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Zhang ZL, Li FZ, Xie TP, Liu FL, Jiang B, Yuan YH, Xiao RH, Wang XN. Chinese mini percutaneous nephrolithotomy for upper urinary calculi under local infiltration anesthesia. Medicine (Baltimore) 2023; 102:e35159. [PMID: 37773861 PMCID: PMC10545285 DOI: 10.1097/md.0000000000035159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/18/2023] [Indexed: 10/01/2023] Open
Abstract
Percutaneous nephrolithotomy is generally performed under general or regional anesthesia; however, it is rarely performed under local infiltration anesthesia (LIA). This study aimed to assess the safety and effectiveness of Chinese mini percutaneous nephrolithotomy (MPCNL) for upper urinary calculi under LIA. A retrospective analysis of 52 patients with upper urinary stones who underwent MPCNL under LIA from April 2019 to May 2022 was performed. Pethidine and Phenergan were intramuscularly injected 30 minutes preoperatively. Oxybuprocaine hydrochloride gel was applied to the urethra for lubricating and mucosal anesthesia. Ropivacaine hydrochloride and lidocaine were injected into the whole percutaneous channel for local anesthesia. An 8/9.8F ureteroscope and an 18F vacuum-assisted access sheath were applied in MPCNL. All 52 patients tolerated procedures and underwent operations successfully; none of them converted the anesthesia method or required additional analgesia. The mean visual analogue scale scores intraoperatively and at 6 hours, 24 hours, and 48 hours after surgery were 3.25 ± 0.52, 3.13 ± 0.69, 2.25 ± 0.56, and 1.58 ± 0.50, respectively. The stone free rate was 84.6%. Complications were seen in 6 (11.5%) patients, including fever in 2 patients (Clavien I), renal colic in 1 patient (Clavien I), clinically insignificant bleeding in 2 patients (Clavien I), and urinary tract infection in 1 patient (Clavien II). No severe complications were observed in any patients. Chinese MPCNL under LIA was a feasible option and achieved good outcomes in appropriately selected patients, and it may become the routine procedure for general patients.
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Affiliation(s)
- Zhao-Lin Zhang
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Fang-Zhi Li
- First Clinical Medical College, Gannan Medical University, Ganzhou, Jiangxi, China
| | - Tian-Peng Xie
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Fo-Lin Liu
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Bo Jiang
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Yuan-Hu Yuan
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Ri-Hai Xiao
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Xiao-Ning Wang
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
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Ding X, Hou Y, Wang C, Wang Y. Super-stiff guidewire or loach guidewire during percutaneous nephrolithotomy? BJUI COMPASS 2023; 4:562-567. [PMID: 37636203 PMCID: PMC10447211 DOI: 10.1002/bco2.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 12/08/2022] [Accepted: 12/19/2022] [Indexed: 08/29/2023] Open
Abstract
Objectives The objectives of this work are to compare the outcomes between loach guidewire and super-stiff guidewire during percutaneous nephrolithotomy (PCNL) and find potential indications of different guidewires. Patients and methods We retrospectively reviewed our institutional PCNL database from 2017 to 2021. Patients who underwent PCNL guided by loach guidewire were assigned to group A (489 patients); patients who received super-stiff guidewire were assigned to group B (269 patients). Preoperative demographic data, intraoperative parameters, and postoperative complications were compared. The conditions and reasons of failed placement of guidewire needed readjustment were evaluated as well. Results Preoperative demographic data and most intraoperative parameters were not statistically different between the groups. Postoperative Clavien-Dindo complications were also comparable, with low rate of complications. However, failed placement of guidewire more occurred in group A (8.2% vs. 4.0%, respectively, p = 0.03). Compared with the super-stiff guidewire, the loach guidewire was easier pass/slip into any place either it be perinephric or blood vessels. In most failed group A cases and all failed group B cases, the guidewire was placed in the perirenal fat. Six patients (15%) in group A, the guidewires entered into vessels. Conclusions Our results support that the faulty placement of loach guidewire is significantly more common compared with super-stiff guidewire. Double confirmation is needed to prevent a major complication out of wrong dilatation whenever there is doubt about the wrong location of the guidewire.
