scholarly journals Prospective study on standard and totally tubeless percutaneous nephrolithotomy

2019 ◽  
Vol 6 (11) ◽  
pp. 3972
Author(s):  
V. Vishnu Vardhana Reddy ◽  
Amar Kumar Repaka
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Elective Surgery ◽  
Demographic Data ◽  
Operation Time ◽  
Patient Comfort ◽  
Standard Group ◽  
Early Return ◽  
Significant Difference ◽  
Analgesia Requirement ◽  
Tubeless Percutaneous Nephrolithotomy

Background: With the improvement of instrumentation and experience of percutaneous nephrolithotomy (PCNL), several modifications to the procedure have taken place in order to reduce the morbidity and early return to normal lifestyle. This study aimed to compare the totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy techniques.Methods: It is a prospective randomized, clinical trial done on 60 patients was patients older than 20 years and younger than 60 years who were chosen for elective surgery of kidney stones via the PCNL technique. Patients were divided into two groups, standard PCNL (with a nephrostomy tube) and totally tubeless PCNL (no ureter stents or ureteric catheters).Results: Demographic data is matched in two groups of patients. The mean operation time was slightly longer in the standard group (108 minutes) than in the totally tubeless group (102 minutes), but there was no statistically significant difference. There was no significant difference between the two groups with regard to serum creatinine change or blood loss. Haemoglobin drop, hospital stay, Pain score and analgesia requirement was significantly less in the totally tubeless group. 4 patients in each group had bleeding postoperatively. Only five patients developed pyrexia in the postoperative period. The differences in the need for blood transfusion and postoperative pyrexia were not found to be statistically significant. 19 in standard group and 2 patients in totally tubeless group developed urine leak, found to be statistically significant.Conclusions: Author can conclude that the tubeless procedure has fewer complications, improved postoperative patient comfort, shorter hospitalization, and a reduced need for analgesics. 

scholarly journals The Outcomes of Minimally Invasive Percutaneous Nephrolithotomy with Different Access Sizes for the Single Renal Stone ≤25 mm: A Randomized Prospective Study

2021 ◽  
pp. 1-6
Author(s):  
Weimin Yu ◽  
Yuan Ruan ◽  
Zhuang Xiong ◽  
Yunlong Zhang ◽  
Ting Rao ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Percutaneous Nephrolithotomy ◽  
Operative Time ◽  
Controlled Trial ◽  
Demographic Data ◽  
Operation Time ◽  
Stone Free Rate ◽  
Significant Difference ◽  
Minimally Invasive Percutaneous Nephrolithotomy ◽  
Free Rate

<b><i>Objectives:</i></b> The aim of this study was to provide a randomized controlled trial comparing the outcomes of different access sizes used in the solo ultrasonic-guided minimally invasive percutaneous nephrolithotomy (mini-PCNL). <b><i>Methods:</i></b> From January 2018 to December 2019, a total of 160 cases with single renal stones of &#x3c;25 mm were randomized to undergo mini-PCNLs with Fr16, Fr18, Fr20, or Fr22 accesses. All accesses were established with the axis of the target calyx as the marker for puncture location and then expanded to the desired size. Hemoglobin reduction, operative time, stone-free rate, complications, etc., were all recorded and assessed. <b><i>Results:</i></b> The demographic data were similar, and there were no significantly intergroup differences in stone-free rate, complications, and hospital stay time. The hemoglobin reduction was comparable and was 0.9 ± 0.6, 0.9 ± 0.7, 1.0 ± 0.5, and 1.1 ± 0.7 g/dL for the groups Fr16, Fr18, Fr20, and Fr22, respectively. The operative time was 53.4 ± 14.5, 48.5 ± 15.2, 42.8 ± 13.3, and 43.3 ± 13.1 min for the 4 groups, which decreased significantly from group Fr16 to Fr20, but there was no significant difference between Fr20 and Fr22 groups. <b><i>Conclusions:</i></b> The axis of target calyx is a reliable marker for establishment of percutaneous renal access under ultrasonic guidance. The surgical outcomes of different access sizes were comparable, but the operation time was significantly shortened with the increase of size. However, Fr22 was not more efficient than Fr20.

