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Tamalvanan V, Rajandram R, Kuppusamy S. Reduction of pre-procedural anxiety for repeat sessions in extracorporeal shockwave lithotripsy (ESWL) reduces pain intensity: A prospective observational study. Medicine (Baltimore) 2022; 101:e30425. [PMID: 36123909 PMCID: PMC9478226 DOI: 10.1097/md.0000000000030425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Pain control is a major determinant for successful stone clearance in extracorporeal shockwave lithotripsy (ESWL) for urolithiasis. Pain perception during ESWL may be influenced by patient factors like gender, age, body habitus and anxiety level, and stone related factors like size, laterality and location of stone. We investigated in general, the confounding patient and stone factors influencing pain perception during ESWL with importance given to procedural anxiety in first and the subsequent session of ESWL. This was a prospective observational study of all new consecutive patients who underwent ESWL for a period of 1 year at a tertiary Urological Centre. Demographic and stone anthropometry were analyzed. Pre-procedural anxiety was assessed prior to procedure using hospital anxiety and depression score (HADS) and pain was scored using numerical rating scale-11 at baseline, 30-minutes (i.e., during) and 24 hours after ESWL. Univariate and multivariate analysis for confounding factors included HADs were performed for pain perception. A P value < .05 was considered to be statistically significant. For the study duration, 119 patients were recruited and 72 of them returned for a second session. Procedural anxiety was the only independent factor affecting pain score in ESWL for the first session in multivariate analysis. A statistically significant reduction of mean procedural anxiety score from 6.7 ± 4.5 to 3.2 ± 2.7 (P < .05) for the second ESWL session was observed (n = 72). This was in conjunction with statistical reduction of mean pain score 30 minutes after ESWL from 5.2 ± 2.1 to 4.2 ± 2.1 (P < .05). Patients with HADS ≥ 8 had statistically significant higher mean pain score at all 3 intervals in the first ESWL session. This study has shown that pre-procedural anxiety mainly anticipatory, reduces and shows reduction in pain intensity among patients undergoing repeat ESWL. Hence, anxiety reducing methods should be explored in patients undergoing ESWL to avoid unnecessary analgesic use.
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Affiliation(s)
- Vethunan Tamalvanan
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Retnagowri Rajandram
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shanggar Kuppusamy
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Division of Urology, Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
- * Correspondence: Shanggar Kuppusamy, Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia (e-mail: )
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Jain K, Blachman-Braun R, Jain E, Eng A, Peters B, Patel P. Ureteroscopy under conscious sedation: A proof-of-concept study. Can Urol Assoc J 2022; 16:E461-E467. [PMID: 35426786 PMCID: PMC9484746 DOI: 10.5489/cuaj.7750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Ureteroscopy (URS) is commonly performed under general anesthesia (GA) to maximize patient tolerability and minimize surgical complications; however, given the improvements in endoscopic technology and risks associated with GA, alternate forms of anesthesia have been postulated. We aimed to evaluate the outcomes of URS under conscious sedation. METHODS We completed a retrospective cohort study from November 2019 to June 2020 at a tertiary-level hospital. All URSs that were performed under urologist-directed conscious sedation were included. Our primary outcome was the ability to complete URS, defined as success rate. Secondary outcomes included: stone-free rate, intraoperative complication rate, hospital admission rate, and sedation requirement. Univariate- and multivariate-adjusted logistic regression analyses were employed. RESULTS Ninety-nine URSs were included. Most (73/99, 73.7%) were performed for urolithiasis. The overall success rate was 83.8% (83/99), with 81.0% (34/42) intra-renal and 70.0% (16/23) proximal ureter success rates. The stone-free rate was 80.8% (59/73). No intraoperative complications nor hospital admissions were reported. The mean amount of sedation required was 3 mg (interquartile range [IQR] 2-4] of midazolam and 100 μg (100-150) of fentanyl. On multivariate analysis, midazolam was significantly associated with increased success (odds ratio 2.496, 95% confidence interval 1.057-5.892, p=0.037). CONCLUSIONS We have shown that proximal and intrarenal URS under conscious sedation is safe and effective. We were limited by our lack of followup, small sample size, selection bias to chose healthy patients, and lack of patient tolerability data. Patients and healthcare systems may benefit from implementing this innovation more broadly.
