scholarly journals Comparative Analysis of the Efficacy and Safety of Combined Pneumatic and Ultrasonic Lithotripsy in the Treatment of Patients with Staghorn Nephrolithiasis

Health of Man ◽  
2021 ◽  
pp. 49-53
Author(s):  
Serhii Vozianov ◽  
Mykola Sosnin ◽  
Vadym Slobodyanyuk ◽  
Andrii Sagalevich ◽  
Andrii Boyko ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Blood Loss ◽  
Kidney Stones ◽  
Operation Time ◽  
Complete Removal ◽  
Common Disease ◽  
Efficacy And Safety ◽  
Ultrasonic Lithotripsy ◽  
Combined Technique ◽  
Combined Mode

Urolithiasis is one of the most common disease encountered in the daily practice of a urologist. Depending on the severity of the course, patients with urolithiasis and, in particular, kidney stones, are often required to have the surgical treatment. The greater problem is deemed to be staghorn nephrolithiasis and the choice of the optimal surgical technique for the elimination of kidney stones. The objective: to evaluate the efficacy and safety of the combined method of fragmentation of coral kidney stones in comparison with standard ultrasound lithotripsy. Materials and methods. A total of 352 percutaneous nephrolithotripsies (PCNL) were performed: 187 (53,1%) – patients who were diagnosed with staghorn calculi. The age of the patients ranged from 26 to 66 (mean age 42,5 years). There were 89 men and 98 women. 78 (41.7%) patients had previously undergone surgical treatment (open surgery or PCNL) of kidney stones, in which recurrent staghorn stones were subsequently identified. Nine (4,8%) patients had bilateral coral calculi. The size of the stone varied from 3,5 to 11,0 cm. Their density ranged from 300 to 1500 Hounsfield units. The most frequent complication of the underlying disease was chronic pyelonephritis – 145 (77,5%) patients. Hydronephrosis on the affected side was diagnosed in 98 (52,4%) patients. A combined pneumatic and ultrasonic lithotripter ShockPulse-SE from Olympus (Japan) was used for breaking kidney stones. We performed PCNL in a combined mode in 41 (21,9%) patients with staghorn nephrolithiasis. Results. In the group of patients using combined pneumatic and ultrasonic lithotripsy, complete removal of the staghorn calculus was achieved in 97,6% of cases (in 40 of 41 patients), whereas in the opposite group, using an ultrasonic lithotripter only in 84,9% (in 124 of 146 patients). The duration of the PCNL operation using the ShockPulse-SE device was from 35 to 130 minutes, on average – 48±5 minutes. The duration of the surgical intervention using an ultrasound lithotripter is from 90 to 180 minutes, an average –105±7 minutes. Blood loss during PCNL using an ultrasonic lithotripter was 200–400 ml, whereas with the ShockPulse-SE apparatus – 100–200 ml. An exacerbation of pyelonephritis was noted in 7 patients (in two patients after PCNL in a combined mode and in five after PCNL using an ultrasonic lithotripter). The mean length of patient hospitalization after surgery ranged from 4 to 10 days. At the same time, the average duration after PCNL using the combined ShockPulse-SE technique was 4±1 days, while after PCNL using an ultrasonic lithotripter it was 6±1 days. Conclusions. The combined technique of lithotripsy with a combined probe for simultaneous pneumatic and ultrasound lithotripsy has shown better results in terms of safety and efficacy compared to using only an ultrasound lithotripter. Used for decades, ultrasound lithotripsy for staghorn stone PCNL is both effective and safe moreover it’s a traditional technique. Thus, in comparison with ultrasound lithotripsy, the combined technique showed a shorter operation time, with less blood loss, a shorter length of patient hospitalization and less pyelonephritis in the postoperative period, as a result of maintaining a lower intrarenal pressure gradient during the operation. At the same time, the cost of the procedure using a combined probe was estimated, which turned out to be higher than traditional ultrasound lithotripsy. The use of combined lithotripsy with simultaneous aspiration of stone fragments is an indisputable advantage of this kind of PCNL in patients with staghorn nephrolithiasis, which brings the effectiveness of this technique closer to 100%.

