ABSTRACT Introduction and Objectives Percutaneous nephrolithotomy (PCNL) is the standard technique for managing large renal calculi. Second-look PCNL is typically performed under intravenous (IV) sedation or spinal / general anesthesia when removing remnant stones. This requires additional pre-anesthesia assessment and close monitoring. To simplify this procedure, we investigated the feasibility and safety of second-look PCNL without anesthesia and sheath after maturation of the nephrostomy tract. Material and Methods This study included 14 eligible patients with remnant stones >5mm in diameter, as determined by simple CT scan after supine PCNL through a single nephrostomy tract under general anesthesia. A 24Fr nephrostomy tube was inserted after surgery. Second-look PCNL was performed after seven days of maturation of the nephrostomy tract. Prior to second-look surgery, 25mg pethidine was injected intravenously. Second-look supine PCNL was performed using a rigid or flexible renoscope without anesthesia or sheath. Results The mean patient age was 57.4±8.5 years. The mean stone diameter was 5.4 × 3.3cm, while the mean number of stone branches was 4.1±1.4. The mean operation time during the first PCNL was 131.1±24.8 min, and the mean residual stone rate was 24.3%±10.2%. The mean operation time during second-look PCNL was 97.4±36.0 min; after the second procedure, the mean pain score on the numeric rating scale was 2.8±1.0. All patients were stone-free without complications. Conclusion Second-look PCNL without anesthesia and sheath after maturation of the nephrostomy tract may be an effective procedure for removing remnant stones in select patients without excessive levels of pain.

Purpose To evaluate the association between prostatic inflammation and lower urinary tract symptoms (LUTS), and to identify the effects of prostatic inflammation on the treatment with an alpha blocker. Materials and Methods 111 Participants who were aged ≥ 50 years, the presence of LUTS (maximal flow rate < 20 m/s, IPSS ≥ 11), and an elevated PSA level (3-20ng/mL) were treated with tamsulosin 0.2mg once daily for 3 months after prostate biopsies. Prostatic inflammation was scored as none (0), mild (I), moderate (II), or marked (III). LUTS parameters including urine flow rates, IPSS, PSA, and prostate volume were evaluated. Results Inflammation grading resulted in 25, 60, and 26 patients that were grade 0, I, and II, respectively. Lower grade inflammation was related to higher urine flow rate at baseline. Patients with higher inflammation grades had larger prostate volumes, larger total and transitional zone volumes, and higher PSA levels. Overall, urine flow rates and residual urine volume were improved after 3 months of alpha blocker therapy. Eighty percent of patients with grade 0 inflammation, 73% of patients with grade I inflammation, and 92.3% of patients with grade II inflammation showed improvement of LUTS after treatment. Longer duration of treatment was related to a decreased chance of improvement of LUTS. Patients with increased IPSS voiding subscales could be predictive of improvement of LUTS. Conclusions Patients with high grade inflammation had lower flow rates and higher prostatic volumes than patients with low grade inflammation. Inflammation grade did not affect the outcomes of alpha blocker treatment.