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Affiliation(s)
- Xiaobo Ding
- Department of RadiologyFirst Hospital of Jilin UniversityChangchunChina
| | - Yuchuan Hou
- Department of UrologyFirst Hospital of Jilin UniversityChangchunChina
| | - Chunxi Wang
- Department of UrologyFirst Hospital of Jilin UniversityChangchunChina
| | - Yanbo Wang
- Department of UrologyFirst Hospital of Jilin UniversityChangchunChina
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Zhang Z, Leng S, Xie T, Yuan Y, Wang X. Flexible ureteroscopic lithotripsy with a suctioning ureteral access sheath for removing upper urinary calculi under local anesthesia. Front Surg 2023; 10:1242981. [PMID: 37822642 PMCID: PMC10563815 DOI: 10.3389/fsurg.2023.1242981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/31/2023] [Indexed: 10/13/2023] Open
Abstract
Objectives We aimed to probe the safety and effectiveness of flexible ureteroscopic lithotripsy (FURL) with a suctioning ureteral access sheath (S-UAS) for removing upper urinary calculi under local anesthesia (LA). Materials and methods The clinical data of 56 patients with upper urinary calculi treated by FURL with an S-UAS under LA during the period between September 2019 and November 2022 were analyzed retrospectively. For LA, intramuscular pethidine (1.0-2.0 mg/kg) and phenergan (25 mg) were administered 30 min prior to surgery, and oxybuprocaine hydrochloride gel was administered through the urethra at the start of the surgery. The S-UAS and flexible ureteroscope were used for FURL. Demographic characteristics, stone-related parameters, and clinical outcomes were analyzed. Result A total of 66 procedures were performed successfully on 46 patients (Group A), who underwent unilateral surgeries, and on 10 patients (Group B) who underwent same-session bilateral surgeries. All 56 patients were operated upon without altering the anesthesia strategy, and none required additional analgesia. The mean stone sizes of the Group A and Group B patients were 20.24 ± 5.45 mm and 29.40 ± 3.89 mm, respectively. The mean operative times of the two groups were 53.04 ± 13.35 min and 90.00 ± 15.81 min, respectively. In Group A, the stone-free rates (SFRs) were 76.1% (35/46) and 85.1% (40/46) at postoperative day 1 and day 30, respectively. In Group B, the SFRs were 80.0% (16/20) and 85.0% (17/20), respectively. Four (8.7%) patients in Group A suffered complications such as fever, stent pain, urosepsis, and steinstrasse. In Group B, one (10%) patient suffered from fever. Conclusion FURL, combined with an S-UAS under LA, is a feasible option and provides satisfactory clinical outcomes for appropriately selected patients.
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Affiliation(s)
- Zhaolin Zhang
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Song Leng
- First Clinical Medical College, Gannan Medical University, Ganzhou, China
| | - Tianpeng Xie
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Yuanhu Yuan
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Xiaoning Wang
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China
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Sankar K, Anand K, Ramani S, Gayathri B. A Randomized Control Trial to Compare Hemodynamic Parameters of Patients Undergoing Percutaneous Nephrolithotomy Under Combined Spinal-Epidural and General Anesthesia in a Tertiary Hospital. Local Reg Anesth 2023; 16:41-49. [PMID: 37223489 PMCID: PMC10202212 DOI: 10.2147/lra.s410510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/03/2023] [Indexed: 05/25/2023] Open
Abstract
Background and Aim Percutaneous nephrolithotomy (PCNL) under epidural anesthesia has been reported to have few advantages over general anesthesia, like lower postoperative pain and less need for analgesics. There are limited studies on PCNL being performed under neuraxial anesthesia in supine position. Hence the present study was conceived to compare hemodynamic parameters in patients undergoing percutaneous nephrolithotomy (PCNL) in the supine position under combined spinal-epidural with general anesthesia (GA). Material and Methods A prospective, randomized control trial was conducted among 90 patients who were posted to undergo elective percutaneous nephrolithotomy in the the supine position, after obtaining Institutional Ethical Committee (IEC) approval and CTRI (Clinical Trial Registry - India) registration. Patients were randomly allotted to undergo surgery either under general anesthesia (group GA) or combined spinal epidural anesthesia (group CSE) by computer-generated random number method. Hemodynamic parameters, postoperative analgesic requirement and incidence of blood transfusion were recorded and analyzed. Results There was no significant difference between the two groups with respect to gender, ASA grade, surgery duration, calculus size and pulse rate. There was a statistically significant reduction in mean arterial pressure from 5 to 50 minutes of surgery and less incidence of blood transfusion in patients in the CSE group. Patients who underwent PCNL in the supine position under CSE required lesser analgesics postoperatively compared to those under general anesthesia. Conclusion Combined spinal epidural analgesia can be used as an alternative to general anesthesia for patients undergoing PCNL in the supine position in view of less MAP and reduced postoperative analgesic and blood transfusion requirement.