scholarly journals Open Nephroureterectomy Compared to Laparoscopic in Upper Urinary Tract Urothelial Carcinoma: A Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Guihong Liu ◽  
Zeqin Yao ◽  
Guoqiang Chen ◽  
Yalang Li ◽  
Bing Liang
Keyword(s):  
Urinary Tract ◽  
Blood Loss ◽  
Urothelial Carcinoma ◽  
Meta Analysis ◽  
Operation Time ◽  
Upper Urinary Tract ◽  
Efficacy And Safety ◽  
Lower Blood ◽  
Urinary Tract Urothelial Carcinoma ◽  
Laparoscopic Nephroureterectomy

Background: In this meta-analysis, we will focus on evaluating the effects of open nephroureterectomy compared with laparoscopic nephroureterectomy on postoperative results in upper urinary tract urothelial carcinoma subjects.Methods: A systematic literature search up to January 2021 was performed, and 36 studies included 23,013 subjects with upper urinary tract urothelial carcinoma at the start of the study; of them, 8,178 were laparoscopic nephroureterectomy, and 14,835 of them were open nephroureterectomy. They were reporting relationships between the efficacy and safety of open nephroureterectomy compared with laparoscopic nephroureterectomy in the treatment of upper urinary tract urothelial carcinoma. We calculated the odds ratio (OR) or the mean difference (MD) with 95% CIs to evaluate the efficacy and safety of open nephroureterectomy compared with laparoscopic nephroureterectomy in the treatment of upper urinary tract urothelial carcinoma using the dichotomous or continuous method with a random or fixed-effect model.Results: Laparoscopic nephroureterectomy in subjects with upper urinary tract urothelial carcinoma was significantly related to longer operation time (MD, 43.90; 95% CI, 20.91–66.90, p < 0.001), shorter hospital stay (MD, −1.71; 95% CI, −2.42 to −1.00, p < 0.001), lower blood loss (MD, −133.82; 95% CI, −220.92 to −46.73, p = 0.003), lower transfusion need (OR, 0.56; 95% CI, 0.47–0.67, p < 0.001), and lower overall complication (OR, 0.79; 95% CI, 0.70–0.90, p < 0.001) compared with open nephroureterectomy.However, no significant difference was found between laparoscopic nephroureterectomy and open nephroureterectomy in subjects with upper urinary tract urothelial carcinoma in 2–5 years recurrence-free survival (OR, 0.90; 95% CI, 0.69–1.18, p = 0.46), 2–5 years cancer-specific survival (OR, 0.94; 95% CI, 0.69–1.28, p = 0.68), and 2–5 years overall survival (OR, 1.31; 95% CI, 0.91–1.87, p = 0.15).Conclusion: Laparoscopic nephroureterectomy in subjects with upper urinary tract urothelial carcinoma may have a longer operation time, shorter hospital stay, and lower blood loss, transfusion need, and overall complication compared to open nephroureterectomy. Further studies are required to validate these findings.

scholarly journals Treatment of irreducible atlantoaxial dislocation using one-stage retropharyngeal release and posterior reduction

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901987046 ◽  
Author(s):  
Xianfeng Ren ◽  
Feng Gao ◽  
Siyuan Li ◽  
Jiankun Yang ◽  
Yongming Xi
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Japanese Orthopaedic Association ◽  
Operation Time ◽  
Atlantoaxial Dislocation ◽  
Efficacy And Safety ◽  
Estimated Blood Loss ◽  
Irreducible Atlantoaxial Dislocation ◽  
The Mean

