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Chen H, Li X, Xiong M, Yang L, Tao Y, Wen W, Cai Z, Chen J, Yu Z, Su N, He Q, Mao X. Investigation of the application of Enhanced Recovery After Surgery (ERAS) in elderly patients undergoing surgery for kidney stones. Am J Transl Res 2024; 16:1711-1720. [PMID: 38883383 PMCID: PMC11170615 DOI: 10.62347/qoar2593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 04/29/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To investigate the efficacy and application of Enhanced Recovery After Surgery (ERAS) in elderly patients undergoing surgery for kidney stones. METHODS Clinical data of 104 elderly patients who underwent kidney stone surgery at West China Hospital, Sichuan University from January 2020 to December 2022 were retrospectively analyzed in this study. The patients were divided into two groups according to different nursing plans. Among them, 52 patients in the control group received conventional nursing, and 52 patients in the study group received ERAS mode nursing. Postoperative recovery, anxiety, complications, stress response and quality of life were compared between the two groups. RESULTS The time to recovery of postoperative rehabilitation indices in the research group was significantly shorter compared to the control group (P < 0.05). The research group also exhibited a significantly lower incidence of complications such as hematuria, abdominal pain, vomiting, chills, fever, and hypotension (all P < 0.05). Before the initiation of nursing care, there were no significant differences in the State Anxiety Inventory (SAI) and Trait Anxiety Inventory (TAI) scores between the two groups (both P > 0.05). However, after nursing care, the research group exhibited lower SAI and TAI scores compared to the control group (all P < 0.05). Similarly, there was no significant difference in the General Quality of Life Inventory-74 (GQOLI-74) scores in any dimension between the two groups before nursing care (P > 0.05), but the research group showcased higher scores in every dimension after nursing care (P < 0.05). The levels of Heme Oxygenase-1 (HO-1), Endothelin-1 (ET-1), Adrenocorticotropic Hormone (ACTH), and Cortisol (Cor) were significantly lower in the research group after nursing care (all P < 0.05). The acknowledgment and approval scores of nursing care in the research group were higher than those in the control group (P < 0.05). CONCLUSION The application of ERAS in elderly patients with kidney stones undergoing transurethral ureteral holmium laser lithotripsy is efficacious in mitigating stress reactions, enhancing quality of life and reducing perioperative anxiety, minimizing the incidence of complications, and promoting overall patient recovery.
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Affiliation(s)
- Hua Chen
- Guang'an People's Hospital Guang'an, Sichuan, China
| | - Xilin Li
- People's Hospital of Guang'an District Guang'an, Sichuan, China
| | - Ming Xiong
- Guang'an People's Hospital Guang'an, Sichuan, China
| | - Lin Yang
- Guang'an People's Hospital Guang'an, Sichuan, China
| | - Yan Tao
- Guang'an People's Hospital Guang'an, Sichuan, China
| | - Wei Wen
- Guang'an People's Hospital Guang'an, Sichuan, China
| | - Zhiju Cai
- Guang'an People's Hospital Guang'an, Sichuan, China
| | - Jing Chen
- Guang'an People's Hospital Guang'an, Sichuan, China
| | - Zhili Yu
- Guang'an People's Hospital Guang'an, Sichuan, China
| | - Na Su
- Guang'an People's Hospital Guang'an, Sichuan, China
| | - Qiying He
- West China Hospital, Sichuan University Chengdu, Sichuan, China
| | - Xiaorong Mao
- General Surgery Area, Department of Nursing, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China Chengdu, Sichuan, China