Tubeless Percutaneous Nephrolithotomy with Hemostatic Plug Using Surgiflo® versus Standard Percutaneous Nephrolithotomy using a Nephrostomy Tube: A Prospective Randomized Controlled Study

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hisham Mohamed Fathey Elshawaf ◽  
Mohamed Ismail Shabayek ◽  
Mohamed Ahmed Saleh Ahmed
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Intraoperative Complications ◽  
Demographic Data ◽  
Renal Stones ◽  
Controlled Study ◽  
P Value ◽  
Nephrostomy Tube ◽  
Gelatin Matrix ◽  
Significant Difference ◽  
Tubeless Pcnl

Abstract Background Percutaneous Nephrolithotomy (PCNL) is the preferred technique for treating large renal stones (over 2cm in diameter). It involves keyhole surgery performed through a small skin incision overlying the kidney. Objectives Our study aimed at evaluating the safety and efficacy of local hemostatic sealant (surgiflo®) use in tubeless PCNL to enhance postoperative outcomes of PCNL. Patients and Methods We randomized our patients into two groups, Group A nephrostomy tube was used as standard PCNL, and at group B tubeless PCNL was done followed by injection of the local hemostatic flowable gelatin matrix (surgiflo®) under fluoroscopic guidance in the prone position Results There was no statistically significant difference between two groups regarding demographic data age, sex and BMI (P- value 0.280, 0.736 and 0.440 respectively), stone site and size (P- value 0.525 and 0.533 respectively), operative time (P- value 0.855), intraoperative complications as blood loss and pelvicalyceal perforation, (P- value 0.92 and P- value 0.83 respectively), postoperative complication as fever, haematuria and UTI (P- value 1.000, 0,113 and 1.000 respectivly), and Hb drop (P- value 0.735). Conclusion Tubeless PCNL with hemostatic sealant use is associated with less pain, no leakage from nephrostomy tract, less narcotic agent use, and a shorter hospital stay.

Predictive Value of Charlson Comorbidity Index and Cofactors on 2-Year Mortality in Older Patients With Intertrochanteric Fractures: A Retrospective Analysis

2021 ◽  
Author(s):  
Jianda Xu ◽  
Homma Yasuhiro ◽  
Yuta Jinnai ◽  
Tomonori Baba ◽  
Zhuang Xu ◽  
...  
Keyword(s):  
Blood Loss ◽  
Older Patients ◽  
Demographic Data ◽  
Survival Rates ◽  
Operation Time ◽  
Intertrochanteric Fractures ◽  
Time Out ◽  
Time Operation ◽  
Significant Difference ◽  
First Time

Abstract The aim of this study was to evaluate the role of Charlson comorbidities index (CCI) and cofactors on 2-year mortality in older patients with intertrochanteric fractures. 60 cases with unilateral intertrochanteric fracture were retrospectively analyzed and divided into Low-CCI group (CCI: 1-4) or high-CCI groups (CCI: 5-6). All the patients’ electronic hospital records were reviewed. The preoperative situations (demographic data, comorbidities and fracture conditions), perioperative situations (wait time, operation time, implant choice, blood loss, transfusion or not) and postoperative situations (complications, first time out of bed, function about 1-/2- week and 2-year mortality) were recorded. 51.67% were in low-CCI group and 48.33% in high-CCI group. The survival rates in low- and high-CCI group were 93.5% and 86.2 % respectively. According to the functional results of 1- or 2- week after operation, no significant difference was found (P=0.955, 0.140). Log-rank analysis showed that the main prognostic factors were blood loss, first time out of bed and complication (P<0.05). Multivariate analysis confirmed that complication and first time out of bed were significant factor on survival rate (P=0.029, 0.010). Charlson comorbidities index maybe not the indicator of 2-year mortality in older patients with intertrochanteric fractures. In order to improve the prognosis, more attentions should be paid to reduce the complications and encourage postoperative earlier excise out of bed.

scholarly journals Nighttime Appendectomy is Safe and has Similar Outcomes as Daytime Appendectomy: A Study of 1198 Appendectomies

2020 ◽  
pp. 145749692093860
Author(s):  
T. Mönttinen ◽  
H. Kangaspunta ◽  
J. Laukkarinen ◽  
M. Ukkonen
Keyword(s):  
Acute Appendicitis ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Time Of Day ◽  
University Hospital ◽  
Patient Comfort ◽  
Intraoperative Bleeding ◽  
Significant Difference ◽  
Clinically Significant