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Affiliation(s)
- Ksheerabdhi Sankar
- Department of Anesthesiology, SRM Medical College Hospital and Research Centre, Potheri, 603203, India
| | - Kuppusamy Anand
- Department of Anesthesiology, SRM Medical College Hospital and Research Centre, Potheri, 603203, India
| | - Swetha Ramani
- Department of Anesthesiology, SRM Medical College Hospital and Research Centre, Potheri, 603203, India
| | - Balasubramaniam Gayathri
- Department of Anesthesiology, SRM Medical College Hospital and Research Centre, Potheri, 603203, India
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Yu Y, Hu J, Liu W, Peng Z, Wang M, Zhou X, Xi H. Performing percutaneous nephrolithotomy under modified local anesthesia. Front Surg 2022; 9:922158. [PMID: 36303852 PMCID: PMC9592855 DOI: 10.3389/fsurg.2022.922158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022] Open
Abstract
Objective This pilot study aimed to assess the practicability and effectiveness of percutaneous nephrolithotomy (PCNL) with vacuum-assisted nephrostomy sheaths for patients under modified local anesthesia (m-LA). Methods PCNL with a vacuum-assisted nephrostomy sheath under m-LA was performed in 83 patients between November 2020 and May 2021. An 18F or 20F ClearPetra Nephrostomy Sheath connected vacuum aspiration was used in surgery to keep low pressure in the renal pelvis. For LA, lidocaine and ropivacaine hydrochloride were 1:1 mixed and instilled under ultrasound guidance through the percutaneous nephrolithotomy channel directed toward the design calix. Demographic characteristics, stone characteristics, visual analogue scale (VAS) score, vital signs, operation time, complications, and stone clear rate were recorded and analyzed. Results All operations were completed. The mean VAS score was 3.9 ± 1.0. The mean operation time was 55.1 ± 23.6 min. The changes for systolic blood pressure, diastolic blood pressure, and heart rate were 3 ± 21 mmHg, 1 ± 14 mmHg, and −6 ± 14 beats/min, respectively. The change for hemoglobin was −10.7 ± 10.9 g/L. The change for C-reactive protein was 5.39 ± 43.1 mg/L. The total stone-free rate was 69.9% (93.8% for simple stones and 54.9% for complex stones). Conclusion Performing PCNL with vacuum-assisted nephrostomy sheaths under modified local anesthesia under ultrasound guidance was found to be strongly practical and effective.
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Affiliation(s)
- Yue Yu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jieping Hu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China,Correspondence: Haibo Xi Jieping Hu
| | - Wei Liu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhixiong Peng
- Department of Surgery, Traditional Chinese Medicine Hospital of Yichun City, Yichun, China
| | - Mengzhen Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaochen Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haibo Xi
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang, China,Correspondence: Haibo Xi Jieping Hu
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Dar MA, Malik SA, Dar YA, Wani PM, Wani MS, Hamid A, Khawaja AR, Sofi KP. Comparison of percutaneous nephrolithotomy under epidural anesthesia versus general anesthesia: A randomized prospective study. Urol Ann 2021; 13:210-214. [PMID: 34421253 PMCID: PMC8343281 DOI: 10.4103/ua.ua_82_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 12/30/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction: PCNL has revolutionized the treatment of renal calculi putting almost an end to the era of open stone surgery. The procedure can safely be carried out under general anesthesia (GA) or regional anesthesia viz. spinal anesthesia (SA), epidural anesthesia (EA) or combined spinal and epidural anesthesia (CSE). Aims and Objectives: We evaluated the surgical outcome after PCNL in two groups of patients randomly divided to undergo procedure under GA or EA. Patients and Methods: Two hundred and thirty patients with American Society of Anesthesiologists (ASA) score <3 were randomly divided into two groups according to the type of anesthesia: i.e. GA (n=110) or EA (n=120). All patients underwent PCNL in prone position. Puncture was done using Bulls eye technique under fluoroscopic guidance and tract dilated using serial dilators up to 24Fr-28 Fr. Demographics, perioperative and postoperative parameters were noted and data analysed. Results: The two groups were comparable in terms of mean age, distribution of stone location, and stone burden. The stone free rate was 90.9% in GA group and 89.2% in EA group and the difference was statistically insignificant (P= 0.659). The requirement for auxiliary procedures was similar between the two groups. A significant difference in pain score was seen in favor of EA group during early post-operative period (P< 0.05). Conclusion: It seems that PCNL can be performed safely and effectively under regional epidural anesthesia with results comparable to general anesthesia with the added advantage of less immediate postoperative pain and analgesic requirement.
