Complications of percutaneous procedures

Medicated adhesive dressing is a safe and non-inferior cutaneous seal as compared to compound tincture benzoin dermal seal for percutaneous interventions

Background:

Compound tincture benzoin (CTB) is used as a post-procedure skin seal antiseptic agent since ancient times; but this drug is reported to cause allergic contact dermatitis and other unwanted side effects. Our aim of the present study was to compare alternative agent like Medicated Adhesive dressing (MAD) with CTB as a post-procedure skin seal dressing.

Design:

This prospective randomized controlled experimental study included an equal number of patients in MAD and CTB as a post-operative seal dressing material for percutaneous interventions. Both the groups were graded for various efficacy parameters like comfort, applicability, dressing material, and immediate post-operative complications by operating doctor and attending nurse with a maximum 10 points in each group.

Results:

120 patients were studied in each MAD and CTB group. Out of total patients 31.25% were males and the mean age of the patient was 33.56 ± 11.10. Allergic contact dermatitis developed in 9 (7.49%) of CTB group and in 1 (0.83%) of MAD group (P < 0.002), while local site skin infections were noted in 8 (6.67%) of CTB group and in 1 (0.83%) of MAD (P < 0.002). Operating doctor graded MAD and CTB to 7.60 ± 0.49 and 3.62 ± 0.48 (P < 0.003); and attending nurse 7.40 ± 0.49 and 3.41 ± 0.49 (P < 0.003) respectively.

Conclusion:

MAD is a safe, efficient and non-inferior alternative dressing material for post-procedure skin incision seal in comparison to CTB.

Modified Seoul National University Renal Stone Complexity score for retrograde intrarenal surgery

The Seoul National University Renal Stone Complexity (S-ReSC) score is a well-validated tool for the prediction of stone-free rate (SFR) after percutaneous nephrolithotomy. We modified the S-ReSC score system for application to retrograde intrarenal surgery (RIRS) and evaluated this score. A total of 88 patients who underwent RIRS from 2011 to 2013 were included. The modified S-ReSC score was assigned according to the number of sites involved in the renal pelvis (#1), superior and inferior major calyceal groups (#2-3), and anterior and posterior minor calyceal groups of the superior (#4-5), middle (#6-7), and inferior calyx (#8-9). If the stone was in the inferior sites (#3, #8-9), one additional point per site was added to the original score. The SFR was examined according to the modified S-ReSC score. To evaluate the predictive accuracy, the area under the receiver operating characteristic curve (AUC) was used and compared with the Resorlu-Unsal Stone (RUS) score. The SFR was 85.2% and was significantly decreased in the order of low (1-2: 94.2%), medium (2-4: 84.0%), and high (>4: 45.5%) modified ReSC score groups (p < 0.001). AUCs of the modified S-ReSC score (0.806) and score group (0.766) were higher than the AUC of the RUS score (0.692; p = 0.012 and p = 0.040, respectively). The modified S-ReSC score predicts the SFR after RIRS well. Furthermore, its predictive accuracy is higher than that of the RUS score.

Comparison of percutaneous nephrolithotomy, shock wave lithotripsy, and retrograde intrarenal surgery for lower pole renal calculi 10-20 mm

OBJECTIVE

To compare the results of percutaneous nephrolithotomy (PCNL), shock wave lithotripsy (SWL), and retrograde intrarenal surgery (RIRS) for 1- to 2-cm lower pole kidney stones.

PATIENTS AND METHODS

This retrospective study was based on data collected from the files of patients between January 2007 and May 2012. The files of 383 patients (221 SWL, 144 PCNL, 38 RIRS) were evaluated. The groups were compared for stone size, success rate, and complication rate using the modified Clavien grading system.

RESULTS

The stone burdens of the groups were similar (p = 0.36). The success rates were 76, 94, and 73%, respectively, in SWL, PCNL, and RIRS. The highest stone-free rate was in the PNL group (p < 0.05). When the complication rates were evaluated using the Clavien grading system, they were determined to be 13% in PCNL, 3% in SWL, and 5% in RIRS. Especially GII and GIII complications were more common in the PCNL group (p < 0.05).

CONCLUSION

PCNL seems to be the most successful but most invasive method. However, with relatively low complication rates, SWL and RIRS are other techniques to keep in mind. To determine the first-line treatment, prospective randomized studies with larger series are needed.