Introduction: Although it is controversial whether appendectomy can be safely delayed, it is often unnecessary to postpone operation as a shorter delay may increase patient comfort, enables quicker recovery, and decreases costs. In this study, we sought to study whether the time of day influences the outcomes among patients operated on for acute appendicitis. Materials and Methods: Consecutive patients undergoing appendectomy at Tampere University Hospital between 1 September 2014 and 30 April 2017 for acute appendicitis were included. Primary outcome measures were postoperative morbidity, mortality, length of hospital stay, and amount of intraoperative bleeding. Appendectomies were divided into daytime and nighttime operations. Results: A total of 1198 patients underwent appendectomy, of which 65% were operated during daytime and 35% during nighttime. Patient and disease-related characteristics were similar in both groups. The overall morbidity and mortality rates were 4.8% and 0.2%, respectively. No time categories were associated with risk of complications or complication severity. Neither was there difference in operation time and clinically significant difference in intraoperative bleeding. Patients undergoing surgery during night hours had a shorter hospital stay. In multivariate analysis, only complicated appendicitis was associated with worse outcomes. Discussion: We have shown that nighttime appendectomy is associated with similar outcomes than daytime appendectomy. Subsequently, appendectomy should be planned for the next available slot, minimizing delay whenever possible.

scholarly journals Sutureless hemorrhoidectomy vs open hemorrhoidectomy: a prospective study in a regional hospital of Western Nepal

2015 ◽  
Vol 3 (2) ◽  
pp. 121-123
Author(s):  
P Ghimire ◽  
NV Gurung ◽  
PK Upadhaya ◽  
S Shrestha ◽  
A Gurung ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Demographic Data ◽  
Operating Time ◽  
Operation Time ◽  
Regional Hospital ◽  
Time Duration ◽  
Duration Of Symptoms ◽  
Sutureless Technique ◽  
Open Hemorrhoidectomy ◽  
Early Return

Background: The aim of this study is to compare sutureless Hemorroidectomy with Conventional Open Hemorrhoidectomy in terms of safety and clinical efficacy.Method: A prospective analytical study of 60 operated patients (a nonrandomized cohort) was carried out by following up from admission to 1 month period after hospital discharge in between July, 2013 to February, 2014 in Western Regional Hospital, Pokhara, Nepal. Demographic data, clinical data, mean operation time, duration of hospital stay, number of parenteral analgesic injections and post-operative complications between the two groups were recorded and analyzed.Result: There were no statistically significant differences between the two groups in terms of age, gender, duration of symptoms, grade of the hemorrhoid(s), or number of hemorrhoids resected. The mean operating time for LigaSure sutureless hemorrhoidectomy was significantly shorter than that for the Open hemorrhoidectomy (P < 0.001). Patients treated with the LigaSure technique had less blood loss, a better pain score (P < 0.001), less parenteral analgesic requirement (P < 0.001), shorter hospital stay (P < 0.001), and early return to work (P < 0.01). Conclusion: Sutureless Technique is safe and effective as compared to Conventional Open Hemorrhoidectomy for grade III and IV hemorrhoids.Nepal Journal of Medical Sciences Vol.3(2) 2014: 121-123

scholarly journals Effects of Granisetron on Spinal Anesthesia-induced Hypotension

2021 ◽  
Author(s):  
Cem Koray Çataroğlu ◽  
Alp Alptekin ◽  
Aysel Gezer ◽  
Murat Sayın ◽  
Aslı Dönmez
Keyword(s):  
Heart Rate ◽  
Sodium Chloride ◽  
Spinal Anesthesia ◽  
Chloride Solution ◽  
Sodium Chloride Solution ◽  
Elective Surgery ◽  
Demographic Data ◽  
Hyperbaric Bupivacaine ◽  
Significant Difference ◽  
Isotonic Sodium Chloride

Objective: It was aimed to evaluate the effect of intravenous (IV) granisetron used for nausea and vomiting prophylaxis on hypotension and bradycardia caused by spinal anesthesia. Methods: 120 ASA 1-2 patients undergoing elective surgery under spinal anesthesia were randomly divided into Group G (Ganisetron; n=60) and Group P (Placebo; n=60) groups. Five minutes before spinal anesthesia, Group G received 1 mg intravenous granisetron diluted in 10 mL of isotonic sodium chloride solution and Group P received 10 mL of isotonic sodium chloride solution. Spinal anesthesia with hyperbaric bupivacaine 0.5%, 15 mg at the level of L4-5 was applied for both groups. Hemodynamic data, sensory and motor block parameters were recorded before and after spinal anaesthesia every 5 minutes during 20 minutes of surgery. Results: There was no difference in the demographic data of both groups. Although hemodynamic data showed a decrease in both groups according to initial values, blood pressure measurements in group G were significantly higher than the first measure values. There was no significant difference in heart rate values between the groups. Conclusion: Intravenous granisetron reduces hypotension after spinal anesthesia, but it has no significant effect on heart rate.

