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Indra Rachman R, Birowo P, Nurullah G, Cho PSY, Atmoko W, Widyahening IS, Rasyid N. General versus spinal anesthesia in percutaneous nephrolithotomy: A systematic review and meta-analysis. F1000Res 2023; 12:281. [PMID: 38618023 PMCID: PMC11016174 DOI: 10.12688/f1000research.124704.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 04/16/2024] Open
Abstract
Background: Percutaneous nephrolithotomy (PCNL) is the preferred treatment for the removal of large kidney stones, sized >20 mm. However, there is still an ongoing debate concerning the best anesthesia for PCNL. This study aimed to compare the efficacy and safety between general and spinal anesthesia for PCNL. Methods: A systematic review and meta-analysis study. A systematic, electronic literature search was performed in several databases, including PubMed, Scopus, and Google Scholar until July 1 st, 2022. The quality of the articles was examined using Crombie's Items (for non-randomized controlled trials (RCTs)) and Jadad Scale (for RCTs). The outcomes assessed were operation time, fluoroscopy time, length of stay, stone-free rate, overall complication rate, specific postoperative complications, cost, pain score, and postoperative analgesic requirement. The article selection was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We assessed four RCTs and eight retrospective studies. Meta-analysis of selected studies was performed using the Review Manager 5.3. Results: General anesthesia resulted in fewer Clavien-Dindo grade II (OR: 0.68; 95% CI: 0.49 - 0.94; p=0.02), major complications (OR: 0.65; 95% CI: 0.45 - 0.94; p=0.02, and lower transfusion rates (OR: 0.70; 95% CI: 0.53 - 0.94; p=0.02). Whereas spinal anesthesia resulted in faster operation time (Mean Difference: -12.98; 95% CI: -20.56 - -5.41; p<0.001, fluoroscopy time (MD: -26.15; 95% CI: -42.79 - -9.50; p=0.002), reduced length of stay (MD: -0.47; 95% CI: -0.75 - 0.20; p<0.001), and lower postoperative analgesic requirement and cost. No significant difference in stone-free rate (OR: 1.08; 95% CI: 0.92 - 1.26; p=0.37). PCNL performed using either general anesthesia or spinal anesthesia is equally safe and effective. Conclusions: Each method of anesthesia has its own advantages and disadvantages. The final choice between general and spinal anesthesia should be based on the patient's condition and surgical team preference.
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Affiliation(s)
- Rinaldo Indra Rachman
- Department of Urology, Faculty of Medicine. Universitas Indonesia. Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430, Indonesia
| | - Ponco Birowo
- Department of Urology, Faculty of Medicine. Universitas Indonesia. Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430, Indonesia
| | - Ghifari Nurullah
- Department of Urology, Faculty of Medicine. Universitas Indonesia. Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430, Indonesia
| | - Prof. Sung Yong Cho
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, 101 Daehak-Ro Jongno-Gu, South Korea
| | - Widi Atmoko
- Department of Urology, Faculty of Medicine. Universitas Indonesia. Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430, Indonesia
| | - Indah Suci Widyahening
- Department of Community Medicine, Faculty of Medicine. Universitas Indonesia, Jalan Pegangsaan Timur no 16, Jakarta, 10430, Indonesia
| | - Nur Rasyid
- Department of Urology, Faculty of Medicine. Universitas Indonesia. Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta, 10430, Indonesia
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Shahait M, Farkouh A, Mucksavage P, Somani B. Outcome of Mini-PCNL Under Loco-Regional Anesthesia: Outcomes of a Systematic Review. Curr Urol Rep 2023; 24:417-426. [PMID: 37418069 DOI: 10.1007/s11934-023-01169-2] [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: 05/22/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE OF REVIEW Miniaturized PCNL (mi-PCNL) for stone disease is performed under a general anesthesia. However, the role of loco-regional anesthesia in mi-PCNL and its outcomes are not well defined yet. Here, we review the outcomes and complications of loco-regional anesthesia for mi-PCNL. A Cochrane-style review was performed in accordance with the preferred reporting items for systematic reviews to evaluate the outcomes of loco-reginal anesthesia for URS in stone disease, including all English language articles from January 1980 and October 2021. RECENT FINDINGS Ten studies with a total of 1663 patients underwent mi-PCNL under loco-regional anesthesia. The stone-free rate (SFR) for mi-PCNL under neuro-axial anesthesia ranged between 88.3 and 93.6%, while it ranged between 85.7 and 93.3% for mi-PCNL under local anesthesia (LA). The conversion rate to another anesthesia modality was 0.5%. The complications ranged widely between 3.3 and 85.7%. The majority were Grade I-II complications and none of the patients had grade V complications. Our review shows that mi-PCNL under loco-regional anesthesia is feasible with good SFR and a low risk of major complications. The conversion to general anesthesia is needed in a small minority, with the procedure itself being well tolerated and a big step towards establishing an ambulatory pathway for these patients.
