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ObjectiveTo assess the efficacy and safety of mini-percutaneous nephrolithotomy (PCNL) for small renal stones 1–2 cm in size in infants less than one year.Material and MethodsThis descriptive case series was conducted in the department of pediatric urology Institute of Kidney Diseases Peshawar, Pakistan, from March 2019 to March 2022. All the patients underwent mini-PCNL in prone position under GA with 14 Fr access sheath and 10 Fr nephroscope. Stone clearance was assessed by non-contrast CT KUB at 30th postoperative day. Patients with no residual fragments on the non-contrast CT KUB were defined as stone-free. Patients with residual fragments of any size were defined as procedure failure. Safety was determined in terms of intra and postoperative complications.ResultsA total of 51 infants were included in the study. The mean age of patients was 9.6 + 1.8 (5–12 month). The mean stone size was 15.8 + 2.7 (10–21) mm in length and 12.3 + 2.2 (8–17) mm in width. PCNL mean operative time was 51.6 ± 7.1 (40–70) minutes. Complete stone clearance at one month was observed in 46 (90.2%) patients. Residual fragments were seen in 5(9.8%) patients with a mean size of 1.6 + 0.4 (0.9–2.0) mm. None of the patients required any additional procedure for clearance of stones. In 7 (13.7%) patients, some post-operative complications were observe, all were grade I complications, including fever in 5(9.8%) and transient hematuria in 2(3.9%) patients.ConclusionMini-PCNL is a safe and effective treatment for renal stones in infants measuring 1–2 cm with high SFR and an acceptable complication rate.

Background: Urinary tract infection and pyelonephritis are very common in patients with renal transplant. One of mechanism to prevent pyelonephritis is performing a non-refluxing anastomosis of ureter with bladder. Whether this procedure can decrease the rate of urinary tract infection and pyelonephritis is controversial. Objective: To assess the out-come of refluxing versus non-refluxing ureterovesical anastomosis in renal transplant recipients. Study Design: Randomized Control Trial (RCT) Methodology: This RCT was carried out in the Department of Urology and Renal Transplant, Institute of Kidney Diseases Hayatabad Medical Complex Peshawar from January 2015 to January 2020. A total of 52 patients who underwent live donor renal transplant were equally divided into two groups by block randomization, Group A-refluxing and Group B-non-refluxing ureterovesical anastomosis. Informed written consent was obtained from all patients. Each patient was followed for a period of one year and outcome parameters including frequency of anastomotic leakage, anastomotic stenosis, symptomatic UTI, hematuria and mean nadir creatinine level were recorded. The data were analyzed using SPSS version 26 using chi-square test for categorical data and T-test for numerical data keeping p-value < 0.05 as significant. Results: The mean age in group A and group B was 36.6 + 6.1 and 35 + 4.7 years respectively (p-value > 0.05). In group A, no patient developed anastomotic stenosis whereas in group B, 2 (7.7 %) patient developed anastomotic stenosis (p-value > 0.05). 1 (3.8 %) patient in group A developed anastomotic leakage while none of the patients in group B developed any leakage (p-value > 0.05). The mean nadir serum creatinine in group A was 1.3 + 0.4 mg/dl and 1.2 + 0.2 mg/dl in group B (p-value > 0.05). 4 (15.4%) of patients in group A and 3 (11.5%) of the patients in group B developed UTI (p-value > 0.05). Practical Implication: The refluxing ureterovesical anastomosis is relatively easier and less time consuming in comparison to the non-refluxing technique, since there is no statistical difference between their outcomes, the refluxing technique can be utilized in adult kidney transplant recipients. Conclusion: We concluded from this study that there is no statistically significant difference in the out-come between refluxing and non-refluxing ureterovesical anastomosis in renal transplant patients of adult age. Keywords: Lich-Gregoire, Renal Transplantation, Refluxing Ureterovesical anastomosis, Urine Leakage, UTI

Introduction: Pakistan is situated in the Afro-Asian stone belt. We come across a vast majority of patients having renal calculi. The treatment of renal stones has evolved from open surgery to extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in past 20 years. Objective: To determine mean skin to stone distance (SSD) in patients undergoing ESWL for renal pelvic stones and to compare mean SSD between patients with successful ESWL and failed ESWL outcomes for renal pelvic stones. Subjects and Methods: This descriptive case series study was carried out in the Department of Urology, Institute of Kidney Diseases Hayatabad Medical Complex Peshawar from September 2017 to March 2018. A total of 50 patients with renal pelvic stones were enrolled for the study. After consent, non-contrast computed tomography of the kidney ureter and blabber (NCCT KUB) was performed and SSD was measured. All patients underwent ESWL. The patient status either as stone free or having residual stones based on NCCT KUB result was noted on 3rd month. Patients having no stone fragments were defined as stone free and the procedure was defined as successful. Results: The mean age of the patients was 39.02 +/- 12.16 years. 33 (66%) were male and 17 (34%) were female. ESWL was successful in 39 (78%) of patients. 11 (22%) of the patients had residual stones. The mean SSD in patients with successful ESWL outcome was significantly lower than the patients with failed ESWL outcome (10.9 +/- 3.0 vs 14.8 +/- 1.8 cm, p-value = 0.001) Practical Implication: The study results will help the urologists in deciding appropriate treatment modality for patients with renal pelvic stones. Conclusion: We conclude that SSD is lower in patients with successful outcome of ESWL in comparison to those with failed outcome. Therefore pre-treatment NCCT KUB should be used in patients with renal stones to determine the SSD which might predict the outcomes of ESWL. Keywords: Renal calculi, Skin to stone distance, extracorporeal shockwave lithotripsy.

Objectives: To assess the safety and effectiveness of mini-percutaneous nephrolithotomy (PCNL) in paediatric age patients. Materials and Methods: This descriptive case series study was conducted in the Department of Paediatric Urology, Institute of Kidney Diseases, Hayatabad Medical Complex, Peshawar, Pakistan from June 2017 to June 2020. Children < 14 years, diagnosed with renal stone > 1cm in size on non-contrast CT of Kidney Ureter and Urinary Bladder (KUB) and having negative urine culture were enrolled in the study. Patients having abnormal renal functions and bleeding diathesis were omitted from the study. Informed written consent was taken from the parents of all the children. Children with no stone fragments in the kidney or ipsilateral ureter on non-contrast CT KUB at one month were labelled as stone free. Results: A total of 213 children who underwent mini-PCNL were analyzed. 130 (61.03%) of the stones were 10-15 mm and 83 (38.97%) were > 15 mm in size. The mean operation time was 56.02 + 7.82 (40-81) minutes .The mean hospital stay was 2.22 + 0.67 (2-7) days. The mean decrease in haemoglobin was 1.30 + 0.67 (0.2-4.0) gm/dL. No major intraoperative complication was observed. 24 (11.27%) of the patients developed post-operative complications including 10.33 % minor and 0.94 % major complications which were statistically insignificant. As a monotherapy mini-PCNL achieved complete stone clearance at one month in 191 (89.67%) of the patients. Retreatment was required in 22 (10.33%) of the patients including extracorporeal shock wave lithotripsy (ESWL) in 7 (3.29%), ureteroscopy (URS) in 10 (4.69%) and Re-PCNL in 5 (2.35%) patients. Conclusion: This study concludes that mini-PCNL in a paediatric population is safe and effective for renal stones > 10 mm with acceptable stone clearance and complications. Keywords: Kidney calculi, Pediatrics, Percutaneous, Children, Urolithiasis