Introduction: Irreducible atlantoaxial dislocation (IAAD) has been challenging for spine surgeons. Various methods have been used to treat IAAD, but no consensus has been reached. This study aimed to retrospectively analyze the efficacy of anterior submandibular retropharyngeal release and posterior reduction and fixation for IAAD. Methods: From March 2007 to May 2015, 13 patients diagnosed with IAAD underwent anterior submandibular retropharyngeal release and sequential posterior reduction and fixation. The operation time, blood loss, postoperative complications, and Japanese Orthopaedic Association (JOA) scores were retrospectively recorded. Results: The surgeries were accomplished successfully. The mean operative time was about 3.8 h. The mean estimated blood loss was about 130 mL. The patients experienced postoperative pharyngeal pain. Only one patient had a vague voice and increased oral discharge postoperatively. At the final follow-up, JOA scores had significantly increased ( p < 0.05), and all the patients had solid bony fusion. Conclusion: The present study reinforces the efficacy and safety of anterior submandibular retropharyngeal release and posterior reduction and fixation for IAAD. It can achieve satisfactory clinical outcomes and is safe for experienced spine surgeons.

scholarly journals Interval versus external fixation for the treatment of pelvic fractures: a comparative study

2017 ◽  
Author(s):  
Xianping Ma ◽  
Xudong Zheng ◽  
Wei Zhao ◽  
Zifeng Lu ◽  
Lei Xu ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Postoperative Complications ◽  
Blood Loss ◽  
External Fixation ◽  
Operation Time ◽  
Pelvic Fractures ◽  
Efficacy And Safety ◽  
Postoperative Rehabilitation ◽  
Clinical Indicators ◽  
Postoperative Fever

Purpose: This retrospective study evaluated the efficacy and safety of internal fixation (IF) in the treatment of pelvic fractures (PF). Methods: A total of 263 unstable PF patients were treated from February 2009 to April 2015. Patients were divided into two groups according to type of fixation used to treat their PF: 136 cases received IF surgery (IF group); and, 127 cases received external fixation (EF) surgery (EF group). Postoperative follow-ups were conducted to record the clinical data, perioperative clinical indicators, Matta scores for fracture displacements, Majeed scores for hip functions and postoperative complications. Results: Operation time, blood loss, the total length of the wound, postoperative fever rate, hospitalization time and complication rate for the IF group were significantly decreased in comparison with the EF group, while the ratings of pain, working and sitting ability and Matta and Majeed scores of the IF group were significantly higher than those of the EF group. Conclusion: IF was found to be associated with shorter operation times, less blood loss and better postoperative rehabilitation in comparison with EF, suggesting that it is an effective therapy for the treatment of unstable PF and will lead to restoration of normal pelvis functions.

scholarly journals Arthroplasty Is Not Superior Than Internal Fixation for Intertrochanteric Fractures in the Elderly: a Meta-analysis

2021 ◽  
Author(s):  
Kexiao Yu ◽  
Weizhong Lu ◽  
Qiuke Xiao ◽  
Ruijie Wan ◽  
Lujue Dong ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Blood Loss ◽  
Internal Fixation ◽  
Meta Analysis ◽  
Operation Time ◽  
The Elderly ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Increased Risk ◽  
Significant Difference

Abstract Background: Surgical treatment is the first choice for intertrochanteric fractures in the elderly as it allows early rehabilitation and functional recovery. Recently, more and more surgeons prefer arthroplasty instead of internal fixation in the treatment of senile intertrochanteric fractures. However, there is conflicting evidence as to which is the best surgical treatment for them. In this article, we performed a systematic review and meta-analysis to compare the clinical effectiveness of internal fixation (IF) and arthroplasty (AR) for intertrochanteric fractures in the elderly. Methods: The online databases of PubMed, Cochrane Database, and Web of Science were searched to include studies conducted from 01/01/2000 to 11/30/2018 in English using keywords to identify articles relevant to this study. All studies had to have evaluated the treatment of patients with intertrochanteric fractures in the elderly(≥60 years of age). The quality of the trials was assessed and meta-analyses were conducted using the Cochrane Collaboration’s RevMan 5.3 version. Results: A total of 14 studies involving a total of 1588 patients were suitable for inclusion in this meta-analysis. There was no significant difference between the IF and AR groups for postoperative complications-related general condition (OR=1.24; 95% CI= 0.90, 1.70; P=0.19), hospital stay (SMD=0.16; 95% CI= -0.5, 0.82; P =0.64), and Harris hip score (SMD= -0.12; 95% CI= -0.79, 0.54; P =0.71). AR group had a significantly lower rate of complications-related operation (OR= 2.21; 95% CI= 1.41, 3.45; P=0.0005) and reoperation (OR=2.74; 95% CI= 1.57, 4.76; P=0.0004). However, compared with AR group, IF group could reduce the blood loss (OR=-4.08; 95% CI=-4.58, -3.59; P<0.00001), transfusion requirement (SMD= -0.67; 95% CI= -1.08, -0.26; P=0.001), operation time (SMD= -0.80; 95% CI= -1.47, -0.12; P < 0.00001), and have a lower rate of mortality within 1-year (OR= 0.67; 95% CI= 0.52, 0.86; P=0.002).Conclusion: AR is associated with less rates of complications-related operation and reoperation but has an increased risk of blood loss, transfusion, operation time and mortality within 1-year. Our findings demonstrated that AR does not have significant advantages over IF for intertrochanteric fractures in the elderly.