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Affiliation(s)
- Manzoor Ahmad Dar
- Department of Urology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Sajad Ahmad Malik
- Department of Urology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Yaser Ahmed Dar
- Department of Urology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Prince Muzafer Wani
- Department of Urology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Mohammad Saleem Wani
- Department of Urology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Arif Hamid
- Department of Urology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Abdul Rouf Khawaja
- Department of Urology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Khalid Parvez Sofi
- Department of Anaesthesia, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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El-Shaer W, Shaboob I, Abdel-Lateef S. Mini-percutaneous Nephrolithotomy Under mixture of Local Anesthesia: A Randomized-Controlled Study. J Endourol 2021; 35:1750-1756. [PMID: 34036796 DOI: 10.1089/end.2021.0234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE to evaluate the safety, efficacy, and feasibility of mini-percutaneous nephrolithotomy (MPCNL) under mixture of local anesthetics (MLA) versus spinal anesthesia (SA) for management of large renal stones. PATIENTS AND METHODS the current study was a prospective randomized controlled study. A total of 120 consecutive patients who met the inclusion criteria of the study and agreed to sign the informed consent form were randomized to undergo MPCNL under MLA (60 patients) or SA (60 patients). Intra- and post-operative findings included visual pain analogue scale (VAS), operative time, hospital stay, adverse events, stone-free rate and related data were recorded. RESULTS Baseline characteristics and demography included age, sex; stone's site, size and density were comparable for both groups (p> 0.05). The average VAS scores in MLA group at 0, 2, 6, 12; and 24 hours were 2.5; 0;1; 1 and 0, respectively. The corresponding values in the SA group were 2; 1; 2; 2; and 1, respectively, (p< 0.05). The average operation time was about an hour for both groups and the length of hospital stay was 1.5 days for both groups (p> 0.05). While the mean hemoglobin deficit was 1.04±0.54 % vs 1.27±0.46 (p=0.013), and the primary postoperative stone clearance was 93.4%, vs 88.3% (p > 0.05), for MLA and SA groups, respectively. Post-operative analgesic consumption and Complications were similar in the MLA and SA groups. CONCLUSION Single tract MPCNL is feasible under either mixture of Local or Spinal anesthesia with comparable stone clearance & adverse events. Perioperative VAS was similar and acceptable for both modalities.
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Affiliation(s)
- Waleed El-Shaer
- Benha University Faculty of Medicine, 68817, urology , Farid Nada st,Benha, Faculty of medicine, Benha university, Benha, Egypt, 13511;
| | - Islam Shaboob
- Banha University, 68816, Anesthesiology, Benha, Egypt;
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Zhai J, Wang H, Xu X, Liu Z, Man L. PCNL in COPD patient in the sit position under local infiltration anesthesia case report. BMC Urol 2020; 20:70. [PMID: 32552883 PMCID: PMC7301984 DOI: 10.1186/s12894-020-00640-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 06/09/2020] [Indexed: 11/15/2022] Open
Abstract
Background Percutaneous nephrolithotomy is traditionally performed in the prone or supine position. We report the first case of percutaneous nephrolithotomy in sit position under local infiltration anesthesia. Case summary A 69-year-old male presented with left flank pain. Kidney B ultrasound and computed tomography scan showed multiple left renal calculi and hydronephrosis. He had a long history of chronic obstructive pulmonary disease, with severe ventilatory and cardiac dysfunction, and cannot tolerate the prone or supine position. The patient received the surgery in sit position under local infiltration anesthesia. The operative time was 1 h. The visual analogue scale score during the surgery was 3. The patient had no intraoperative and postoperative complications. The postoperative plain radiography showed no residual stone fragments. Conclusions We believe that in high-risk patients who need to undergo PCNL, a combination of sit position and local infiltration anesthesia is an alternative method.
