PAIN IN RIGHT FLANK IN A CASE OF ADPKD

A 35 year old gentleman came with ADPKD came with right flank pain and feeling of heaviness on right side.

On evaluation he had accelerated hyperetension of 180/110 mm Hg ; he was a known case of hypertension on Losar -H.

Cardiological evaluation was done and his ECHO/ ECG were grossly normal and the cardiologist added him on extra antihypertensives for control of the blood pressure.

His CECT revealed rt lower ureteric calculi and bilateral renal calculi of 6-8 mm.He had a cyst in right upper pole of the kidney about 7 cm and there was upper polar caliectasis on CT Urolography.

We took him up for URS and LASER LITHOTRIPSY and cleared the ureteric calculi.Then we did RGP to find out the cause for right upper polar caliectasis. There was apparently no cause. We attributed it to extrinsic pressure by the upper polar cyst of the ADPKD.

We did stenting with upper end into the upper calyx and planning to monitor him for hypertension and flank pain.If the pain persists and BP remain high on multidrug regime then we are planning to laparoscopic deroofing of the upper polar cyst to ease pressure on the upper calyceal infundibulum.
  

BILATERAL SIMULTANEOUS PCNL IN A BILATERAL STAGHORN CALCULUS

A 42 year old gentleman came with bilateral staghorn calculus in a normally excreting kidneys on IVP.

He didn't have any comorbidities and was symptomatic only for left side.His hematological and biochemical parameters were normal.

We did bilateral simultaneous PCNL for the patient.The surgery was uneventful and the post-operative imaging is awaited but on the table there was complete clearance. 

The treatment of bilateral urinary calculus disease is often staged, irrespective of the modality of the treatment. Bilateral simultaneous percutaneous nephrolithotomy (PCNL) is still considered by many to be adventurous and risky.But we feel in a young patient with no comorbidties and spacious calyceal system especially upper calyceal dilatation we can chose to do bilateral PCNL. 

We undertake PCNL in a side where the kidney function is better or patient is symptomatic then if the PCNL completes uneventfully without any bleeding and with complete clearance then such a subset of the patients; we go for second side  PCNL.

We usually keep nephrostomy to have a re look after a peiod of 24-48 hours allowing oedema to settle and also allowing patients post-operative reactions like fever to subside.

  

SUPPURATIVE EPIDIDYMO-ORCHITIS LEADING TO UROSEPSIS

           A 55 y male , Diabetic and hypertensive, presented with high grade fever and left scrotal pain and features of frank sepsis. On evaluation he had left suppurative epididymorchitis with urosepsis, he was started on broad spectrum antibiotics ( Meropenem - later converted to colistin + sulbactum, i/v/o clinical and biochemical deterioration). As there was no much response with just antibiotics, left orchidectomy was done. There was dramatic improvement in his clinical status. Hence there should be a low threshold in deciding for orchidectomy in such cases and be proactive for surgical intervention, to prevent clinical deterioration. 

USG DOPPLER SCROTUM REVEALING INCREASED VASCULARITY,DIFFUSE SKIN AND SUBCUTANEOUS OEDEMA AND HYDROCELE

TENDER AND SWOLLEN LEFT TESTIS

MIDPENILE HYPOSPADIAS WITH CHORDEE: SINGLE STAGE CORRECTION WITH LATERAL BASED FLAP

A 30 year old gentleman came with chordee and midpenile hypospadias. We did a lateral based flap technique after releasing chordee. We had to excise the urethral plate and do deep Y-shaped cut on the glans to accommodate the tubularized lateral plate.
Step by step demonstration of how we did the surgery:

Pre op

Chordee correction:

INCISING DEEPLY ACROSS THE URETHRAL PLATE AND THE FIBROTIC TISSE TO RELEASE THE CHORDEE

RAISING AND TUBULARISING THE LATERAL FLAP

COMPLETION OF TUBULARISATION: NEOURETHRA COMPLETED

PLACEMENT OF THE NEOURETHRA INTO A DEEP GROOVE CREATED BY Y SHAPED  INCISION ON THE GLANS

THIRD LAYER TUNICA VAGINALIS COVER AFTER DARTOS COVERAGE

FINAL PHOTOGRAPH

DIAGRAMMATIC REPRESENTATION OF THE LATERAL FLAP TECHNIQUE: ONLY DIFFERENCE WE FOLLOW IS PUTTING TUNICA VAGINALIS COVERAGE

ESWL IN LARGE STONE: A POSSIBLE OPTION BASED ON IMAGING CRITERIA

The Xray characteristics of the stone can give a fair idea to the treating urologist about the stone fragmentation chances after ESWL.

We have seen that the pelvic stone, irregular stone, stone having a density less than tip of the 12  th rib; if these criteria are met then even a borderline stone for PCNL also we have taken up for ESWL and got excellent results.We keep stent in all big stones for ESWL. If stone doesnot get cleared totally we do saecondary  RIRS.

....

Mete UK, Naveen A. Ranagnathan P et al. Can X-ray KUB replace costly CT density measurement of renal stones to predict fragmentation buy ESWL? J. Endourol. (Abstract) 2004, 18 (Suppl) A-110.

Recently we did ESWL for a 2 cm pelvic calculus in the normally excreting kidney with DJ stenting. The stone got fragmented in a single sitting.

ESWL IN A 2 CM CALCULUS