Perioperative Outcomes of Percutaneous Nephrolithotomy in Septuagenarians and Beyond

2021 ◽  
Vol 104 (9) ◽  
pp. 1497-1502
Keyword(s):  
Renal Function ◽  
Percutaneous Nephrolithotomy ◽  
Age Groups ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
Renal Calculus ◽  
Perioperative Outcomes ◽  
Kidney Calculi ◽  
Operative Outcomes ◽  
Estimated Blood Loss

Background: Life expectancy has continuously risen worldwide. Because the elderly may tolerate complications poorly, the risks and benefits of percutaneous nephrolithotomy (PCNL) in those patients should be discussed thoroughly. Objective: To analyze utility and operative outcomes of PCNL with respect to age. Materials and Methods: A retrospective study of PCNL was performed at Ramathibodi Hospital between 2011 and 2020. The patients were divided into two age groups, 1) below 70 years old and 2) 70 years old and above. Comparison of demographics, operative data, and postoperative outcomes were analyzed. Results: Of the 253 patients, the overall stone-free rate (SFR) was 59.7%. The SFR in younger groups and older groups were 59.4% (126/212) and 61.0% (25/41), respectively, which was not significantly different (p=0.999). There was a similar in-stone burden between the two groups (p=0.573). Patients in the older group had worse renal function, higher American Society of Anesthesiologists score, and more comorbidities, including hypertension and ischemic heart disease. However, estimated blood loss, length of hospital stay, operative time, percent change in eGFR, and complications were comparable between the groups. Conclusion: PCNL is a safe and effective treatment of kidney calculi in septuagenarians and older patients, even with the risk of higher comorbidities and poorer renal function than in younger patients. Keywords: Percutaneous nephrolithotomy; Renal calculus; Stone-free status; Septuagenarians

Contained Power Morcellation Versus Transvaginal Extraction for Retrieval of Laparoscopically Removed Myomas: A Comparison of Perioperative Outcomes

2018 ◽  
Vol 26 (1) ◽  
pp. 72-76 ◽  
Author(s):  
Aysen Boza ◽  
Selim Misirlioglu ◽  
Cagatay Taskiran ◽  
Bulent Urman
Keyword(s):  
Hospital Stay ◽  
Hospital Costs ◽  
Final Analysis ◽  
Perioperative Outcomes ◽  
Retrieval Time ◽  
Operative Outcomes ◽  
Specimen Retrieval ◽  
Estimated Blood Loss ◽  
Power Morcellation ◽  
Time Required

Objective. To evaluate clinical and operative outcomes of transvaginal extraction (TVE) and contained power morcellation (CPM) for myoma retrieval after laparoscopic myomectomy. Materials and Methods. Prospective data from 35 consecutive cases using CPM were compared with retrospective data of all cases using TVE from December 2014 to January 2017. Patients were matched 1:1 based on myoma diameter. A total of 62 women were included in the final analysis. Specimen retrieval was performed using the TVE or CPM within an insufflated isolation bag. Results. Age, body mass index, mode of prior obstetric delivery, history of previous abdominal surgery, indication for myomectomy, and the myoma(s) characteristics were similar between groups. Retrieval time was significantly shorter in the TVE group compared with the CPM group: 10 minutes (3-15 minutes) versus 17 minutes (14-42 minutes); P < .001. Time required for placement of the instruments was 9.7 minutes for the isolation bag and 0.5 minutes for the vaginal extractor. Additional analgesic administration for pain relief was necessary in 13 patients (42%) in the TVE group and 23 patients (72%) in the CPM group ( P = .01). Total cost of the hospital stay was significantly higher in the CPM group compared with the TVE group ( P < .001). Estimated blood loss and duration of hospital stay were similar between groups. Conclusion. Both CPM and TVE can be used for safe retrieval of large myomas that are removed laparoscopically. Compared with CPM, TVE was associated with a shorter retrieval time, less postoperative pain, and less hospital costs.

scholarly journals Absence of age and gender effects on the pharmacokinetics of a single 500-milligram oral dose of levofloxacin in healthy subjects.