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Affiliation(s)
- Jianpo Zhai
- Department of Urology, Beijing Jishuitan Hospital, No68.Huinanbei Road, Changping District, Beijing, 100096, China
| | - Hai Wang
- Department of Urology, Beijing Jishuitan Hospital, No68.Huinanbei Road, Changping District, Beijing, 100096, China.
| | - Xiao Xu
- Department of Urology, Beijing Jishuitan Hospital, No68.Huinanbei Road, Changping District, Beijing, 100096, China
| | - Zhenhua Liu
- Department of Urology, Beijing Jishuitan Hospital, No68.Huinanbei Road, Changping District, Beijing, 100096, China
| | - Libo Man
- Department of Urology, Beijing Jishuitan Hospital, No68.Huinanbei Road, Changping District, Beijing, 100096, China
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Chen K, Xu K, Li B, Wang S, Xiang S, Li H. Predictive factors of stone-free rate and complications in patients undergoing minimally invasive percutaneous nephrolithotomy under local infiltration anesthesia. World J Urol 2020; 38:2637-2643. [DOI: 10.1007/s00345-019-03070-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 12/27/2019] [Indexed: 11/25/2022] Open
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Wang X, Ye Q, Liu X, Chen J, Wang Z, Xu W, Zhao P, Tao B. Comparison of the clinical efficacy of sonography-guided percutaneous nephrolithotomy (PCNL) under local and general anesthesia. J Int Med Res 2019; 47:4143-4150. [PMID: 31291811 PMCID: PMC6753540 DOI: 10.1177/0300060519859767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Objective This study aimed to compare the effect of percutaneous nephrolithotomy (PCNL)
under local infiltration anesthesia (PCNL-LIA) and general anesthesia
(PCNL-GA) to treat upper urinary tract calculi on clinical application
values. Methods Patients were randomly divided into the PCNL-LIA (16 patients) and PCNL-GA
(20 patients) groups. Data on safety, cost, complications, rate of residual
calculi, and prognosis were compared. Results The mean operation time in the PCNL-LIA group was less than that in PCNL-GA
group (100±7.7 versus 120±9.0 minutes). The mean length of hospital stay in
the PCNL-LIA group was shorter than that in the PCNL-GA group (6.9±0.5
versus 10.5±1.2 days). The rate of patients who required blood transfusion
because of blood loss during or after surgery was less in the PCNL-LIN group
than in the PCNL-GA group (13% versus 40%). The intervention rate in the
PCNL-GA group was higher than that in the PCNL-LIA group. Visual analogue
pain scale assessment showed that the PCNL-LIA group showed slightly more
pain than the PCNL-GA group. Conclusion PCNL-LIA is safer, faster, and more convenient, and it also provides the
benefits of a lower rate of blood loss and complications, lower cost, faster
recovery, and shorter hospital stay compared with PCNL-GA.
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Affiliation(s)
- Xunbao Wang
- Department of Urology, Renmin Hospital, Susong, Anhui Province, China
| | - Qiongxiang Ye
- Department of Urology, Renmin Hospital, Susong, Anhui Province, China
| | - Xinguo Liu
- Department of Urology, Renmin Hospital, Susong, Anhui Province, China
| | - Jinjun Chen
- Department of Urology, Renmin Hospital, Susong, Anhui Province, China
| | - Zhiyong Wang
- Department of Urology, Renmin Hospital, Susong, Anhui Province, China
| | - Wanfeng Xu
- Department of Urology, Renmin Hospital, Susong, Anhui Province, China
| | - Pengfei Zhao
- Department of Urology, Renmin Hospital, Susong, Anhui Province, China
| | - Baozhou Tao
- Department of Urology, Renmin Hospital, Susong, Anhui Province, China
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Capodice JL, Parkhomenko E, Tran TY, Thai J, Blum KA, Chandhoke RA, Gupta M. A Randomized, Double-Blind, Sham-Controlled Study Assessing Electroacupuncture for the Management of Postoperative Pain after Percutaneous Nephrolithotomy. J Endourol 2019; 33:194-200. [PMID: 30693806 DOI: 10.1089/end.2018.0665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PCNL) is the gold standard procedure for large renal calculi but postoperative (PO) pain remains a concern. Modifications of the PCNL technique and intraoperative and PO strategies have been tested to reduce pain. PO pain control reducing risk of long-term pain medication and narcotic use is of considerable importance. Acupuncture is a common medical procedure shown to alleviate PO pain. Some benefits are that it is nonpharmacologic, easy to administer, and safe. The purpose of this study was to evaluate the effects of electroacupuncture (EA) on PO pain in patients undergoing PCNL. MATERIALS AND METHODS This was a randomized, double-blind, sham-controlled study. The study was Institutional Review Board approved and performed under standard ethical guidelines. Fifty-one patients undergoing PCNL by a single surgeon were randomized to one of the three groups: true EA (n = 17), sham EA (SEA, n = 17), and no acupuncture (control, n = 17). The EA and SEA were performed by a single licensed acupuncturist <1 hour before operation. PCNL was performed without the use of intraoperative nerve block(s) or local anesthetic. Pain scores (visual analog scale [VAS]), narcotic use (morphine equivalents), and side effects were recorded at set intervals postoperatively. RESULTS Mean VAS scores for flank and abdomen pain were lower at all time periods in the EA compared with the SEA and control groups. Mean cumulative opioid usage was lower in the EA group immediately postoperatively compared with both SEA and control groups. Two patients in the EA group did not require any PO narcotics. No differences between groups were found for PO nausea and vomiting. No adverse effects of EA or SEA were noted. CONCLUSIONS EA significantly reduced PO pain and narcotic usage without any adverse effects after PCNL. This promising treatment for managing PO pain warrants further investigation.