Surgical Treatment and Rediscussion of Day’s Classification of Crescent Pelvic Fracture Combined with the Sacral Fracture

2021 ◽  
Vol 11 (5) ◽  
pp. 1471-1476
Author(s):  
Qing-Song Fu ◽  
Xiao Yu ◽  
Xin-Hua Yuan ◽  
Wei-Bin Wang ◽  
Yi Zheng ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Blood Loss ◽  
Bone Mass ◽  
Pelvic Fracture ◽  
Sacroiliac Joint ◽  
Scoring System ◽  
Good Condition ◽  
Operation Time ◽  
Sacral Fracture ◽  
The Mean

Objective: The aim of this study was to summarize the surgical treatment of crescent pelvic fracture combined with the sacral fracture and rediscuss the Day’s classification in the pelvic crescent fractures. Methods: From May 2012 to May 2019, 24 patients of crescent pelvic fracture combined with the sacral fracture were included in this study (15 males, 9 females, mean age: 46.8 years). In this study, there were 8 cases, whose posterior bone mass was large, involving less than 1/2 of the sacroiliac joint. The lateral position was used and the arc incision along the posterior iliac ridge could be taken, the fracture should be first reduced and fixated with lag screw, and then with reconstruction plate. There were another 16 cases, whose posterior bone mass was small, involving more than 1/2 of the sacroiliac joint. For the patients with less injury of sacroiliac joint posterior ligament, the anterior ring of pelvis was fixated first, then the arc-shaped incision along the posterior iliac ridge on both sides was taken in prone position, the fracture could be reduced and fixated with lag screws and then fixated with tension plate. For the patients with server sacroiliac joint complex injury, the open reduction of anterior and posterior rings of the pelvis was taken in the floating position and fixation or arthrodesis of the sacroiliac joint could be taken. For the patients without obvious displacement of the sacroiliac joint, the anterior and posterior approaches could be used at the same time in the supine position to fixate the sacroiliac joint fixation. In addition, the average operation time, the mean blood loss, displacement differences between preoperation and postoperation, fracture union time and Hannover Scoring System were recorded. Results: The average operation time was 75 mins (range from 40 mins to 160 mins), the mean blood loss was 561.7 ml (range from 300 ml to 1100 ml). Meanwhile, no lumbosacral radiculomyelitis was injured in these cases. The mean follow-up period was 16.1 months (range from 12 months to 36 months) and the mean radiographic healing time was 3.6 months (range from 3 months to 6 months) respectively. Due to Hannover Scoring System, 18 patients were in excellent condition and 6 patients were in good condition. Conclusion: The crescent pelvic fracture combined with the sacral fracture was not included in current Day’s classification. We treated 24 cases of crescent pelvic fracture combined with the sacral fracture and obtained good clinical outcome. Therefore, we posed a new type to complement it to the Day’s classification, which was defined as crescent pelvic fracture combined with sacral fracture. It was helpful for the surgeons to choose suitable approach and implants.

scholarly journals Arthroplasty versus internal fixation for intertrochanteric fractures in the elderly: A meta-analysis

