Introduction: Anastomotic pseudoaneurysm is one of the rarest vascular complications after renal transplant surgery. Therapeutic options include open surgical repair or endovascular stenting.Case presentation: Case 1 had pseudoaneurysm involving external iliac artery and was managed by jump graft to allograft using cadaveric donor iliac arteries and patch angioplasty repair of external iliac artery after excising pseudoaneurysm. Case 2 had undergone orthotopic renal transplant with spleno‐renal arterial anastomosis and developed a massive pseudoaneurysm proximal to spleno‐renal arterial anastomosis. This patient underwent endovascular stenting preserving allograft vascularity and graft function. Outcome in both patients was successful with normalization of renal function to baseline levels.Conclusion: Treatment of renal transplant anastomotic pseudoaneurysms is difficult and associated with high rates of graft loss. Open surgery is the gold standard providing several possibilities for arterial reconstruction preserving graft and limb circulation. Endovascular treatment should be considered in high‐risk surgical patients with favorable anatomy.

We report a large hydrocalyx with multiple calculi resembling renal cyst with milk of calcium. A 15-year-old female presented with intermittent colicky right flank pain for 10 years with recent increase in pain severity and frequency. Renal ultrasound and CT abdomen revealed right upper pole renal cyst. To further evaluate, retrograde pyelogram was done which delineated a hydrocalyx with narrow infundibulum filling and draining slowly causing renal colic. Thulium Fiber Laser (TFL) was used to perform laser infundibulotomy and stone fragmentation. TFL has lower depth of penetration and hence was useful for ureteroscopic endoincision in this case.

Complete staghorn renal calculi are surgical challenge requiring multi-tract or staged PCNL. We report a case of supine PCNL where complete stone clearance was achieved with dual tracts (24 Fr/lower pole and 16Fr/upper pole) through which two surgeons operated simultaneously using two different energy sources (pneumatic/ultrasound lithotripter through 24Fr and Thulium Fiber laser through 16Fr). Strong water currents generated by dual-tract irrigation augmented the mini-PCNL venturi effect facilitating stone fragment evacuation. This is first reported case of two surgeons operating simultaneously using two different energy sources, in supine position in a limited space on a complete staghorn stone.

Emphysematous cystitis (EC) is an uncommon and potentially serious urinary tract infection (UTI) characterized by gas formation within the bladder wall or lumen, frequently observed in patients with diabetes mellitus (DM). We report the case of a 76-year-old female with a history of atrial fibrillation (aFib) and heart failure (HF), who was incidentally diagnosed with EC on imaging during the evaluation of transient gross hematuria. She was clinically asymptomatic, with negative urine and blood cultures, and no systemic signs of infection. Notably, she was taking empagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor. The patient was managed conservatively with antibiotics, foley catheterization, and discontinuation of empagliflozin, with complete radiographic resolution of EC. This case highlights the hypothesis of potential association between SGLT2 inhibitors and EC. In our case, conservative treatment and removal of empagliflozin led to a complete resolution of EC.

Emphysematous pyelonephritis (EPN) developing in the contralateral kidney after ureteroscopic laser lithotripsy is an unusual clinical presentation and has never been reported in the literature. After ensuring sterile urine culture a 73-year-old female underwent left ureteroscopy, laser lithotripsy and stent placement for 15mm lower calyceal renal calculus. She was discharged same day and stent removed after 4 days. 1 week later she was admitted with sepsis and found to have EPN in the right kidney, with no evidence of stone or infection in the operated kidney. High index of clinical suspicion and prompt management resulted in successful outcome.