Myotonic dystrophy is a debilitating genetic disease that carries a predilection for a variety of comorbidities. Kidney stone disease in this population can present a variety of unique challenges related to patient age, comorbidities, and social factors. We present a video review case of a 13-year-old girl with myotonic dystrophy who was treated surgically for large bilateral stone burden, bilateral retained ureteral stents with nephrostomy tubes, and right ureteral stricture. The patient had multiple prior urologic procedures and recurrent admissions for infection prior to presentation. Preoperative planning included non-contrast CT imaging, admission to an intensive care unit, and multidisciplinary discussion of treatment and goals. Through combined antegrade and retrograde approaches, the patient\'s stone burden was cleared, right ureteral stricture was treated, and all tubes were able to be removed in two major procedures and one minor cystoscopy with stent removal under anesthesia. Early referral to tertiary care centers and involvement of multiple specialist teams may help reduce perioperative risk and minimize the number of surgeries. Additionally, patients at high anesthesia risk may benefit from concurrent percutaneous nephrolithotomy with endopyelotomy.

Although ureteroscopy is a minimally invasive procedure, there have been reports of some minor and major complications, from self-limited to complicated events such as ureteral avulsion, urosepsis, and even death due to cerebrovascular accidents and deep vein thrombosis. Herein, we aim to report seven patients who presented with cardiovascular collapse during ureteroscopy in a 19-year period from January 2002 to January 2021.

Introduction: Surgical experience is associated with superior outcomes in complex urologic cases, such as prostatectomy, nephrectomy, and cystectomy. The question remains whether experience is predictive of outcomes for less complex procedures, such as ureteroscopy (URS). Our study examined how case volume and endourology-fellowship training impacts URS outcomes. Methods: We retrospectively reviewed URS cases from 2017 to 2019 by high ureteroscopy volume urologists (HV), low ureteroscopy volume urologists (LV), endourology-fellowship trained (FT), and non-endourology FT (NFT) urologists. Surgical outcomes including stone-free rate (SFR), complication and reoperation rates, and postoperative imaging follow-up were analyzed between groups. Results: One thousand fifty-seven cases were reviewed across 23 urologists: 6 HV, 17 LV, 3 FT, and 20 NFT. Both FT and HV operated on more complex cases with lower rates of pre-stented patients. HV also operated on patients with higher rates of renal stones, lower pole involvement, and prior failed procedures. Despite this, FT and HV showed between 11.7% and 14.4% higher SFR, representing 2.7- to 3.6-fold greater odds of stone-free outcomes for primary and secondary stones. Additionally, HV and FT had a 4.9% to 7.8% lower rate of postoperative complications and a 3.3% to 4.3% lower rate of reoperations, representing 1.9- to 4.0-fold lower odds of complications. Finally, their patients had a 1.6- to 2.1-fold higher odds of postoperative imaging follow-up with a greater proportion receiving postoperative imaging within the recommended 3-month postoperative period. Conclusions: More experienced urologists, as defined by higher case volume and endourology-fellowship training, had higher SFR, lower complication and reoperation rates, and better postoperative imaging follow-up compared with less experienced urologists. Although less experienced urologists had outcomes in-line with clinical and literature standards, continued training and experience may be a predictor of better outcomes across multiple URS modalities.

Duplex renal systems is a common anomalies. Incidence rate of 0.8% in healthy adult population and 2-4% in patients investigated for urinary tract symptoms. Urolithiasis management for patients with anomalies is complex and require proper imaging and planning. We have a patient with a partial duplex collecting system presented with a right renal calculus in a non-functioning lower moiety and multiple distal ureteric calculi. Preoperative planning done and surgery performed with good outcome without any early and late complications.

Percutaneous nephrolithotomy (PNL) surgeries are performed with different patient positions, anesthesia methods and different-sized access sheaths in order to reduce the complication rates. Supine positioned PNL can be performed safely in the high-risk group patients with comorbidities. Herein, we present a patient who had a past surgical history of right pneumonectomy and underwent a supine PNL procedure under regional anesthesia for a staghorn renal stone in the right kidney.