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Affiliation(s)
| | - Ala'a Farkouh
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | | | - Bhaskar Somani
- Department of Urology, University Hospital Southampton, Southampton, UK.
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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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Comparison of retrograde intrarenal surgery under regional versus general anaesthesia: A systematic review and meta-analysis. Int J Surg 2020; 82:36-42. [DOI: 10.1016/j.ijsu.2020.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/29/2020] [Accepted: 08/01/2020] [Indexed: 12/21/2022]
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Çakici MÇ, Özok HU, Erol D, Çatalca S, Sari S, Özdemir H, Selmi V, Kartal İG, Karakoyunlu N. Comparison of general anesthesia and combined spinal-epidural anesthesia for retrograde intrarenal surgery. MINERVA UROL NEFROL 2019; 71:636-643. [DOI: 10.23736/s0393-2249.19.03481-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Moawad HES, El Hefnawy AS. Spinal vs. general anesthesia for percutaneous nephrolithotomy: A prospective randomized trial. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2014.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Ahmed S. El Hefnawy
- Urology Department, Urology and Nephrology Center , Mansoura University , Egypt
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Smith LM, Cozowicz C, Uda Y, Memtsoudis SG, Barrington MJ. Neuraxial and Combined Neuraxial/General Anesthesia Compared to General Anesthesia for Major Truncal and Lower Limb Surgery. Anesth Analg 2017; 125:1931-1945. [DOI: 10.1213/ane.0000000000002069] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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The Effect of Peritubal Infiltration with Bupivacaine and Morphine on Postoperative Analgesia in Patients Undergoing Percutaneous Nephrolithotomy. Pain Res Manag 2017; 2017:2454267. [PMID: 28484316 PMCID: PMC5412177 DOI: 10.1155/2017/2454267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/04/2017] [Accepted: 02/07/2017] [Indexed: 11/24/2022]
Abstract
Objective. We aimed to investigate the effect of peritubal local anesthetic and opioid infiltration on pain scores and analgesic consumption in patients who underwent percutaneous nephrolithotomy. Material and Methods. Patients aged between 18 and 65 years and ASA I-III were included in this double-blind, randomized study. The patients were divided into two groups. All patients underwent spinoepidural anesthesia. 20 mL of 0.25 percent bupivacaine + 5 mg morphine (0.5 mL), in Group P (n = 66), infiltrated the renal capsule, perinephric fat, muscles, subcutaneous tissue, and skin under fluoroscopy. In Group C (n = 64), none of the patients received a peritubal injection. In the first 24 h pain scores, time of the first analgesic demand, the mean number of analgesic demands, and postoperative complications were compared between groups. Results. The mean VAS score at postoperative 8, 12, and 24 h and dynamic VAS score at postoperative 4, 8, 12, and 24 h were significantly lower in Group P. VAS score at postoperative 4 h was not significant. Time of the first analgesic demand was significantly longer in Group P. Conclusion. Our study results suggest that peritubal infiltration of bupivacaine with morphine after percutaneous nephrolithotomy is an effective method for postoperative pain control and reduces analgesic consumption.