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Affiliation(s)
- Jillian L Capodice
- 1 Department of Urology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Egor Parkhomenko
- 1 Department of Urology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Timothy Y Tran
- 1 Department of Urology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Julie Thai
- 1 Department of Urology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Kyle A Blum
- 1 Department of Urology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Ryan A Chandhoke
- 1 Department of Urology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - Mantu Gupta
- 1 Department of Urology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
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Carrion DM, Cansino JR, Quintana LM, Gómez Rivas J, Mainez Rodriguez JA, Pérez-Carral JR, Martínez-Piñeiro L. Prone percutaneous nephrolithotomy: its advantages and our technique for puncture. Transl Androl Urol 2018; 7:950-959. [PMID: 30505733 PMCID: PMC6256044 DOI: 10.21037/tau.2018.10.04] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Percutaneous nephrolithotomy (PCNL) is considered the treatment of choice for large urinary calculi and staghorn lithiasis. The approach for this surgery may be either supine or prone, and different access techniques are described in the literature with the use of ultrasound, fluoroscopy, or both combined. We believe that prone PCNL offers to the urologist key advantages, such as the possibility of puncturing anatomically abnormal urinary tracts, to perform multiple percutaneous tracts in the same kidney, experiencing the vacuum cleaner effect, ease of exploring the upper calyx through the inferior calyx, possibility to perform endoscopic combined intrarenal surgery (ECIRS) and bilateral simultaneous surgery, and to performed over local anesthesia. An adequate training for the endourologist should include both the prone and supine techniques for PCNL and to know which patient can benefit the most from each one.
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Affiliation(s)
- Diego M Carrion
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | - José Ramón Cansino
- Department of Urology, La Paz University Hospital, Madrid, Spain.,La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Luis M Quintana
- Department of Urology, La Paz University Hospital, Madrid, Spain
| | - Juan Gómez Rivas
- Department of Urology, La Paz University Hospital, Madrid, Spain.,La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
| | | | | | - Luis Martínez-Piñeiro
- Department of Urology, La Paz University Hospital, Madrid, Spain.,La Paz University Hospital Institute for Health Research (IdiPAZ), Madrid, Spain
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13
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Wei C, Zhang Y, Pokhrel G, Liu X, Gan J, Yu X, Ye Z, Wang S. Research progress of percutaneous nephrolithotomy. Int Urol Nephrol 2018; 50:807-817. [PMID: 29556901 DOI: 10.1007/s11255-018-1847-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/12/2018] [Indexed: 12/29/2022]
Abstract
Percutaneous nephrolithotomy (PCNL) is generally accepted as the gold standard treatment for the treatment of large kidney stones (> 2 cm). For nearly 40 years, with the continuous progress of technology and the constant updating of ideas, PCNL has made great progress. In this review, we discuss the current research progress, recent advancement and hot spot of the whole process of PCNL including anesthesia, position, puncture, dilation, lithotripsy approaches, perfusate, tube placement, hospitalization time, drug, treatment of residual stones, prognosis judgment and operation evaluation by summarizing the related research in this article.
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Affiliation(s)
- Chao Wei
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Yucong Zhang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Gaurab Pokhrel
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Xiaming Liu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Jiahua Gan
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Xiao Yu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China.