UNASSIGNED: Overall incidence of stones in kidney transplant recipients is 1%. En-bloc kidney transplant is a rare anatomical condition in which kidney stones treatment can be extremely difficult to treat. As far as we know, no cases of staghorn calculi in en-bloc kidney transplant have been published so far.
UNASSIGNED: A 27-year-old woman presented to the Emergency Department because of asthenia, adynamia and weight loss associated with lower urinary tract symptoms and subfebrile temperature. Ten years before, she had undergone an en-bloc kidney transplant because of end-stage renal disease secondary to perinatal asphyxia syndrome. One kidney was implanted capo-volta in the right iliac fossa and the other one in the right flank. NCCT scan showed incomplete staghorn calculi in the iliac fossa transplanted kidney. Besides, severe dilation of the native and the right flank transplanted kidney, due to two ureteral stones of 6 and 7 mm impacted in the uretero-ureteral anastomosis, was found. After hospital admission and under ceftriaxone prophylaxis, an attempt to perform primary RIRS following our COVID protocol was carried out. Nevertheless, we ended up placing a JJ stent because once the guidewire passed through the ureteral stones, purulent material came out from the ureteral orifice. She stayed 9 days in-hospital for management of postobstructive polyuria and was discharged with oral antibiotics. Three weeks afterward, we removed the stent and performed flexible ureteroscopy and holmium laser lithotripsy of the ureteral stones. In the same procedure, we performed Mini-ECIRS (21 French) previous ultrasound-guided upper pole puncture. Postoperative NCCT scan showed neither residual fragments nor operative complications.
UNASSIGNED: This is the first clinical case reporting Mini-ECIRS in a patient with an en-bloc kidney transplant. This endourological approach seems to be a feasible, safe and effective approach to treat stones in this anatomically challenging condition.

With increased use of sodium-glucose co-transporter 2 (SGLT2) inhibitors as antidiabetic agents, the risk of serious fungal urinary tract infection (UTI) may be increased. We present the case of a 67-year-old Caucasian female who was admitted for emphysematous pyelitis and found to have a fungal ball in the renal pelvis. Candida glabrata was cultured and the patient was managed with percutaneous nephrostomy tube placement and antifungal treatment. The fungal ball persisted and required surgical removal with ureteroscopy and basket extraction. Fungal balls can be a difficult sequelae of UTIs requiring a combination of antifungal and surgical intervention for definitive management.

Abdominal compartment syndrome is a life-threatening complication of conventional percutaneous nephrolithotomy (PCNL), with few cases reported in different positions. We present the first case of abdominal compartment syndrome as a complication of supermini percutaneous nephrolithotomy (SMP) in The Galdakao-modified supine Valdivia position, possibly predisposing factors, diagnosis, and management. Although it is a challenging diagnosis and life-threatening condition, morbidity and mortality can be decreased with early detection and drainage of the intra-peritoneal fluid, causing increased abdominal pressure, which is the most important prognostic factor.

Urolithiasis is a common condition managed by urologists. We present a rare CASE of a ureteric calculus migrating into the patient\'s psoas muscle in context of chronic infection and obstruction and summarize the literature surrounding this phenomenon. To our knowledge, only four cases have previously been presented in the literature of obstructing calculi migrating into the retroperitoneum. Our case is the first in which there was no associated psoas abscess and the migrated calculus has remained in situ without any further sequelae.

BACKGROUND: The optimal patient positioning for percutaneous nephrolithotomy (PCNL) based on the complexity of stone burden is not yet defined in the literature This report elaborated left complex kidney stones case underwent endoscopic-guided PCNL with a prone split-leg position (ePSL).
METHODS: Forty-three years old women were referred with a history of failed left open kidney surgery because of frozen kidney. A renal biopsy examination confirmed xanthogranulomatous tissue. Standard prone PCNL was performed. There were so many debris in pelviocalyceal system, so we used ultrasound guidance to puncture instead of fluoroscopy. There was residual stone in superior calyx that nephroscope couldn\'t reach. ePSL method was used in the second procedure. The stone was fragmented with pneumatic lithotripter. Evaluation using C-arm and nephroscope illustrated no residual stones, infundibulum laceration, and active bleeding.
CONCLUSIONS: This technique\'s main objectives are to remove urinary tract stones along the whole tract with a one-step and one-access approach with optimal utilization of full array endourologic equipment. The prone split-leg position was chosen for multiple reasons such as operator preference, the familiarity of a specific position, and inability to perform direct puncture in the upper pole. The main limitation is no long-term follow-up for patients to see the effectiveness and safety of this technique.
CONCLUSIONS: To conclude, ePSL with a prone split-leg position is a safe procedure with a relatively low rate of complications and can be used for complex kidney stone.