1997 ◽  
Vol 41 (7) ◽  
pp. 1562-1565 ◽  
Author(s):  
S C Chien ◽  
A T Chow ◽  
J Natarajan ◽  
R R Williams ◽  
F A Wong ◽  
...  
Keyword(s):  
Renal Function ◽  
Healthy Subjects ◽  
Age Groups ◽  
The Elderly ◽  
Gender Effects ◽  
Pharmacokinetic Parameters ◽  
Age And Gender ◽  
Male And Female ◽  
Young Males ◽  
And Gender

The influence of age and gender on the pharmacokinetics of levofloxacin in healthy subjects receiving a single oral 500-mg dose of levofloxacin was investigated in this parallel design study. Six young males (aged 18 to 40 years), six elderly males (aged > or = 65 years), six young females (aged 18 to 40 years), and six elderly females (aged > or = 65 years) were enrolled and completed the study. The study reveals that the bioavailability (rate and extent) of levofloxacin was not affected by either age or gender. In both age (young and elderly) and gender (male and female) groups of subjects, peak concentrations in plasma were reached at approximately 1.5 h after dosing; renal clearance of levofloxacin accounted for approximately 77% of total body clearance, and approximately 76% of the administered dose was recovered unchanged in urine over the 36 h of collection. The apparent differences in the calculated pharmacokinetic parameters for levofloxacin between the age groups (young versus elderly) and between the gender groups (males versus females) could be explained by differences in renal function among the subjects. A single dose of 500 mg of levofloxacin administered orally to both young and old, male and female healthy subjects was found to be safe and well tolerated. As the differences in levofloxacin kinetics between the young and the elderly or the males and the females are limited and are mainly related to the renal function of the subjects, dose adjustment based on age or gender alone is not necessary.

The Self-Retaining Barbed Suture for Parenchymal Repair in Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 26 (6) ◽  
pp. 744-752
Author(s):  
Hailun Zhan ◽  
Chunping Huang ◽  
Tengcheng Li ◽  
Fei Yang ◽  
Jiarong Cai ◽  
...  
Keyword(s):  
Renal Function ◽  
Blood Loss ◽  
Hospital Stay ◽  
Partial Nephrectomy ◽  
Operative Time ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
The Self ◽  
Barbed Suture ◽  
Estimated Blood Loss

Objectives. The warm ischemia time (WIT) is key to successful laparoscopic partial nephrectomy (LPN). The aim of this study was to perform a meta-analysis comparing the self-retaining barbed suture (SRBS) with a non-SRBS for parenchymal repair during LPN. Methods. A systematic search of PubMed, Scopus, and the Cochrane Library was performed up to March 2018. Inclusion criteria for this study were randomized controlled trials (RCTs) and observational comparative studies assessing the SRBS and non-SRBS for parenchymal repair during LPN. Outcomes of interest included WIT, complications, overall operative time, estimated blood loss, length of hospital stay, and change of renal function. Results. One RCT and 7 retrospective studies were identified, which included a total of 461 cases. Compared with the non-SRBS, use of the SRBS for parenchymal repair during LPN was associated with shorter WIT ( P < .00001), shorter overall operative time ( P < .00001), lower estimated blood loss ( P = .02), and better renal function preservation ( P = .001). There was no significant difference between the SRBS and non-SRBS with regard to complications ( P = .08) and length of hospital stay ( P = .25). Conclusions. The SRBS for parenchymal repair during LPN can significantly shorten the WIT and overall operative time, decrease blood loss, and preserve renal function.

A Comprehensive Comparison of Guy’s Stone Score, CROES Nomogram, S.T.O.N.E. Nephrolithometry, and the Seoul Renal Stone Complexity Scoring System in Predicting Perioperative Outcomes after Percutaneous Nephrolithotomy

2020 ◽  
Vol 103 (8) ◽  
pp. 762-766
Keyword(s):  
Free Group ◽  
Percutaneous Nephrolithotomy ◽  
Kidney Stones ◽  
Scoring System ◽  
Renal Stone ◽  
Length Of Hospital Stay ◽  
Scoring Systems ◽  
Postoperative Outcomes ◽  
Perioperative Outcomes ◽  
National University

Background: Various nephrolithometry scoring systems (NSS) are proposed to determine the structural configuration of kidney stones. Nevertheless, evidence of the comparison among these scoring systems in anticipating postoperative outcomes after percutaneous nephrolithotomy (PCNL) are limited. Objective: To compare the correlation of four NSS with stone-free rates and perioperative results following PCNL. Materials and Methods: The authors examined a retrospective study of patients with kidney stones who received PCNL. One hundred seventy-two patients admitted for surgery at Ramathibodi Hospital were assessed. Four NSS were compared, Guy’s Stone Score (GSS), the Clinical Research Office of the Endourological Society nephrolithometric nomogram (CROES), S.T.O.N.E. Nephrolithometry (STONE), and the Seoul National University Renal Stone Complexity (S-ReSC) scoring system. The authors evaluated the correlations between these four scoring systems with stone-free rates and postoperative outcomes. Results: The stone-free status was 53.5%. There were significant differences in the mean scores of the four systems between the stone-free group and the not stone-free group (1.97 versus 3.70, p<0.05 in GSS; 242.40 versus 159.28, p<0.05 in CROES; 6.64 versus 9.08, p<0.05 in STONE; and 3.44 versus 8.41, p<0.05 in S-ReSC). Multivariate analysis revealed only S-ReSC as independent preoperative factors for PCNL success (p<0.001). Moreover, each scale had a significant correlation with blood loss, length of hospital stay, and operative time. Three scoring systems, all except STONE, were significantly associated with percentage change in estimated glomerular filtration rates (eGFR). There was no significant association among all four scoring systems with postoperative complications. Conclusion: All four NSS represent excellent predictors for stone-free rates and correlate well with surgical outcomes. Keywords: GSS, CROES, STONE, S-ReSC, Percutaneous nephrolithotomy