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Lyon M, Sun A, Shah A, Llarena N, Dempster C, Sivalingam S, Calle J, Gadani S, Zampini A, De S. Comparison of Radiation Exposure for Pregnant Patients Requiring Intervention for Suspected Obstructing Nephrolithiasis. Urology 2023; 182:61-66. [PMID: 37783398 DOI: 10.1016/j.urology.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/08/2023] [Accepted: 09/23/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE To identify the differences in radiation exposure per suspected stone episode between percutaneous nephrostomy tube (PCN), stent, and primary ureteroscopy (URS).The incidence of nephrolithiasis in pregnancy is low; however, repercussions for both mother and fetus can be significant. In cases of suspected obstructing nephrolithiasis, intervention may be required, including ureteral stent, PCN, or URS, with the potential for multiple subsequent procedures that often utilize fluoroscopy. METHODS Pregnant patients who required an intervention (stent, PCN, or URS) for suspected obstructing nephrolithiasis were retrospectively reviewed. The primary outcome was total fluoroscopy exposure per suspected stone episode. Secondary outcomes included fluoroscopic exposure per procedure and number of procedures required. RESULTS After excluding patients with renal anomalies and incomplete radiation data, 78 out of 100 patients were included in the analysis. Forty patients (51.3%) underwent initial stent placement, 22 (28.2%) underwent initial PCN placement, and 16 (20.5%) underwent primary URS. Total mean radiation exposure per stone episode was significantly higher in patients who underwent PCN, (286.9 mGy vs 3.7 mGy (stent) and 0.2 mGy (URS), P <.001). In addition, patients who underwent initial PCN placement had significantly more procedures (P <.001) and mean radiation exposure per procedure was higher (P <.001). More than 40% of PCNs experienced dysfunction, and mean duration between PCN exchanges was 16.5 days. CONCLUSION In pregnant patients with suspected obstructing nephrolithiasis requiring intervention, initial PCN placement was associated with a significantly higher number of procedures, radiation exposure per procedure, and total radiation exposure per suspected stone episode compared to stent and URS.
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Affiliation(s)
- Madison Lyon
- Cleveland Clinic Foundation, Glickman Urologic Institute, Cleveland, OH.
| | - Alec Sun
- Case Western Reserve University, Cleveland, OH
| | - Anup Shah
- Cleveland Clinic Foundation, Glickman Urologic Institute, Cleveland, OH
| | - Natalia Llarena
- Cleveland Clinic Foundation, Department of Obstetrics and Gynecology and Women's Health, Cleveland, OH
| | - Carrie Dempster
- Cleveland Clinic Foundation, Department of Obstetrics and Gynecology and Women's Health, Cleveland, OH
| | - Sri Sivalingam
- Cleveland Clinic Foundation, Glickman Urologic Institute, Cleveland, OH
| | - Juan Calle
- Cleveland Clinic Foundation, Glickman Urologic Institute, Cleveland, OH
| | - Sameer Gadani
- Cleveland Clinic Foundation, Department of Vascular and Interventional Radiology, Cleveland, OH
| | - Anna Zampini
- Cleveland Clinic Foundation, Glickman Urologic Institute, Cleveland, OH
| | - Smita De
- Cleveland Clinic Foundation, Glickman Urologic Institute, Cleveland, OH
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Masselli G, Bonito G, Gigli S, Ricci P. Imaging of Acute Abdominopelvic Pain in Pregnancy and Puerperium-Part II: Non-Obstetric Complications. Diagnostics (Basel) 2023; 13:2909. [PMID: 37761275 PMCID: PMC10528125 DOI: 10.3390/diagnostics13182909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Emergency imaging in pregnancy and puerperium poses unique challenges both for clinicians and radiologists, requiring timely and accurate diagnosis. Delay in treatment may result in poor outcomes for both the patient and the foetus. Pregnant and puerperal patients may present in the emergency setting with acute abdominopelvic pain for various complications that can be broadly classified into obstetric and non-obstetric related diseases. Ultrasonography (US) is the primary diagnostic imaging test; however, it may be limited due to the patient's body habitus and the overlapping of bowel loops. Computed tomography (CT) carries exposure to ionising radiation to the foetus, but may be necessary in selected cases. Magnetic resonance imaging (MRI) is a valuable complement to US in the determination of the etiology of acute abdominal pain and can be used in most settings, allowing for the identification of a broad spectrum of pathologies with a limited protocol of sequences. In this second section, we review the common non-obstetric causes for acute abdominopelvic pain in pregnancy and post partum, offering a practical approach for diagnosis and pointing out the role of imaging methods (US, MRI, CT) with the respective imaging findings.
