Percutaneous antegrade management of large proximal ureteral stones using non-papillary puncture

Objective:To evaluate the feasibility and the safety of medial non-papillary percutaneous nephrolithotomy(npPCNL)for the management of large proximal ureteral stones.Methods:We evaluated prospectively collected data of 37 patients with large proximal ureteral stones more than 1.5 cm in diameter treated by prone npPCNL.Depending on stone size,in-toto stone removal or lithotripsy using the Lithoclast®Trilogy(EMS Medical,Nyon,Switzerland)was performed.Perioperative parameters including operative time(from start of puncture to the skin suturing),stone extraction time(from the first insertion of the nephroscope to the extraction of all stone fragments),and the stone-free rate were evaluated.Results:Twenty-one males and 16 females underwent npPCNL for the management of large upper ureteral calculi.The median age and stone size of treated patients were 58(interquartile range[IQR]:51-69)years and 19.3(IQR:18.0-22.0)mm,respectively.The median operative time and stone extraction time were 25(IQR:21-29)min and 8(IQR:7-10)min,respectively.One case(2.7%)of postoperative bleeding and two cases(5.4%)of prolonged fever were managed conservatively.The stone-free rate at a 1-month follow-up was 94.6%.Conclusion:The npPCNL provides a straight route to the ureteropelvic junction and proximal ureter.Approaching from a dilated portion of the ureter under low irrigation pressure with larger diameter instruments results in effective and safe stone extraction within a few minutes.

Grafts in Peyronie’s surgery without the use of prostheses:a systematic review and meta-analysis

Peyronie’s disease(PD)is characterized by abnormal penile curvature,and various surgical methods have been developed usingdifferent graft materials.However,there is currently no universal agreement on which type of graft is the best.The objective of thisreview was to evaluate the available literature and identify the most effective graft material for penile curvature correction in PD.A literature search was conducted using electronic databases,including PubMed,Scopus,and the Cochrane Library.The patients,intervention,comparison,and outcome(PICO)approach was used to define the eligibility of studies.Two authors independentlyselected studies,evaluated them,and extracted data.Random-effect models using the DerSimonian–Laird method were used.Moststudies were single-arm studies and had a high risk of bias.Buccal mucosa grafts(BMG)were found to result in the highest penilestraightening rates and were associated with the least de novo erectile dysfunction.TachoSil grafts demonstrated a high successrate in straightening despite a higher mean preoperative curvature,while Tutoplast grafts had a higher incidence of postoperativeerectile dysfunction.BMG had the highest percentage of postoperative penile straightening.Overall,the TachoSil graft showed thebest performance when preoperative curvature is taken into account.Based on the available literature,BMG appear to be the mosteffective for penile curvature correction in PD,but this is offset by the requirement for low preoperative curvature.The TachoSilgraft shows the best overall performance when preoperative curvature is considered.Comparative randomized clinical trials arestill needed to determine graft superiority.