A Randomized Controlled Trial Assessing the Effect of a Continuous Subcutaneous Infusion of Local Anesthetic Following Elective Surgery to the Great Toe

2016 ◽  
Vol 10 (2) ◽  
pp. 116-124 ◽  
Author(s):  
Barry Rose ◽  
Kumar Kunasingam ◽  
Tristan Barton ◽  
James Walsh ◽  
Karen Fogarty ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Continuous Infusion ◽  
Postoperative Analgesia ◽  
Local Anesthetic ◽  
Elective Surgery ◽  
Controlled Trial ◽  
Demographic Data ◽  
Randomised Control Trial ◽  
Randomized Controlled ◽  
Significant Difference

Local anesthetic use for wound infusions, single injection, and continuous nerve blocks for postoperative analgesia is well established. No study has investigated the effect of a continuous block of the saphenous and superficial peroneal nerves at the level of the ankle joint following first ray surgery. A double blind randomized controlled trial was designed. One hundred patients with hallux valgus and rigidus requiring surgical correction were recruited and randomized to receive a postoperative continuous infusion at the ankle of normal saline or ropivacaine for 24 hours. Pain scores were recorded on postoperative days 1 and 7. There were more females than males. Follow-up was 100%. There were no significant differences in demographic data between the 2 randomized groups. There was no significant difference between the absolute visual analog scale scores on day 1 (P = .14) and day 7 (P = .16); nor was there a significant difference in reduction in scores between days 1 and 7 (P = .70). This study has shown no benefit to postoperative analgesia with the use of a continuous infusion of ropivacaine at the ankle. We, therefore, cannot currently recommend its use in the way described. Further studies may still identify a role for continuous local anesthetic infusions at the ankle to improve postoperative analgesia. Levels of Evidence: Level I : Prospective randomised control trial.

scholarly journals Analgesic Effects of Pre-induction Low-dose Ketamine on Post-tonsillectomy Patients

2018 ◽  
Vol 8 (2) ◽  
pp. 74-79
Author(s):  
Muhammad Delwar Hussain ◽  
Md Torab Mallick ◽  
Mohammad Kamal Hossain
Keyword(s):  
Pain Intensity ◽  
General Anaesthesia ◽  
Analgesic Effect ◽  
Low Dose ◽  
Demographic Data ◽  
Operation Time ◽  
Patient Comfort ◽  
Military Hospital ◽  
Control Group ◽  
Post Operative Pain

Background: Post-operative pain management aims to decrease pain intensity with patient comfort and to improve post-operative outcome. Multimodal analgesia is currently recommended for effective post-operative pain control with lower total doses of analgesics and fewer side effects.Objective: To compare the analgesic effect of pre-induction low-dose ketamine against conventional general anaesthesia.Materials and Methods: This prospective comparative study was conducted over a period of 12 months at Combined Military Hospital, Dhaka. Two hundred and forty patients of either sex requiring tonsillectomy were divided into two groups: conventional general anaesthesia (control group) and general anaesthesia with low-dose ketamine (ketamine group). Non-invasive blood pressure, heart rate and SpO2 were recorded at regular intervals throughout the anaesthetic period. Post-operative analgesia was provided for both the groups using pethidine intramuscularly. Time to complete operation, pain intensity, time to request for first analgesia were noted and total opioid consumption and complications, if any occurred in 24 hours post-operatively, were also recorded and addressed accordingly.Results: The demographic data and mean operation time were similar in both the groups (p>0.05).Time to request for first analgesia was longer in lowdose ketamine group (mean ± SD 5.36±3.21 hours) than in control group (mean ± SD 2.49±1.53 hours) (p<0.05). Total dosage of pethidine consumption over 24 hours period was less in ketamine group with satisfactory pain relief (mean ± SD 98.73±2.60 mg) than in control group (mean ± SD 142.52±3.48 mg) (p<0.05). Post-operative complications were also less in ketamine group than control group (p<0.05).Conclusion: The result of this study suggests that pre-induction low-dose ketamine has pre-emptive analgesic effect and reduces overall post-operative opioid requirements.J Enam Med Col 2018; 8(2): 74-79

scholarly journals A retrospective study comparing super-mini percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of 20–30 mm renal stones in obese patients

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e8532
Author(s):  
Chen Xu ◽  
Rijin Song ◽  
Pei Lu ◽  
Minjun Jiang ◽  
Guohua Zeng ◽  
...  
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Demographic Data ◽  
Operation Time ◽  
Renal Stones ◽  
Flexible Ureteroscopy ◽  
Complication Rates ◽  
Obese Patients ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Stone Characteristics