2020 ◽  
Author(s):  
Kexiao Yu ◽  
Weizhong Lu ◽  
Qiuke Xiao ◽  
Ruijie Wan ◽  
Lujue Dong ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Blood Loss ◽  
Internal Fixation ◽  
Meta Analysis ◽  
Operation Time ◽  
The Elderly ◽  
Harris Hip Score ◽  
Intertrochanteric Fractures ◽  
Increased Risk ◽  
Significant Difference

Abstract Background Surgical treatment is the first choice for intertrochanteric fractures in the elderly as it allows early rehabilitation and functional recovery. Recently, more and more surgeons prefer arthroplasty instead of internal fixation in the treatment of senile intertrochanteric fractures. However, there is conflicting evidence as to which is the best surgical treatment for them. In this article, we performed a systematic review and meta-analysis to compare the clinical effectiveness of internal fixation (IF) and arthroplasty (AR) for intertrochanteric fractures in the elderly. Methods The online databases of PubMed, Cochrane Database, and Web of Science were searched to include studies conducted from 01/01/2000 to 11/30/2018 in English using keywords to identify articles relevant to this study. All studies had to have evaluated the treatment of patients with intertrochanteric fractures in the elderly(≥ 60 years of age). The quality of the trials was assessed and meta-analyses were conducted using the Cochrane Collaboration’s RevMan 5.3 version. Results A total of 14 studies involving a total of 1588 patients were suitable for inclusion in this meta-analysis. There was no significant difference between the IF and AR groups for postoperative complications-related general condition (OR = 1.24; 95% CI = 0.90, 1.70; P = 0.19), hospital stay (SMD = 0.16; 95% CI= -0.5, 0.82; P = 0.64), and Harris hip score (SMD= -0.12; 95% CI= -0.79, 0.54; P = 0.71). AR group had a significantly lower rate of complications-related operation (OR = 2.21; 95% CI = 1.41, 3.45; P = 0.0005) and reoperation (OR = 2.74; 95% CI = 1.57, 4.76; P = 0.0004). However, compared with AR group, IF group could reduce the blood loss (OR=-4.08; 95% CI=-4.58, -3.59; P < 0.00001), transfusion requirement (SMD= -0.67; 95% CI= -1.08, -0.26; P = 0.001), operation time (SMD= -0.80; 95% CI= -1.47, -0.12; P < 0.00001), and have a lower rate of mortality within 1-year (OR = 0.67; 95% CI = 0.52, 0.86; P = 0.002). Conclusion AR is associated with less rates of complications-related operation and reoperation but has an increased risk of blood loss, transfusion, operation time and mortality within 1-year. Our findings demonstrated that AR does not have significant advantages over IF for intertrochanteric fractures in the elderly.

Evaluation of mid-term results of bipolar transurethral resection in the treatment of benign prostatic hyperplasia

2018 ◽  
pp. 1-9
Author(s):  
А.С. Векильян
Keyword(s):  
Surgical Treatment ◽  
Benign Prostatic Hyperplasia ◽  
Blood Loss ◽  
Endoscopic Surgery ◽  
Transurethral Resection ◽  
Operating Time ◽  
Clinical Results ◽  
Massive Bleeding ◽  
Prostatic Hyperplasia ◽  
Surgical Methods