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Affiliation(s)
- Gabriele Masselli
- Department of Emergency Radiology-Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.M.); (P.R.)
| | - Giacomo Bonito
- Department of Emergency Radiology-Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.M.); (P.R.)
| | - Silvia Gigli
- Department of Diagnostic Imaging, Sandro Pertini Hospital, Via dei Monti Tiburtini 385, 00157 Rome, Italy;
| | - Paolo Ricci
- Department of Emergency Radiology-Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.M.); (P.R.)
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
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Juliebø-Jones P, Beisland C, Gjengstø P, Maheswaran R, Ulvik Ø. Ureteroscopy during pregnancy under local anesthesia and light sedation: Technique and video. Curr Urol 2023; 17:219-220. [PMID: 37448618 PMCID: PMC10337810 DOI: 10.1097/cu9.0000000000000180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/29/2022] [Indexed: 03/18/2023] Open
Abstract
Ureteroscopy during pregnancy has become increasingly recognized as a safe intervention. Performing it under local anesthesia and light sedation reduces the risks associated with general or regional anesthesia, such as difficult airway scenarios, hypothermia, and hypotension. In addition, this approach reduces the total amount of fetal exposure to medications and anesthetic agents. Performing ureteroscopy in this manner requires a number of adjustments and modifications to the standard technique. This article provides a summary in a step-by-step format, as well as an accompanying video demonstration.
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Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Peder Gjengstø
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Rachel Maheswaran
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Øyvind Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Dean NS, Krambeck AE. Contemporary Use of Computed Tomography (CT) Imaging in Suspected Urolithiasis in Pregnancy. Curr Urol Rep 2023; 24:443-449. [PMID: 37314612 DOI: 10.1007/s11934-023-01171-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE OF REVIEW We aimed to examine the role of low-dose CT (LDCT) in the diagnostic work-up for suspected urolithiasis in pregnancy. We reviewed contemporary urologic recommendations for CT in pregnancy, its utilization for suspected urolithiasis, and explored barriers to its use. RECENT FINDINGS National urologic guidelines and the American College of Obstetricians and Gynecologists recommend the judicious use of LDCT imaging in pregnancy when necessary. We noted inconsistencies in review article management pathways and recommendations for CT imaging for suspected urolithiasis in pregnancy. Overall CT utilization in pregnancy for suspected urolithiasis is low. Proposed barriers to LDCT use in pregnancy include fears of litigation and misperceptions of the harm of diagnostic radiation. Recent advancements in imaging technologies for urolithiasis in pregnancy are limited. More specific diagnostic pathway recommendations from national urologic guideline bodies for when to use LDCT to investigate renal colic in pregnancy may reduce diagnostic and intervention delays.
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Affiliation(s)
- Nicholas S Dean
- Department of Urology, Northwestern University, 676 N. St. Clair, Suite 2300, Chicago, IL, 60611, United States.
| | - Amy E Krambeck
- Department of Urology, Northwestern University, 676 N. St. Clair, Suite 2300, Chicago, IL, 60611, United States
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Juliebø-Jones P, Beisland C, Gjengstø P, Ulvik Ø. Ureteroscopy in pregnancy can be a preferred option and not just a last resort. World J Urol 2023; 41:1993-1994. [PMID: 36547680 DOI: 10.1007/s00345-022-04265-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
- EAU YAU Urolithiasis Group, Bergen, Norway.
| | - Christian Beisland
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Peder Gjengstø
- Department of Urology, Haukeland University Hospital, Bergen, Norway
| | - Øyvind Ulvik
- Department of Urology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Minervini A, Cadenar A, Di Maida F. Editorial Comment on "Differences in management of pregnant women with obstructing infected ureteral stones: A population-based analysis". Int J Urol 2023; 30:203. [PMID: 36541161 DOI: 10.1111/iju.15132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence-Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Anna Cadenar
- Department of Experimental and Clinical Medicine, University of Florence-Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
| | - Fabrizio Di Maida
- Department of Experimental and Clinical Medicine, University of Florence-Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi Hospital, Florence, Italy
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