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Affiliation(s)
- Kunal Jain
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | | | - Esha Jain
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Amanda Eng
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Brian Peters
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Premal Patel
- Section of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
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Bosquet E, Peyronnet B, Mathieu R, Khene ZE, Pradere B, Manunta A, Vincendeau S, Guille F, Bensalah K, Verhoest G. [Safety and feasibility of outpatient flexible ureteroscopy for urinary stones: A retrospective single-center study]. Prog Urol 2017; 27:1043-1049. [PMID: 28869170 DOI: 10.1016/j.purol.2017.07.246] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 06/16/2017] [Accepted: 07/22/2017] [Indexed: 12/23/2022]
Abstract
AIM Management of urolithiasis has changed over the past decades. Outpatient surgery has become a major issue for healthcare systems. The aim of this study was to assess the feasibility of outpatient flexible ureteroscopy. METHODS A single-center retrospective study has been conducted including all patients who underwent an outpatient flexible ureteroscopy between January 2012 and December 2013. Failure of outpatient management was defined as length of hospital stay>12 hours or readmission within 48 hours after discharge. Univariate analysis was performed to seek for predictors of failure of outpatient management. RESULTS One hundred and fifty-seven patients who underwent a total of 174 procedures were included. They were mostly men (57.5 %), with a mean body mass index of 25.2kg/m2 (±4.3). The stones were mostly unique (64.3 %), with a mean size of 14.2mm (±11.2). Eighty patients had a double J stent preoperatively (46.5 %), and mean operative time was 64.2 minutes (±34.1). An ureteral access sheath was used in 39 procedures (22.4 %). A double J stent was left postoperatively in 103 patients (59.1 %). In total, 165 procedures (94.8 %) were performed successfully as outpatient surgery. On postoperative imaging, the stone-free rate was 69.5 %. Postoperative complications occurred in 3.4 % of cases and were mostly minor (i.e. Clavien 1-2; 83.3 %). Predictive factors of failed outpatient management were male gender (P=0.04), BMI (P=0.03), and anticoagulants intake (P=0.003). CONCLUSION Outpatient flexible ureteroscopy for urinary stones is feasible and its low failure and complications rate may allow a wider spread of its use. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- E Bosquet
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| | - B Peyronnet
- Service d'urologie, CHU de Rennes, 35000 Rennes, France.
| | - R Mathieu
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| | - Z-E Khene
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| | - B Pradere
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| | - A Manunta
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| | - S Vincendeau
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| | - F Guille
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| | - K Bensalah
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
| | - G Verhoest
- Service d'urologie, CHU de Rennes, 35000 Rennes, France
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Oitchayomi A, Doerfler A, Le Gal S, Chawhan C, Tillou X. Flexible and rigid ureteroscopy in outpatient surgery. BMC Urol 2016; 16:6. [PMID: 26822017 PMCID: PMC4731933 DOI: 10.1186/s12894-016-0124-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 01/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Outpatient surgery is critical to improve health care costs. The aim of the study was to prospectively evaluate the results of outpatient treatment of upper tract urinary stones by rigid or flexible ureteroscopy in a routine care setting. METHODS A database was created at the creation of the outpatient surgery department. 87 patients underwent 100 ureteroscopic procedures for urinary lithiasis from June 2013 to March 2015. RESULTS Most of our patients were male with 53 men (sex ratio M/F 1.13), with a mean age of 52.9 ± 15 years old (23.4-82.4). 44 % of ureteroscopies performed were flexible ureteroscopies, 31 % rigid ureteroscopies and 25 % associated rigid and flexible ureteroscopies. The average stone load was 10.1 ± 5.7 mm (2-30) The mean operating time was 58.3 ± 21.1 min (20-150). 82.9 % of patients had a single urinary stone and 17.1 % (n = 14) had 2 or more. 114 stones were treated, 57,1 % intrarenal. There were 6 (6 %) postoperative complications: three Clavien stage 2 infections; three Clavien stage 3b complications (two renal colics requiring ureteral stenting 48 h after discharge and 1 symptomatic perirenal urinoma 48 h after discharge). There was one intraoperative complication (1 %): a ureteral wound with contrast leakage. The rate of transfer to conventional hospitalization was 2.2 %. Stone size influenced the stone-free status (p < 0.0001) and the need for more than one session. There was a significant correlation between operative time and stone size above 10 mm (p < 0.0001). CONCLUSIONS Flexible and rigid ureteroscopy are safe and efficient procedures for upper urinary tract stones and can be carried out in an outpatient department. Stone size had an impact on postoperative stone-free status and operative time.
