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Objectives To present our single‐centre experience of urolithiasis management in anomalous kidneys, highlighting the need for an algorithm‐based approach in deciding the appropriate treatment method for each type. Patients and Methods We retrospectively reviewed the data of all the patients who presented to our renal unit with urolithiasis in an anomalous kidney between January 1990 and July 2014. The peri‐operative characteristics of all the patients, along with management approach, were studied. Results Percutaneous nephrolithotomy (PCNL) was the most common surgical technique used, followed by flexible ureterorenoscopy (URS). Pain was the most common presentation in these patients. The overall stone clearance rate associated with PCNL and flexible URS was 85.8% in cases of anomalous kidneys in this series. The stone clearance rates in ectopic kidneys, horseshoe kidneys, malrotated kidneys and autosomal dominant polycystic kidneys associated with PCNL and flexible URS were similar: 86%, 88%, 76% and 83%, respectively, and 81.2%, 80%, 92% and 100%, respectively . Based on our results, we developed a stone management algorithm. Conclusion The management of renal calculi in patients with renal anomalies may vary based on the stone size, location, density, pelvicalyceal system anatomy and drainage. An algorithm‐based approach could help surgeons decide the appropriate treatment in this population.

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SummaryIn this study, we compared the manoeuvrability and ease of use of the single-use Ambu aScope and Olympus re-usable fibrescope in a manikin set to simulate difficult fibrescope placement. A total of 75 anaesthetists took part in this randomised crossover non-inferiority study. We recorded the time to task completion, tip surface collision count and participants' impression of ease of use. For the Ambu aScope and Olympus fibrescope, the mean (SD) first attempt time to task completion was 63 (31) s and 53 (23) s, respectively (95% CI of the difference 3-17 s), p = 0.008. This rejected the null hypothesis of a difference of > 30 s. The mean (SD) number of tip surface collisions was 2.7 (1.9) and 2.5 (1.8), respectively, (95% CI of the difference )0.4 to 0.7) p = 0.56. However, the participants found the Olympus easier to use (p < 0.001). Mean (SD) visual analogue scores for the perceived ease of use (0 mm = extremely difficult and 100 mm = extremely easy) were 65 (18) mm and 77 (14) mm for the Ambu aScope and Olympus scopes, respectively. This study found that the single-use Ambu aScope is as easy to manoeuvre as the Olympus re-usable fibrescope. This single-use device appears to be an acceptable alternative to the re-usable fibrescope.

IntroductionImaging is a vital cog in the wheel of diagnosis and management of patients suspected with renal and ureteric calculi, and it is imperative to choose the appropriate investigation that is accurate as well as safe for the patient. At present, computed tomography (CT) is the gold standard for a patient suspected to have stone disease. However, CT scan is associated with the hazards of radiation and high cost. Ultrasonography (US) is cheap and also devoid of any radiation hazard to the patient. But, at the same time, its usage is limited by decreased sensitivity and specificity, inaccuracy in measuring stone size, and observer dependency. In this article, we review the techniques to improve the accuracy of US in measuring stone size.Accuracy of USAccording to a review, the sensitivity and specificity for renal calculi are 45% and 88%, respectively, and for ureteric calculi, they are 45% and 94%, respectively. The sensitivity of US decreased when the size of the stone is <3 mm and also in a nondilated system, and the sensitivity increased as the size of the stone increased.Tools to improve accuracyThere are factors that can be adjusted to increase the accuracy of stone measurement. The main factors are changes in gain and depth and alternate modes such as flash angle imaging, harmonic mode, and S mode. Also measures such as use of shadow for size measurement can help in improving the accuracy of stone size measurement. A new automated computerized stone-sizing program improves the accuracy of stone size calculation and reduces user variability.ConclusionUS is an ideal first-line imaging modality for nephrolithiasis due to its advantages such as low cost, absence of radiation, and easy availability. However, the only limitation is its reduced sensitivity and specificity when compared with CT. The addition of newer modes can improve the accuracy in stone size measurement.

Introduction:Simulation-based training in laparoscopic urology is essential, as these surgeries require a different skill set. We validated a chicken model for laparoscopic left modified Lich Gregoir type of ureteric reimplantation.Materials and Methods:Prospective observational study was conducted from August 2016 till February 2017. Thirty novice surgeons and 20 trained laparoscopic surgeons were included in the study. The relevant chicken anatomy and surgical steps were described to all the surgeons. The surgeons were asked to fill an eight-point questionnaire after finishing the procedure and score it on a scale of 1–5. The trainee's performance was also recorded by an investigator on a proforma. The investigator recorded dissection time, suturing time, quality of dissection, quality of suturing, and integrity of anastomosis on a scale of 1–5.Results:All the participants in the study gave a mean score of 3 or more to all the questions asked, except for one question pertaining to tissue feel. Both the groups rated the usefulness of the model very highly with a mean score of 4.20 and 4.15, respectively. Difference in the time taken for dissection and suturing along with the quality of suturing was statistically significant in favor of the expert group.Conclusions:The chicken model for laparoscopic left modified Lich Gregoir type of ureteric reimplantation is a useful, effective, cognitive training tool. This model has a face, content, and construct validity to be used as a teaching and learning tool in laparoscopic urology.

Objective: To develop a new model comprised of a bovine kidney within a chicken carcass for training in percutaneous renal access (PRA) and compare its effectiveness with the traditional mannequin model.Subjects, materials and methods: The study was conducted from January 2017 to June 2017. The content and the construct validity of the new model were confirmed after which it was compared with the traditional non-biological model for PRA. In all, 20 urology residents, with experience of <20 cases, were enrolled in the study. The parameters assessed were time to puncture, attempts to successful puncture, and fluoroscopy exposure time. They were also asked to complete a subjective assessment questionnaire.Results: The new ex vivo biological model had both content and construct validity. On comparison with the non-biological model, there was no statistically significant difference between the two models for time to puncture, total fluoroscopy exposure, and also the number of attempts taken for a successful puncture. The participants felt that the new biological model was better than the non-biological model in terms of overall assessment, tissue feel, and confidence in training. But the non-biological model scored better than the new biological model for ease of puncture and model preparation.Conclusion: The present model is inexpensive and easy to construct, and has both content and construct validity. It is a feasible model for fluoroscopy-guided PRA.Abbreviations: 3D: three-dimensional; PCNL: percutaneous nephrolithotomy; PRA: percutaneous renal access; VR: virtual reality

Transplantation of kidneys from living related donors is Introduction: the treatment of choice for patients with end stage renal disease. With less morbidity and early recovery, laparoscopy has become the standard of care for donor nephrectomies. The precise knowledge of vascular anatomy is crucial to a successful outcome. Computed tomography (CT) findings are misleading and less informative in a small number of cases. The reported accuracy of CT angiography in assessing the vascular anatomy is around 85 to 100 %. We did a prospective study to assess the diagnostic accuracy of CT angiography in the evaluation of vascular anatomy in comparison with intra operative findings.To assess the accuracy of CT in predicting the anatomy in patients who Aim: underwent laparoscopic donor nephrectomy.392 patients who underwent laparoscopic donor Materials and methods: nephrectomy in our institute between January 2010 and December 2012 were included in our study.CT scan correlated well with the intra operative findings in most of our Results: patients with good sensitivity and specificity. CT interpreted a case of double renal vein as single and a case of circumaortic vein reported on CT was not detected intra operatively. A case of right side early branching was not detected on CT. A case of a retroaortic branch of renal vein was missed on CT scan. The incidental findings detected on CT scan such as calculi, mass and hemangioma or fibroid can be of help in managing the patient after surgery.