Представлены клинические результаты хирургического лечения доброкачественной гиперплазии предстательной железы (ДГПЖ) объемом до 100 см3 методом биполярной трансуретральной резекции простаты (БТУР -74 пациента) в сравнении с открытой чреспузырной простатэктомией (ОПЭ - 96 пациентов), ранее применявшейся для подобных клинических случаев в урологической клинике "Железнодорожной больницы" г. Волгоград. При статистически равном операционном времени обоих хирургических методов для БТУР отмечено существенное снижение интраоперационной кровопотери, сроков послеоперационной катетеризации и пребывания в стационаре, минимальная частота геморрагических и инфекционно-воспалительных осложнений. Наблюдение за урологическим статусом пациентов в течение первого послеоперационного года показало одинаковую клиническую эффективность сравниваемых хирургических методов. Значительное снижение объема кровопотери в ходе операции БТУР можно считать большим достижением, поскольку улучшение видимости в зоне хирургического вмешательства позволяет оптимизировать гемостаз, предотвратить массивные кровотечения как во время, так и после операции, сократить сроки послеоперационной катетеризации мочевого пузыря, что в свою очередь, снижает частоту развития инфекционно-воспалительных осложнений. Более быстрое восстановление пациентов после эндоскопических операций имеет медико-социальное и экономическое значение, поскольку минимальное количество послеоперационных осложнений и сокращение сроков госпитализации позволяет существенно снизить затраты на лечение и быстрее нормализовать качество жизни пациентов. Полученные результаты демонстрируют перспективность внедрения биполярных методов эндоскопических операций для лечения ДГПЖ в хирургическую практику урологических стационаров в целях повышения безопасности оперативного лечения и экономии затрат на госпитализацию. The clinical results of surgical treatment of benign prostatic hyperplasia (BPH) up to 100 cm3 by bipolar transurethral resection of the prostate (BTUR - 74 patients) in comparison with open transvesical prostatectomy (OPE - 96 patients), previously used for such clinical cases in the urological clinic "Railway hospital" in Volgograd are presented. With statistically equal operating time of both surgical methods, there was a significant decrease in intraoperative blood loss, the terms of postoperative catheterization and hospital stay, the minimum frequency of hemorrhagic and infectious-inflammatory complications. Observation of the urological status of patients during the first postoperative year showed the same clinical efficacy of the compared surgical methods. A significant reduction in the volume of blood loss during the operation, can be considered a great achievement, since the improvement of visibility in the area of surgical intervention allows to optimize the hemostasis, to prevent massive bleeding during and after surgery, to reduce the duration of postoperative bladder catheterization, which, in turn, reduces the incidence of infectious-inflammatory complications. Faster recovery of patients after endoscopic surgery of medical,social and economic importance, as the minimum number of postoperative complications and reduction of hospitalization can significantly reduce the cost of treatment and quickly normalize the quality of life of patients. The results demonstrate the prospects of the introduction of bipolar methods of endoscopic surgery for the treatment of BPH in the surgical practice of urological hospitals in order to improve the safety of surgical treatment and save costs for hospitalization.

Combined technique of YAG- and the femtosecond laser impacts to the lens nuclei in cataract surgical treatment

2018 ◽  
Vol 16 (4) ◽  
pp. 117-121
Author(s):  
A. V. Tereshchenko ◽  
◽  
I. G. Trifanenkova ◽  
M. V. Okuneva ◽  
N. A. Orlova ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Femtosecond Laser ◽  
Combined Technique

The Role of Tranexamic Acid in Controlling Bloodloss During PCNL for Staghorn Calculi

2019 ◽  
Vol 69 (12) ◽  
pp. 3745-3748
Author(s):  
Raluca Costina Barbilian ◽  
Victor Cauni ◽  
Bogdan Mihai ◽  
Ioana Buraga ◽  
Mihai Dragutescu ◽  
...  
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Percutaneous Nephrolithotomy ◽  
Kidney Stones ◽  
Postoperative Bleeding ◽  
Invasive Technique ◽  
Transfusion Rate ◽  
Staghorn Calculi ◽  
Type Of Surgery

The aim of this paper is to assess the efficiency and safety of the tranexamic acid in reducing blood loss and the need for transfusion in patients diagnosed with staghorn calculi treated by percutaneous nephrolithotomy. Percutaneous nephrolithotomy (PCNL) is a minimally invasive technique used for large kidney stones. Hemorrhagic complications and urinary sepsis are serious complications associated with this type of surgery. Tranexamic acid is an antifibrinolytic drug that has the property of reducing intra or postoperative bleeding. The experience with tranexamic acid in preventing blood loss during percutaneous nephrolithotomy for is limited. The use tranexamic acid in percutaneous nephrolithotomy for staghorn type stones is safe and is associated with reduced blood loss and a lower transfusion rate.

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