (48.3) min. In all, 65 cases (78.3%) were stone‐free after the first procedure and another 14 needed an auxiliary procedure (four second‐look percutaneous nephrolitholapaxy, nine ureterorenoscopy, and one extracorporeal shockwave lithotripsy) to become stone‐free, resulting in a 95.2% stone‐free rate. Complications occurred in 22 procedures (26.5%), 17 of them were Clavien Grade 1 or 2 (20.5%), five were Grade 3 (6%). There were no Grade 4 or 5 complications. The only significant difference between complex and simple stones was the stone‐free rate (96.9% vs 66.7%, P= 0.001). CONCLUSION The MIP technique is effective and safe for larger stones with low morbidity, good success rate and reasonable operative duration.

Our preliminary results with a response rate of 59% with ESWT for Peyronie's disease, including a 17% complete remission rate, is encouraging. However, further multicenter studies will have to prove if ESWT is a real therapeutic option for this disease.

Pollination and thinning are basic procedures of date palms in terms of their impact on fruit development, quality and yield, as well as the organization yearly tree bearing. The development of pollination technology, which leads to an acceptable level of fruit set with the use of small amount of pollen grains and without a further need for thinning, is necessary to improve the productivity of date palms, especially under arid conditions. This examination was done on Saidy date palm for both progressive seasons 2017 and 2018 at El-Kharga Oasis, New Valley Governorate, Egypt. The impact of pollen grain suspension at 0.5, 1.0 and 1.5 g blended with starch 5.0 g, dust pollen at 10, 12.5 and 16.7% as well as fruit thinning at 10, 20 and 30% on fruit retained, fruit weight/bunch, yield and fruit quality were examined. The outcomes announced that utilization pollen grains suspension at 1.0 g + 5.0 g starch and dusting at 10% as well as the fruit thinning at 30% had a decrement level of fruit weight/bunch about 9.64, 9.99 and 9.64% compared to the traditional treatment, respectively. The most elevated estimations fruit weight (11.28, 11.44 and 11.22 g) were obtained from spraying pollen grains suspension at 0.5 g + 5.0 g starch, dusting at 10% and removing 30% of fruit, which led to 20.51, 22.22 and 19.87% increment over the traditional treatment as average of the two seasons, respectively. Likewise, utilizing pollen grains suspension at 0.5 g or pollen dusting at 10% and removing 30% of fruit gave the most elevated values of TSS and sugar contents, while, utilizing the traditional pollination gave the least values. We can conclude from that pollination by either pollen grains suspension at 1.0 g or dusting at 10% should be possible to acquire an extensive yield with great quality, increase the efficiency of the pollination process and combine the two methods of pollination and fruit thinning at the same time in their effect on the productivity of date palms.

Verification of vasal anatomy is a crucial step that should be completed before any dissection. Bringing a looping vas back to the abdominal cavity is usually feasible laparoscopically but in a few cases this may require a small incision to dissect the vasal loop from its inguinal attachments.