scholarly journals Influence of gender, age and renal function on plasma adiponectin level: the Tanno and Sobetsu study

2005 ◽  
Vol 153 (1) ◽  
pp. 91-98 ◽  
Author(s):  
Takeshi Isobe ◽  
Shigeyuki Saitoh ◽  
Satoru Takagi ◽  
Hiroshi Takeuchi ◽  
Yu Chiba ◽  
...  
Keyword(s):  
Renal Function ◽  
Sex Hormones ◽  
Adiponectin Level ◽  
Age Groups ◽  
Free Testosterone ◽  
The Elderly ◽  
Plasma Adiponectin Level ◽  
Significant Independent Variable ◽  
Independent Variable ◽  
Estradiol Levels

Design: The aim of this study was to determine the association between aging and adiponectin level from the aspect of the influence of renal function and sex hormones in humans. Methods: Serum adiponectin and blood urea nitrogen (BUN) levels were measured in 964 subjects (372 males) aged 60.3±12.5 years. Testosterone and free testosterone levels were measured in 123 males, and estrone and estradiol levels were measured in 114 females. The subjects were divided into two age groups; 65 years of age or older (Age ≥65 group) and less than 65 years of age (Age <65 group). Results: Adiponectin level increased linearly with aging in males, whereas it increased dramatically in females until their 50s. The patterns of changes in adiponectin were similar to those in BUN. In multiple- regression analysis using adiponectin as a dependent variable BUN was selected as a significant independent variable in all subjects and in subjects in the Age ≥65 group, whereas bioactive sex hormones were not selected. Conclusions: A decrease in adiponectin clearance in the kidney may be the cause of high levels of adiponectin in the elderly. Adiponectin level seems to be influenced more strongly by BUN than by sex hormones and to be increased by a decline in renal function with aging.

Robotic Minor hepatectomy offers a Favorable Learning Curve and May Result in Superior Perioperative Outcomes Compared with Laparoscopic Approach

2017 ◽  
Vol 83 (10) ◽  
pp. 1085-1088 ◽  
Author(s):  
Victoriav O'Connor ◽  
Brooke Vuong ◽  
Su-Tau Yang ◽  
Andrew Difronzo
Keyword(s):  
Complication Rate ◽  
Laparoscopic Approach ◽  
Length Of Hospital Stay ◽  
Perioperative Outcomes ◽  
Robotic Assisted ◽  
Estimated Blood Loss ◽  
Specimen Volume ◽  
Grade 3 ◽  
American Society ◽  
American Society Of Anesthesiologists

Minorhepatectomy (MH) is a common type of robotic-assisted liver resection, but few studies compared it with laparoscopic. We compared the perioperative outcomes of patients who underwent robotic (RH) or laparoscopic (LH) minor hepatectomy and evaluated the effect of surgeon's experience on outcomes. A prospective database was used to identify patients from 2009 through 2016 who underwent RH or LH. Two surgeons performed RH starting in 2014, whereas LH had been established before that. Of the 93 patients, 42 were in RH and 51 in LH group. The mean patient age, gender, race, American Society of Anesthesiologists score, proportion of patients with cirrhosis and hepatocellular carcinoma were similar. Operative time, estimated blood loss (EBL), conversion to open, 30-day complication rate, Clavien–Dindo grade ≥ 3 complications, and length of hospital stay (LOS) were similar. There was no difference in average tumor size, specimen volume, or achievement of R0 margin. In RH group, after completing 15 cases, there were no conversions to open. After 25 cases, EBL, LOS, and 30-day complication rate were improved as compared with LH. Perioperative outcomes of robotic MH are equivalent to laparoscopic. After approximately 25 cases, robotic-assisted MH may result in superior outcomes compared with laparoscopic.