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Affiliation(s)
- Abeni Oitchayomi
- Urology and Transplantation Department, University Hospital of Caen, CHU Cote de Nacre, Avenue de Cote de Nacre, 14033, Caen, France
| | - Arnaud Doerfler
- Urology and Transplantation Department, University Hospital of Caen, CHU Cote de Nacre, Avenue de Cote de Nacre, 14033, Caen, France
| | - Sophie Le Gal
- Urology and Transplantation Department, University Hospital of Caen, CHU Cote de Nacre, Avenue de Cote de Nacre, 14033, Caen, France
| | - Charles Chawhan
- Urology and Transplantation Department, University Hospital of Caen, CHU Cote de Nacre, Avenue de Cote de Nacre, 14033, Caen, France
| | - Xavier Tillou
- Urology and Transplantation Department, University Hospital of Caen, CHU Cote de Nacre, Avenue de Cote de Nacre, 14033, Caen, France.
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Ktari K, Saidi R, Mahjoub M, Hamdouni W, Macherki S, Ben khalifa B, Hellara W, Saad H. Quels sont les facteurs prédictifs de la douleur lors du traitement des calculs rénaux par lithotritie extracorporelle ? Prog Urol 2015; 25:698-704. [DOI: 10.1016/j.purol.2015.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/18/2015] [Accepted: 07/24/2015] [Indexed: 11/26/2022]
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Kirkegård J, Ryhammer AM, Larsen UT, Borre M. Outpatient endoscopic treatment of ureteric stones: Five years’ experience in a self-contained outpatient surgery unit. Scand J Urol 2015; 49:395-9. [DOI: 10.3109/21681805.2015.1011688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Schoenig A, Vedrine N, Costilles T, Boiteux JP, Guy L. [Pain evaluation during extracorporeal lithotropsy]. Prog Urol 2014; 24:777-82. [PMID: 25193790 DOI: 10.1016/j.purol.2014.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 04/18/2014] [Accepted: 06/15/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to demonstrate the feasibility of extracorporeal lithotripsy using lithotripter Sortz MODULITH SLK(®) without analgesics. MATERIALS AND METHODS An anonymous self-administered questionnaire was sent to 854 patients post-shock wave lithotripsy for urinary lithiasis. No patient had pain medication. The questionnaire included seven questions to assess the pain symptoms due to treatment. After 15 days, a reminder letter was sent. RESULTS The response rate was 69% (591/854). The extracorporeal lithotripsy without analgesic treatment was generally well tolerated. About 70% of patients felt just a few or no pain and average pain assessment was 3.6/10 on VAS. The pain was often considered to be multifactorial, related to the treatment itself, the duration of the session and the position on the table. Anxiety seemed to play an equally important role in pain relief with an average VAS 4.5 against 2.9 for non-anxious patients. If a new session of extracorporeal lithotripsy was necessary, 53% of patients would require no pain medication. CONCLUSIONS The extracorporeal lithotripsy could easily be done without systematic analgesics allowing for outpatient care. In contrast, anxiety seemed to be an important predictor of poor tolerance of sessions so the idea of a prophylactic anxiolytic treatment based on psychological profile of the patient should allow less aggressive and less costly management of urolithiasis.
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Affiliation(s)
- A Schoenig
- Service d'urologie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 58, rue Montalemberg, 63000 Clermont-Ferrand, France.
