Nephrostomy-free or tubeless PCNL reduces postoperative urinary leakage and local pain related to the drainage tube. It also minimizes hospital stay; the majority of patients were discharged from the hospital in fewer than 24 hours.

Aims:There has been much speculation and discussion about the infective complications of percutaneous nephrolithotomy (PCNL). While fever is common after PCNL, the incidence of it progressing to urosepsis is fortunately less. Which patient undergoing PCNL is at risk of developing urosepsis and in whom aggressive treatment of fever postoperatively may prevent the progression to severe sepsis becomes a very important question. This study aims to answer these vital questions.Settings and Design:This is a single institutional, retrospective study over a period of 3 years.Materials and Methods:Retrospective analysis of medical records of the patients undergoing PCNL from August 2012 to July 2015 was done. A total of 580 patients were included in the study, and the study variables recorded were analyzed statistically.Statistical Analysis Used:Statistical analysis was performed by Chi-square test.Results:Three factors significantly correlated with postoperative severe sepsis, namely, stone size >25 mm, prolonged operative time >120 min, and significant bleeding requiring transfusion. Factors associated with fever after PCNL which did not progress to sepsis were the presence of staghorn calculi and multiple access tracts in addition to the factors listed above for sepsis.Conclusions:Fever after PCNL is not uncommon but it has a low incidence of progressing to life-threatening severe sepsis and multiorgan dysfunction syndrome. Special precautions and monitoring should be taken in patients with bigger stone (>25 mm) and patients with severe intraoperative hemorrhage requiring blood transfusion. It is better to stage the procedure rather than prolong the operative time (120 min). Identifying these factors and minimizing them may decrease the incidence of this life-threatening complication.

This report presents a rare case of late-presenting CDH with herniated appendix along with caecum, ascending colon and transverse colon. Unusual presentation of chest pain was due to an attack of acute appendicitis. Late-presenting CDH is a very intriguing defect with a wide spectrum of clinical manifestations. It should be suspected in cases of unexplained acute or chronic respiratory or gastrointestinal symptoms, and abnormal chest radiographic findings. The prognosis is favorable with correct diagnosis and prompt surgical repair.

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Objective:To demonstrate the new technique of Spiral-cap ileocystoplasty for bladder augmentation and simultaneous ureteric reimplant.Materials and Methods:Seven patients with small capacity bladder and simultaneous lower ureteric involvement operated in single tertiary care institute over the last 5 years were included in this study. Spiral-cap ileocystoplasty was used in all the patients for bladder augmentation. Proximal part of the same ileal loop was used in isoperistaltic manner for ureteric reimplantation. Distal end of this ileal loop was intussuscepted into the pouch to decrease the incidence of reflux. Detubularized distal portion of the loop was reconfigured in spiral manner to augment the native bladder. Patients were analyzed for upper tract changes, serum creatinine, bladder capacity, and requirement of clean intermittent self-catheterization in follow-up over 5 years.Results:There was no evidence of any urinary or bowel leak in the postoperative period. Recovery was equivalent with those treated with other methods of bladder augmentation. Follow-up ultrasonography showed good capacity bladder. Upper tracts were well preserved in follow-up. Urinary bladder and lower ureter pathologies were addressed simultaneously.Conclusion:Spiral-cap ileocystoplasty is a useful technique in patients who require simultaneous bladder augmentation and ureteric reimplant.

Abdominal wall metastasis from urothelial cancer is extremely rare and very few such cases have been reported in the literature. As such the treatment protocols are not so well defined. We present an interesting case of a 65-year-old male patient, known case of chronic kidney disease, who presented with a large, fungating infraumbilical mass 8 months postradical cystectomy. The mass involved full thickness anterior abdominal wall and small bowel including the ileal conduit. Wide excision of the mass along with adhered bowel loops and partial excision of the ileal conduit with right ureteric reimplant was performed. The large defect in the anterior abdominal wall was closed using a mesh (permanent with a bioresorbable coating inside) and myocutaneous thigh flap. The histopathological examination of the excised mass was consistent with secondary from the urothelial tumor.

Objective: We report the multidisciplinary management of an unusual case of functional urinary bladder paraganglioma in a 19-year-old hypertensive female patient. Methods: We present the complete clinical presentation, imaging, operative details, histopathology, and follow-up of an unusual case of functional urinary bladder paraganglioma. Results: This case was unique because it presented as a functional tumor arising from urinary bladder in a young patient with uncontrolled hypertension. After biochemical, anatomical, and functional imaging, the diagnosis of a functional urinary bladder paraganglioma was confirmed. Adequate preoperative medical management was given to stabilize her blood pressure. Surgery was performed after proper optimization and explaining all of the high risk factors and expected complications of the procedure. Meticulous surgical planning was done to achieve complete tumor resection without any major complications or compromising the patient's fertility. Genetic analyses of related genes, including succinate dehydrogenase subunit B, were negative. Plasma normetanephrine levels of her first degree relatives were normal. She remained normotensive and asymptomatic at a 1.5-year follow-up. Conclusion: A multidisciplinary team approach consisting of an endocrinologist, a urologist, an anesthesiologist, and support staff is important for the successful management of high-risk cases of functional urinary bladder paraganglioma. (AACE Clinical Case Rep. 2017;3:e79-e82) Abbreviations: MIBG = metaiodobenzylguanidine; SDHB = succinate dehydrogenase subunit B e80 Urinary Bladder Paraganglioma, AACE Clinical Case Rep. 2017;3(No. 1)