scholarly journals P0223AGING CHANGES OF RENAL FUNCTION AND EVALUATION OF DIFFERENT GLOMERULAR FILTRATION RATE ESTIMATION EQUATIONS IN HEALTH PEOPLE IN BEIJING

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Lengnan Xu ◽  
Yonghui Mao ◽  
Aiqun Chen ◽  
Ban Zhao
Keyword(s):  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Age Groups ◽  
The Elderly ◽  
The Body ◽  
True Value ◽  
Age Related

Abstract Background and Aims The kidney is an important organ that removes metabolites and certain wastes and poisons from the body, and retains water and other useful substances through reabsorption. Its aging and function decline have a significant impact on the human health.Rather than simply depending on serum creatinine, glomerular filtration rate (GFR) assessment equation should be given priority in evaluating renal function. Different evaluated GFR (eGFR) equations sometimes have great differences in assessing the true value of GFR, especially for the elderly. The purpose of this study was to analyze the aging changes of renal function in normal people in Beijing and to compare the significance of different eGFR equations in evaluating renal function in Chinese population. Method The age, sex and serum creatinine were recorded in the population who underwent routine physical examination in our hospital from January 2012 to December 2014. Kidney function was assessed by CKD-EPI, MDRD, MDRDc, FAS and BIS equations, respectively. Results A total of 46 713 persons were enrolled in this study, of whom 27 249 (58.33%) were males. They were followed up for 3 years, ranging in age from 16 to 100 years. Both men and women showed age-related change in serum creatinine: serum creatinine and its standard deviation gradually increases parallel with age, indicating that the range of serum creatinine changes in the elderly was larger. Whether male or female, there were differences in eGFR change between different age groups (male: Χ2=141.28, P=0.000; female: Χ2=97.55, P=0.000). For male, eGFR decreased more in the elderly, and it was more common for young people to keep the eGFR constant or increase. However, in female, eGFR remained unchanged in most old people, and increased or decreased in the majority of the young. For all age groups, the ICC was very consistent among the equations, 0.849 for males and 0.817 for females. The whole population was divided into three groups according to serum creatinine &lt; 1mg/dL, &gt; 1mg/dL and &lt; 1.5mg/dL, &gt; 1.5mg/dL. The CKD-EPI equation gave higher stages of CKD than other equations. There was no clear age-related change trend in the 3-year average eGFR change rate of all age groups. For the elderly over 70 years of age, the MDRD and MDRDc equations had higher GFR evaluation results than the other three equations. The BIS equation had the lowest results of all equations. The ICC was very consistent among the equations, 0.966 for males and 0.957 for females. Conclusion we believed that the annual change of GFR varied from person to person and had little to do with age. GFR needed to be calculated more accurately in order to formulate corresponding medical strategies. Those eGFR equations the above-mentioned can be used to evaluate renal function, but the results were very different for different populations and serum creatinine levels. The use of different eGFR equations may lead to large differences in drug dose adjustment and the risk of serious adverse reactions. For the elderly in China, which equation was more suitable was inconclusive and further research was urgently needed.

scholarly journals Simple prostatectomy using the open and robotic approaches for lower urinary tract symptoms: A retrospective, case-control series

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Dor Golomb ◽  
Fernanda Gabrigna Berto ◽  
Jennifer Bjazevic ◽  
Jose A. Gomez ◽  
Joseph L.K. Chin ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Functional Results ◽  
Perioperative Outcomes ◽  
Minimal Risk ◽  
Complication Rates ◽  
Control Series ◽  
Estimated Blood Loss ◽  
Simple Prostatectomy

Introduction: We aimed to assess the outcome of our series of simple prostatectomy using the open simple prostatectomy (OSP) and robotic-assisted simple prostatectomy (RASP) approaches, at our institution. Methods: A retrospective chart review of men who underwent OSP and RASP at Western University, in London, ON. Preoperative, intraoperative, and postoperative data were collected and analyzed. Results: From 2012–2020, 29 men underwent a simple prostatectomy at our institution. Eight patients underwent an OSP and 21 patients underwent a RASP. The median age was 69 years. Preoperative median prostate volume was 153 cm3 (range 80–432 cm3). The surgical indications were failed medical treatment, urinary retention, hydronephrosis, cystolithiasis, and recurrent hematuria. The median operative time was 137.5 minutes in OSP and 185 minutes in the robotic approach (p=0.04). Median estimated blood loss was 2300 ml (range 600–4000 ml) and 100 ml (range 50–400 ml) in the open and robotic procedures, respectively (p=0.4). The mean length of hospital stay was shorter in the RASP group, one day vs. three days (z=4.152, p<0.005). Perioperative complication rates were significantly lower in the group undergoing RASP, with no complications recorded in this group (p=0.004). Both groups demonstrated excellent functional results, with most patients reporting complete urinary continence (p=0.8). Conclusions: We report very good perioperative outcomes, with a minimal risk profile and excellent functional results, leading to marked improvement in patients' symptoms at followup after both the OSP and RASP approaches. RASP was associated with a shorter length of hospital stay, decreased blood loss, and a lower complication rate.