| | - N Vedrine
- Service d'urologie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 58, rue Montalemberg, 63000 Clermont-Ferrand, France
| | - T Costilles
- Service d'urologie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 58, rue Montalemberg, 63000 Clermont-Ferrand, France
| | - J-P Boiteux
- Service d'urologie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 58, rue Montalemberg, 63000 Clermont-Ferrand, France
| | - L Guy
- Service d'urologie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, 58, rue Montalemberg, 63000 Clermont-Ferrand, France
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Mimić A, Denčić N, Jovičić J, Mirković J, Durutović O, Milenković-Petronić D, Lađević N. Pre-emptive tramadol could reduce pain after ureteroscopic lithotripsy. Yonsei Med J 2014; 55:1436-41. [PMID: 25048508 PMCID: PMC4108835 DOI: 10.3349/ymj.2014.55.5.1436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Optimal analgesia in ambulatory urology patients still remains a challenge. The aim of this study was to examine if the pre-emptive use of intravenous tramadol can reduce pain after ureteroscopic lithotripsy in patients diagnosed with unilateral ureteral stones. MATERIALS AND METHODS This prospective pilot cohort study included 74 patients diagnosed with unilateral ureteral stones who underwent ureteroscopic lithotripsy under general anesthesia in the Urology Clinic at the Clinical Center of Serbia from March to June 2012. All patients were randomly allocated to two groups: one group (38 patients) received intravenous infusion of tramadol 100 mg in 500 mL 0.9%NaCl one hour before the procedure, while the other group (36 patients) received 500 mL 0.9%NaCl at the same time. Visual analogue scale (VAS) scores were recorded once prior to surgery and two times after the surgery (1 h and 6 h, respectively). The patients were prescribed additional postoperative analgesia (diclofenac 75 mg i.m.) when required. Pre-emptive effects of tramadol were assessed measuring pain scores, VAS1 and VAS2, intraoperative fentanyl consumption, and postoperative analgesic requirement. RESULTS The average VAS1 score in the tramadol group was significantly lower than that in the non-tramadol group. The difference in average VAS2 score values between the two groups was not statistically significant; however, there were more patients who experienced severe pain in the non-tramadol group (p<0.01). The number of patients that required postoperative analgesia was not statistically different between the groups. CONCLUSION Pre-emptive tramadol did reduce early postoperative pain. The patients who received pre-emptive tramadol were less likely to experience severe post-operative pain.
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Affiliation(s)
- Ana Mimić
- Clinical Center of Serbia, Urology Clinic, Department of Anesthesia, Belgrade, Serbia.
| | - Nataša Denčić
- Clinical Center of Serbia, Urology Clinic, Department of Anesthesia, Belgrade, Serbia
| | - Jelena Jovičić
- Clinical Center of Serbia, Urology Clinic, Department of Anesthesia, Belgrade, Serbia
| | - Jelena Mirković
- Clinical Center of Serbia, Urology Clinic, Department of Anesthesia, Belgrade, Serbia
| | - Otaš Durutović
- Clinical Center of Serbia, Urology Clinic, Department of Urology, Belgrade, Serbia. ; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragica Milenković-Petronić
- Clinical Center of Serbia, Urology Clinic, Department of Urology, Belgrade, Serbia. ; School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nebojša Lađević
- Clinical Center of Serbia, Urology Clinic, Department of Anesthesia, Belgrade, Serbia. ; School of Medicine, University of Belgrade, Belgrade, Serbia
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De S, Monga M, Knudsen B. Office-based stone management. Urol Clin North Am 2013; 40:481-95. [PMID: 24182971 DOI: 10.1016/j.ucl.2013.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
As hospital resources are becoming strained, ambulatory surgical centers and day hospitals are being increasingly utilized. For the urologist, a working knowledge of local anesthetics and conscious sedation protocols are important, as many surgical kidney-stone procedures can be performed without general anesthetic. With any anesthesia, the key goal is to maximize patient comfort while minimizing respiratory depression and avoiding prolonged sedation. When using these medications, a working knowledge of emergency reversal, ventilation (bag mask/laryngeal mask airway/intubation), and cardiopulmonary resuscitation is recommended.