Objective This study aimed to compare the efficacy and safety of Super-mini percutaneous nephrolithotomy (SMP) and flexible ureteroscopy (F-URS) in the treatment of 20–30 mm renal stones in obese patients. Methods We conducted a retrospective analysis of outcomes of patients who underwent SMP and F-URS to treat 20–30 mm renal stones from August 2017 to September 2018. Patients with BMI >30 kg/m2 were enrolled into this study. Forty-eight patients underwent SMP, while 104 patients underwent F-URS by the same surgeon. The patients’ demographic data, stone characteristics, perioperative parameters and outcomes, complications, stone-free rate (SFR) and overall costs were retrospectively assessed. Results No significant differences were found between the two groups in terms of age, gender, BMI, operation side, stone size, number, locations, stone compositions and CT value. The mean operation time was significantly shorter in the SMP group (p < 0.001), while the F-URS group had significantly shorter postoperative stays (p < 0.001) and lower complication rates (p < 0.001). Both groups had similar SFR at a 3-month follow-up (p = 0.190), while the SMP group achieved significant higher SFR 3 days after the operation (p < 0.001). The SMP group had a significantly lower overall cost and fewer stage-2 procedures than the F-URS group. Conclusion SMP and F-URS are equally effective in obese patients with 20–30 mm renal stones. However, F-URS offers the advantage of a lower complication rate, while SMP performed better in terms of operation time, tubeless rate, stage-2 procedures and overall costs.

Pure ICL Implantation: A Novel Ophthalmic Viscosurgical Device-Free Technique

2021 ◽  
Author(s):  
Qin Qin ◽  
Lianyun Bao ◽  
Zifang He ◽  
Feifei Chen ◽  
Dandan Zhu ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Operation Time ◽  
Visual Quality ◽  
Standard Group ◽  
Distance Visual Acuity ◽  
Significant Difference ◽  
Device Free ◽  
Group 1 ◽  
Ophthalmic Viscosurgical Device

Abstract Background: To assess the clinical efficiency of a novel ophthalmic viscosurgical device-free (OVD-free) method for intraocular collamer lens (EVO-ICL) implantation in myopic eyes.Methods: In this retrospective cohort study, 40 eyes underwent standard ICL implantation, and 40 eyes underwent OVD-free (Pure) ICL implantation. Preoperative and postoperative uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BCVA), equivalent spherical degree (SE), intraocular pressure (IOP), visual quality index, subjective visual quality scale, corneal endothelial cell density (ECD), operation time, and complications were compared between and within the standard and pure ICL implantation groups. Results: Increased IOP > 22 mmHg 2 h after surgery was noted in 19 eyes (47.5%) in the standard group, but not in the pure group (0%, P < 0.001). Increased IOP relative to baseline was significantly higher at 2 h and 1 day after surgery for the standard group compared with the pure group (P < 0.001). LogMAR UDVA and LogMAR BCVA were significantly improved in the pure group compared with those in the standard group 1 day (P < 0.001) and 1 week (P < 0.001) after implantation, but not after 3 months (P = 0.747 and P = 1.000, respectively). SE was significantly lower in the pure group than in the standard group 1 day after implantation (P = 0.003). No significant differences in SE were observed at any time point between groups (P = 0.285, P = 0.460). Optical Quality Analysis System (OQAS) II visual quality indicators, such as the modulation transfer function cut-off frequency (MTF cut-off), Strehl ratio (SR), and OQAS under different contrast values [OQAS values (OVs) 20], were significantly better in the pure group than in the standard group 1 day after implantation (P = 0.013, P = 0.009, and P = 0.004, respectively). SR, OV20%, and OV9% were significantly better in the pure group than in the standard group 1 week after implantation (P = 0.003, P = 0.047, and P = 0.002, respectively). No significant difference in ECD changes within or between groups was observed (P > 0.05). The operation time for the pure group (2.897 ± 0.346 min) was significantly shorter than that for the standard group (4.444 ± 0.656 min; P < 0.001). No complications were reported for either group during the observation period, except early IOP elevation in the standard group.Conclusions: The pure ICL implantation method was associated with faster visual acuity recovery, a shorter operation time, and more stable intraocular pressure. Pure ICL represents a safe and convenient method for ICL implantation compared with the standard method, completely eliminating OVD-related complications without causing additional complications.

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