scholarly journals Early Robotic-Assisted Laparoscopic Pyeloplasty for Infants Under 3 Months With Severe Ureteropelvic Junction Obstruction

2021 ◽  
Vol 9 ◽  
Author(s):  
Pin Li ◽  
Huixia Zhou ◽  
Hualin Cao ◽  
Tao Guo ◽  
Weiwei Zhu ◽  
...  
Keyword(s):  
Renal Function ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Solitary Kidney ◽  
Laparoscopic Pyeloplasty ◽  
Renal Hypoplasia ◽  
Robotic Assisted ◽  
Estimated Blood Loss ◽  
Feasible Option ◽  
The Mean

Objective: To present our primary experience of robotic-assisted laparoscopic pyeloplasty (RALP) for severe ureteropelvis junction obstruction (UPJO) infants under 3 months.Methods: We performed a retrospective study of 9 infants under 3 months who underwent RALP for severe UPJO between April 2017 and March 2019 in our center. The severe UPJO was defined as infants with severe hydronephrosis (Society of Fetal Urology grades III or IV, anteroposterior diameter &gt;3 cm or split renal function &lt;40% or T 1/2 &gt;20 min) involving bilateral, solitary kidney, or contralateral renal hypoplasia UPJO at the same time. All clinical, perioperative, and postoperative information was collected.Results: There were four bilateral UPJO cases, two solitary kidney UPJO cases and three unilateral UPJO with contralateral renal hypoplasia cases included. One single surgeon performed RALP on all of the infants. The mean age of the infants was 1.62 ± 0.54 months. The mean operative time was 109.55 ± 10.47 min. The mean estimated blood loss was 19.29 ± 3.19 ml, and the mean length of hospital stay was 5.57 ± 0.73 days. According to the ultrasonography results, all patients had a significant recovery of renal function at 12 months after the operation.Conclusions: To maximize the protection of renal function, early RALP is a safe and feasible option for the treatment of severe UPJO in infants under 3 months.

Treatment of Acute Appendicitis in Geriatric Patients – Literature Review

2016 ◽  
Vol 88 (3) ◽  
Author(s):  
Anna Kot ◽  
Jakub Kenig ◽  
Piotr Wałęga
Keyword(s):  
Acute Appendicitis ◽  
Antibiotic Therapy ◽  
Laparoscopic Appendectomy ◽  
Age Groups ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
Independent Method ◽  
Number Of Patients ◽  
Pubmed Database ◽  
American Society

AbstractDemographic changes associated with the aging population mean that surgeons increasingly have contact and make decisions about treating patients from the oldest age groups.The aim of the study was to review the literature concerning the treatment of acute appendicitis in patients over the age of 60 years old.Material and methods. A review of the literature published in the years 2000-2015 has been carried out using the PubMed database. The initial number of results corresponding to the query in English, „appendicitis (MeSH) AND elderly (MeSH)” was 260. Selection based on the titles, abstracts, and eventually whole articles, ultimately resulted in 11 papers concerning the treatment of appendicitis in patients above 60 years of age.Results. Nine papers were retrospective and 2 were prospective. In total, the studies included 82,852 patients. Laparoscopic appendectomy was associated with a lower mortality rate, a smaller number of postoperative complications and a shorter length of hospital stay, which led to it being recommended by most authors. Four of the ten papers demonstrated that the patients who were qualified for laparoscopic surgery had less comorbidity and were in a lower ASA (American Society of Anaesthesiology) category. Antibiotic therapy as an independent method was assessed in one study in a group of elderly people, on a selected group of 26 patients, and its effectiveness was shown to be 70%. Most studies, however, are highly heterogeneous which significantly hindered comparisons.Conclusions. Currently, laparoscopic appendectomy seems to be the treatment of choice in the elderly with acute appendicitis. Antibiotic therapy, as an independent method of treatment of acute appendicitis, cannot currently be recommended. However, further, prospective, and better-designed studies are needed, involving a larger number of patients, and primarily dedicated to the elderly.

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