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Affiliation(s)
- Shubha De
- Endourology, The Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH 44195, USA
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Gershman B, Eisner BH, Sheth S, Sacco DE. Ureteral Stenting and Retrograde Pyelography in the Office: Clinical Outcomes, Cost Effectiveness, and Time Savings. J Endourol 2013; 27:662-6. [DOI: 10.1089/end.2012.0644] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Boris Gershman
- Department of Urology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Brian H. Eisner
- Department of Urology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Sonali Sheth
- Department of Urology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
| | - Dianne E. Sacco
- Department of Urology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
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Park HK, Lee HW, Lee KS, Choi JS, Jeong BC, Kim HH. Preventive effects of COX-2 inhibitor, celecoxib on renal tubular injury induced by shock wave lithotriptor. ACTA ACUST UNITED AC 2009; 38:223-8. [PMID: 19949782 DOI: 10.1007/s00240-009-0243-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 11/11/2009] [Indexed: 11/26/2022]
Abstract
Our study was designed to investigate the protective effect of the COX-2 inhibitor, celecoxib, on renal tubules against shock wave lithotripsy (SWL). Sprague-Dawley rats were randomly divided into three groups: sham, control, and COX-2 groups. The control group was administrated normal saline. The COX-2 group was administered celecoxib (10 mg/kg). After administration for 1 week, the control and COX-2 groups received 1,000 shock waves. Before and after SWL, 24-h urine was collected. CCr was measured to assess renal function. To determine the renal tubular injury, N-acetyl glucosaminidase (NAG) and beta-2 microglobulin levels in urine were quantified. The COX-2 gene expression was compared between the three groups. Prior to SWL, all groups had similar levels of NAG and beta-2 microglobulin. After SWL, all groups showed similar CCr. Compared with the sham group, control and COX-2 groups produced increase of NAG and beta-2 microglobulin excretion. However, NAG and beta-2 microglobulin excretions were significantly lower in the COX-2 group than control group. The COX-2 gene expression did not increase in the sham group. However, the COX-2 gene expression was significantly increased in the control group, which was prevented by celecoxib in COX-2 group. Biochemical findings supported a renal protective effect of celecoxib on SWL. This study suggests that celecoxib would be useful prior and after SWL because of renal protective effects.
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Affiliation(s)
- Hyoung Keun Park
- Department of Urology, College of Medicine, KonkukUniversity, Chungju, Korea
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Livadas KE, Varkarakis IM, Skolarikos A, Karagiotis E, Alivizatos G, Sofras F, Deliveliotis C, Bissas A. Ureteroscopic removal of mildly migrated stents using local anesthesia only. J Urol 2007; 178:1998-2001. [PMID: 17869304 DOI: 10.1016/j.juro.2007.07.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2007] [Indexed: 11/29/2022]
Abstract
PURPOSE In the outpatient office setting we evaluated the feasibility and efficacy of ureteroscopic removal of upward migrated ureteral stents using local or no anesthesia. MATERIALS AND METHODS Prospectively 37 patients with mild upward stent migration underwent ureteroscopic stent removal under local or no anesthesia. Stent migration was always below the pelvic brim. It was diagnosed by plain x-ray of the kidneys, ureters and bladder, and flexible cystoscopy. Semirigid ureteroscopy was performed in the office outpatient setting. After each procedure patients graded the discomfort and/or pain level experienced by completing 2 separate 5-scale visual analog pain scores, including 1 for flexible cystoscopy and 1 for the ureteroscopic procedure. Pain scores were compared between the 2 procedures. RESULTS Stent removal was successful in 34 of 37 patients (91.9%). Successful procedures were never interrupted due to pain intolerance. No complications occurred. The mean visual analog pain score for ureteroscopic stent removal was 1.73 and it was similar in men and women (p = 0.199). The mean visual analog pain score for flexible cystoscopy was 1.27. This procedure was significantly more painful in men than in women (p = 0.018). Ureteroscopic stent removal was more painful than flexible cystoscopy overall and in women (each p <0.01) but not in men (p = 0.3). All patients were discharged home within 1 hour after the procedure and no patient required hospital admission or a new hospital visit. CONCLUSIONS Ureteroscopic removal of a migrated stent using local anesthesia is effective, safe and tolerable in select patients. Preventing the complications and costs associated with general or spinal anesthesia makes this option appealing to patients and it should be offered when possible.
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Affiliation(s)
- Kostantinos E Livadas
- Second Department of Urology, Athens Medical School, Sismanoglio Hospital, Athens, Greece
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LiteratureWatch. July-December 2005. J Endourol 2006; 20:362-8. [PMID: 16724911 DOI: 10.1089/end.2006.20.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bibliography. Current world literature. Minimally invasive surgery in urology. Curr Opin Urol 2006; 16:112-7. [PMID: 16479214 DOI: 10.1097/01.mou.0000193398.85092.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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