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Ecke TH, Barski D, Weingart G, Lange C, Hallmann S, Ruttloff J, Wawroschek F, Gerullis H. Presentation of a method at the Exploration Stage according to IDEAL: Percutaneous nephrolithotomy (PCNL) under local infiltrative anesthesia is a feasible and effective method - retrospective analysis of 439 patients. Int J Med Sci 2017; 14:302-309. [PMID: 28553161 PMCID: PMC5436471 DOI: 10.7150/ijms.17963] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/28/2016] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION This study addresses minimally invasive anesthesiologic and analgetic approaches for stone surgery in the upper urinary tract. Aim of this retrospective analysis is to compare feasibility, safety and complication rates of percutaneous nephrolithotomy (PCNL) under local infiltration anesthesia alone (Group I) and additive intravenous analgetics and/or sedative medications (Group II). MATERIAL AND METHODS This is a single center study. A total of 439 patients have been included from November 2003 until March 2012. A total of 226 patients were assigned to Group I receiving local infiltration anesthesia alone, whereas 213 patients were assigned to Group II receiving additive intravenous analgetics and/or sedative medications. Demographic characteristics and stone characteristics have been evaluated to determine feasibility, complication rates for safety, and stone-free rates for effectiveness. The study and the reported technique have then been retrospectively analysed according to the IDEAL stages of surgical innovation. RESULTS All included patients who accepted local infiltration anesthesia underwent PCNL successfully. The mean American Society of Anesthesiologists score (ASA) of the included patients was 2.15 ±0.37 (range, 1-4). PCNL was indicated in 138 patients due to pelvic calculi, in 171 patients due to renal calculi, in 66 patients due to partial staghorn, in 48 patients due to complete staghorn and in 16 patients due to upper ureteral stones. The total stone free rate in our patients was 78.4% over all stone localizations. Compared to the possibility of using additive intravenous analgetics and/or sedative medications we could show differences in the median age (p=0.005) suggesting that older patients did better tolerate the infiltration anesthesia than patients at younger ages. We did also remark not statistically significant differences in Group I and Group II as for number of tracts, operation duration, hemoglobin drop, fever, transfusion rate, and stone free rate, but not for severe complications such as perirenal hematoma, colon perforation, pleura perforation, AV fistula, skin fistula, and mortality rate. CONCLUSION PCNL performed under local infiltration anesthesia is a feasible method. It provides satisfactory positive clinical outcomes. Younger age seems to predispose to conversion to extended anesthesiologic procedures. When retrospectively applying the IDEAL criteria, the method can be assigned to the E level or stage 2b.
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Affiliation(s)
| | | | | | - Carsten Lange
- Department of Urology, HELIOS Hospital, Bad Saarow, Germany
| | | | | | - Friedhelm Wawroschek
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany
| | - Holger Gerullis
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Germany
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15
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Hu H, Qin B, He D, Lu Y, Zhao Z, Zhang J, Wang Y, Wang S. Regional versus General Anesthesia for Percutaneous Nephrolithotomy: A Meta-Analysis. PLoS One 2015; 10:e0126587. [PMID: 25961831 PMCID: PMC4427359 DOI: 10.1371/journal.pone.0126587] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 04/06/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To compare the effectiveness and safety of regional anesthesia (RA) and general anesthesia (GA) for percutaneous nephrolithotomy (PNL). PATIENTS AND METHODS PubMed, EMBASE, The Cochrane Library, and the Web of Knowledge databases were systematically searched to identify relevant studies. After literature screening and data extraction, a meta-analysis was performed using the RevMan 5.3 software. RESULTS Eight randomized controlled trials (RCTs) and six non-randomized controlled trials (nRCTs) involving 2270 patients were included. Patients receiving RA were associated with shorter operative time (-6.22 min; 95%CI, -9.70 to -2.75; p = 0.0005), lower visual analgesic score on the first and third postoperative day (WMD, -2.62; 95%CI, -3.04 to -2.19; p < 0.00001 WMD, -0.38; 95%CI, -0.58 to -0.18; p = 0.0002), less analgesic requirements (WMD, -59.40 mg; 95%CI, -78.39 to -40.40; p<0.00001), shorter hospitalization (WMD, -0.36d; 95%CI, -0.66 to -0.05; p = 0.02), less blood transfusion (RR, 0.61; 95%CI, 0.41 to 0.93; p = 0.02), fewer modified Clavion-Dindo Grade II (RR, 0.56; 95%CI, 0.37 to 0.83; p = 0.005), Grade III or above postoperative complications (RR, 0.51; 95%CI, 0.33 to 0.77; p = 0.001), and potential benefits of less fever (RR, 0.79; 95%CI, 0.61 to 1.02; p = 0.07), nausea or vomiting (RR, 0.54; 95%CI, 0.20 to 1.46; p = 0.23), whereas more intraoperative hypotension (RR, 3.13; 95%CI, 1.76 to 5.59; p = 0.0001) when compared with patients receiving GA. When nRCTs were excluded, most of the results were stable but the significant differences were no longer detectable in blood transfusion, Grade II and more severe complications. No significant difference in the total postoperative complications and stone-free rate were found. CONCLUSIONS Current evidence suggests that both RA and GA can provide safe and effective anesthesia for PNL in carefully evaluated and selected patients. Each anesthesia technique has its own advantages but some aspects still remain unclear and need to be explored in future studies.
