Purpose: To evaluate the results of prompt, same-day selective angiography and transcatheter angioembolization (TAE) on delayed post-percutaneous nephrolithotomy (PCNL) hematuria. Materials and methods: Between 2011 and 2017, 21 patients with a mean age of 37 years (range, 21–60 years; males, 18) underwent digital subtraction angiography (DSA) and TAE to control delayed gross hematuria following PCNL. Discharged patients who following an uneventful PCNL presented to the emergency room with gross, brisk hematuria were included in the study and taken up for prompt, same-day DSA and same-session TAE with N-butyl-2-cyanoacrylate glue, without resorting to any initial conservative measures. All patient data were retrieved from medical records. Results: Angiography revealed vascular lesions in all the cases (pseudoaneurysms, 14 cases; arteriovenous fistula, 2; mixed lesions, 5). The mean time of onset of delayed hemorrhage was 10.10±2.67 days. The average time from onset of bleeding to TAE was 4.31±0.64 hours (range 3.5–5.5 hours). Bleeding was controlled in all the cases without any recurrence or the need for further embolization. There were no procedural complications except for transient elevation of serum creatinine in four cases. Conclusion: Primary DSA and TAE is a safe, effective, and time-saving alternative to conservative management for post-PCNL, delayed, gross hematuria.

Loss of tone of the anterolateral abdominal wall muscles due to denervation injury is quite common after open renal surgery by lumbotomy incision. Although rare, flank bulge following percutaneous nephrolithotomy (PCNL) after supracostal approach has been reported in literature. But pseudohernia after PCNL with subcostal access has not been reported yet. In this case report, we present the rare complication of an abdominal wall bulge that occurred after PCNL with a subcostal access. The index case had been operated for a partial staghorn calculus with lower calyceal extension. PCNL with subcostal approach was used. Complete stone-free status was achieved with an uneventful recovery. During the first follow-up after 1 week, an unsightly, painless flank bulge was noticed, which continued to persist till 9 months of periodic follow-up.

Background and rationale: Percutaneous nephrolithotomy (PCNL) is the preferred treatment option for large kidney stones due to high stone-free rates. Usually, a contrast study via retrograde ureteral catheter (U-Cath) visualises the pelvicalyceal system (PCS) under fluoroscopy. Although U-Cath is recommended in conventional PCNL (cPCNL), modifications such as direct puncture with antegrade contrast pyelography or stone-guided puncture followed by contrast injection have been employed in different circumstances. However, there are safety concerns in performing stone-guided PCNL (sg-PCNL) ‘without contrast pyelography or ultrasound’. We aim to evaluate the safety and effectiveness of sg-PCNL in selected cases without contrast pyelography or ultrasound. Materials and methods: This study reports PCNL outcomes in 57 patients with urolithiasis who underwent stone-guided puncture (sg-PCNL) by a single surgeon at a tertiary hospital. The puncture landmark was the calyceal stone (aimed at its distal margin), targeted end-on using the Bull’s eye technique, with the initial puncture needle (IPN) aligned along the stone’s long axis; the puncture was performed solely under fluoroscopic guidance. In addition to demographic features, procedural variables such as puncture time, number of punctures, operation time, haemoglobin drop, stone-free rate, and complications were recorded and analysed. Results: The operation duration in the sg-PCNL cohort averaged 54.45 min, with most surgeons rating visualisation as excellent (96.4%). There was a minimal, non-significant decrease in haemoglobin (0.9 ± 0.7 g/dL, p = 0.32) and creatinine (0.3 ± 0.7 mg/dL, p = 0.442). Stone-free status was achieved in 94.6% of patients, with 5.4% having residual stones. The complication rate was 3.6%, all grade I ( p = 0.627). Guidewire patterns were ‘Ureteric line’ (U) in 67.9% and ‘Upper pole-pelvic’ (UP) in 32.1%. Conclusion: sg-PCNL is a safe, effective alternative to traditional techniques in select patients when performed by an experienced surgeon.

Introduction and Importance: Advances in endourology have greatly reduced open stone surgeries (OSS) worldwide. However, in some rural areas of developing countries, PNL for large, complex stones is not feasible due to limited resources and lack of angioembolisation. We share our experience in such cases. Materials and Methods: Using STROCSS 2025 and PROCESS 2023 checklists, we outlined objectives and reported a case series. From January 2012 to June 2023, 2241 patients had surgery for urinary stones at a rural hospital: 286 PNL, 1625 URS, 281 RIRS, and 49 OSS. We retrospectively analysed demographic data, stone burden, surgical techniques, and outcomes. Outcomes: There were 23 men and 26 women, aged 31 to 66 (average: 52 years). CSB was included in 46 patients (93.8%), and CSB with PUJ obstruction in 3 patients (6.12%). Procedures were pyelolithotomy (26.53%), extended pyelolithotomy (38.77%), and pyelolithotomy with lower calyceal nephrotomy (24.48%). Mandatory intraoperative nephroscopy was used to remove calyceal stones. Complete stone-free status was achieved in 47 cases (95.9%) at discharge and 3-month CT. Two patients (4.08%) had residual fragments needing RIRS at 3 months. The mean operative time was 88.67 min (70– 120), and hospital stay averaged 5.87 days (5– 8). The follow-up period averaged 24.48 months (24– 30). Intraoperative complications occurred in 10.20%, and significant postoperative complications in seven cases (14.28%), including sepsis, urinary leakage, chest effusion, and wound issues. Conclusion: Single-session OSS with Nephroscopic clearance can achieve a higher stone-free rate. Although the morbidity of OSS is considerably higher than that of PNL, it may be safe and effective for managing complex stone burdens in resource-constrained rural areas of developing countries.