Objective: To identify the pre- and intraoperative factors that affect the development of postoperative systemic inflammatory response syndrome (SIRS) following percutaneous nephrolithotomy (PCNL). Patients and Methods: A total of 200 patients were treated with PCNL, 56 of which developed postoperative SIRS (group I) and 144 did not (group II). For these 2 groups, the patient factor, operative factor, preoperative urine culture, pelvic urine culture, and stone culture were compared. Results: Average age, stone size, operative time, success rate, and number of tubeless PCNL were not significantly different between the 2 groups. However, preoperative urine culture, pelvic urine culture, and stone culture, respectively, were positive in 66.1, 46.4 and 48.2% of the patients in group I, but only 10.4, 3.5 and 3.5% for the corresponding specimens in group II. In addition, 5 patients in group I developed clinical septic shock, 4 of which were positive for all cultures and 1 positive only for stone culture. Conclusion: Infection following PCNL is common, but only a few cases progress to septic shock. Positive preoperative urine, intraoperative pelvic urine and stone cultures are important factors indicating the development of postoperative SIRS. Intraoperative cultures are important for decision-making about the treatment of postoperative infection complications.

Background and purpose: Percutaneous nephrolithotomy (PCnL) in elderly patients is challenging due to the high prevalence of comorbidity and single kidney. We compared the results and complications of patients who were submitted to PCnL according to age (higher than and lower than 65 years old). Materials and Methods: A total of 61 patients aged more than 65 years old (group I) and 385 patients aged 65 years old or less (group II) were treated with PCnL. PCnL was performed by a standard technique under fluoroscopic guidance. The operative time, length of hospital stay, success rate, auxiliary treatment and complications of both groups were compared. Results: Patients older than 65 years old (group I) had more comorbidities mainly diabetes mellitus, hypertension and higher level of ASA classification (P < 0.001). The success rate was 85.24% and 86.24% of groups I and II, respectively. Four patients (6.56%) of group I and 55 patients (14.29%) of group II needed auxiliary treatment (P = 0.098). Among the complications, only sepsis was significantly higher in group I (6.56% of group I and 1.3% of group II, P = 0.007). The operative time, success rate, hospital stay and complications except sepsis episode did not significantly differ between the two groups. Conclusion: Percutaneous nephrolithotomy is effective and safe in elderly patients even though with more comorbidities. Sepsis is the only more frequent common complication following PCnL in elderly.

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Objective. To predict the success rate and complications following percutaneous nephrolithotomy via the upper pole using the Guy's Stone Score (GSS) based on the findings of a preoperative intravenous pyelogram (IVP). Patients and Methods. Two hundred and twenty-seven renal operations, which were carried out using PCNL via the upper pole, were classified according to the GSS assigned. Any complications were classified according to the Clavien classification. The success rates and incidence of any complications were compared between each GSS. Results. The immediate success rates were 87.50% of GSS1, 71.43% of GSS2, 53.62% of GSS3, and 38.46% of GSS4, P < 0.01. There were statistically significant differences between the groups in stone size, overall immediate success rate, operative time, number of access tracts, and frequency of tubeless PCNL. Major complications (a Clavien score of 3–5) were significantly higher in the cases with a higher GSS. Conclusion. A GSS based on an IVP is a simple and reliable tool in predicting the success rate and possible complications following upper pole access PCNL.

A 33-year-old man presented with a painless, non-growing left testicular mass for five years. Preoperative ultrasonography (US) of the scrotum showed a small, circumscribed calcific mass in the right testis and another well-defined heterogeneous echoic mass with a partially calcified wall in the left testis, with avascularity on colour Doppler US. These imaging findings in a clinical setting of non-growing testicular masses were highly suggestive of epidermoid cysts, thus leading to testis sparing surgery. Histopathology confirmed bilateral epidermoid cysts. To the best of our knowledge, only 15 cases of bilateral epidermoid cysts have been reported. We discuss the US features of epidermoid cyst and its surgical management, as well as various cases of testicular masses.