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Affiliation(s)
- Henglong Hu
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Baolong Qin
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Deng He
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuchao Lu
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhenyu Zhao
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaqiao Zhang
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yufeng Wang
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shaogang Wang
- Department and Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Pu C, Wang J, Tang Y, Yuan H, Li J, Bai Y, Wang X, Wei Q, Han P. The efficacy and safety of percutaneous nephrolithotomy under general versus regional anesthesia: a systematic review and meta-analysis. Urolithiasis 2015; 43:455-66. [PMID: 25926280 DOI: 10.1007/s00240-015-0776-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 04/13/2015] [Indexed: 02/05/2023]
Abstract
This meta-analysis was performed to evaluate the efficacy and safety of percutaneous nephrolithotomy (PCNL) under regional anesthesia (RA) vs. general anesthesia (GA). A systematic literature search in the electronic databases (Cochrane CENTRAL, Medline and EMBASE) was performed up to April 2014. Twelve trials, including 1954 patients, met the inclusion criteria and were included in the final analysis. Our pooled analysis showed that PCNL under RA could reduce surgical duration (MD, -2.47; 95 % CI, -3.51 to -1.44), hospitalization period (MD, -0.48; 95 % CI -0.93 to -0.04), fluoroscopy time (MD, -0.48; 95 % CI, -0.83 to -0.14), blood transfusion (OR, 0.59; 95 % CI, 0.38-0.92), postoperative pain (MD, -1.99; 95 % CI, -2.2 to -1.78), and analgesic requirements (MD, -19.14; 95 % CI, -26.64 to -11.63). However, there was no difference between RA and GA groups with regard to stone-free rate (OR, 1.09; 95 % CI, 0.86-1.37) and postoperative complications associated with PCNL (OR, 0.95; 95 % CI 0.58-1.54). Our results show that PCNL under RA offers several potential advantages over GA in terms of surgical duration, hospitalization period, fluoroscopy time, blood transfusion, postoperative pain, and analgesic requirements, but both anesthetic techniques appear to be equivalent with regard to the stone-free rate and complication rate. Along with the suggested favorable hemodynamic profile and lower cost, RA may prove a better alternative than GA.
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Affiliation(s)
- Chunxiao Pu
- Department of Urology, West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jia Wang
- Department of Urology, West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yin Tang
- Department of Urology, West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Haichao Yuan
- Department of Urology, West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jinhong Li
- Department of Urology, West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yunjin Bai
- Department of Urology, West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiaoming Wang
- Department of Urology, West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Ping Han
- Department of Urology, West China Hospital, Sichuan University, No.37 Guoxue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
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Gupta S, Singh V, Sankhawar S. Re: Li et al.: Percutaneous nephrolithotomy under local infiltration anesthesia: a single-center experience of 2000 Chinese cases (Urology 2013;82:1020-1025). Urology 2014; 83:1206. [PMID: 24767533 DOI: 10.1016/j.urology.2013.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/23/2013] [Accepted: 12/06/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Saurabh Gupta
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vishwajeet Singh
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Li B, Li H. Reply by the authors. Urology 2014; 83:1206-7. [PMID: 24767532 DOI: 10.1016/j.urology.2013.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 12/30/2013] [Accepted: 12/31/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Bingkun Li
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Hulin Li
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
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Li B, Li H. Reply by the authors. Urology 2014; 83:680. [PMID: 24581534 DOI: 10.1016/j.urology.2013.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 12/05/2013] [Accepted: 12/06/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Bingkun Li
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Hulin Li
- Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
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20
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Singh BP, Dhakad U. Re: Li et al.: Percutaneous nephrolithotomy under local infiltration anesthesia: a single-center experience of 2000 Chinese cases (Urology 2013;82:1020-1025). Urology 2014; 83:679-80. [PMID: 24581532 DOI: 10.1016/j.urology.2013.11.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/15/2013] [Accepted: 11/16/2013] [Indexed: 12/12/2022]
Affiliation(s)
- Bhupendra Pal Singh
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Urmila Dhakad
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
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