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Percutaneous Nephrolithotomy: Current Clinical Opinions and Anesthesiologists Perspective. Anesthesiol Res Pract 2016; 2016:9036872. [PMID: 27110239 PMCID: PMC4826713 DOI: 10.1155/2016/9036872] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/01/2016] [Accepted: 03/13/2016] [Indexed: 11/17/2022] Open
Abstract
Percutaneous nephrolithotomy (PCNL), a minimally invasive method for removal of renal calculi, was initially started in the 1950s but gained popularity about two decades later and has now become standard practice for management. There has been an immense improvement in technique and various guidelines have been established for treatment of renal stones. However, it has its own share of complications which can be attributed to surgical technique as well as anesthesia related complications. PubMed and Google search yielded more than 30 articles describing the different complications seen in this procedure, out of which 15 major articles were selected for writing this review. The aim of this review article is to describe the implications of the complications associated with PCNL related to the anesthesiologist. The anesthesiologist is as much responsible for the management of the patient perioperatively as the surgeon. Therefore, it is mandatory to be familiar with the various complications, some of which may be life threatening and he should be able to manage them efficiently. The paper also analyses the advantages and drawbacks of the available options in anesthesia, that is, general and regional, both of which are employed for PCNL.
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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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Falahatkar S, Moghaddam KG, Kazemnezhad E, Farzan A, Aval HB, Ghasemi A, Shahab E, Esmaeili SS, Motiee R, Langroodi SAM, Nemati M, Allahkhah A. Factors affecting complications according to the modified Clavien classification in complete supine percutaneous nephrolithotomy. Can Urol Assoc J 2015; 9:e83-92. [PMID: 25737769 DOI: 10.5489/cuaj.2248] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION An increase in percutaneous nephrolithotomy (PCNL) has been accompanied by an increase in complications. We identified the parameters affecting the severity of complications using the modified Clavien classification (MCC). METHODS From 2008 to 2013, 330 patients underwent complete supine PCNL using subcostal access, one-shot dilation, rigid nephroscopy, and pneumatic lithotripsy. We assessed the impact of the following factors on complication severity based on the MCC: age, gender, body mass index, hypertension, diabetes, previous stone surgery and extracorporeal shock wave lithotripsy, preoperative hemoglobin, renal dysfunction (creatinine >1.4 mg/dL), preoperative urinary tract infection, anatomic upper urinary tract abnormality (AUUTA), significant (moderate-severe) hydronephrosis, stone-related parameters (opacity, number, burden, location, staghorn, complex stones), anesthesia type, kidney side, imaging and calyx for access, tract number, tubeless approach, operative time, postoperative hemoglobin, and hemoglobin drop and stone-free results. RESULTS The complication rate was 19.7% (MCC: 0=80.3%, I=6.4%, II=11.2%, ≥III=2.1%). On univariate analyses, only the following factors affected MCC: gender, preoperative hemoglobin, AUUTA, significant hydronephrosis, imaging for access, calyx for access, tract number, postoperative hemoglobin, hemoglobin drop and stone-free result. Renal dysfunction was accompanied by higher complications, yet the results were not statistically significant. Multivariate logistic regression analysis demonstrated renal dysfunction, absence of significant hydronephrosis, AUUTA, multiple tracts, lower postoperative hemoglobin, and higher postoperative hemoglobin drop as the significant parameters which affected MCC and predicted higher grades. The paper's limitations include a low number of cases in the higher Clavien grades and some subgroups of variables, and not applying some techniques due to surgeon preference. INTERPRETATION Many of the complete supine PCNL complications were in the lower Clavien grades and major complications were uncommon. Renal dysfunction, AUUTA, significant hydronephrosis, tract number, postoperative hemoglobin, and hemoglobin drop were the only factors affecting MCC.
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Affiliation(s)
- Siavash Falahatkar
- Urology Research Center, Guilan University of Medical Sciences; and the Razi Hospital, Rasht, Iran
| | | | - Ehsan Kazemnezhad
- Urology Research Center, Guilan University of Medical Sciences; and the Razi Hospital, Rasht, Iran
| | - Alireza Farzan
- Urology Research Center, Guilan University of Medical Sciences; and the Razi Hospital, Rasht, Iran
| | - Hamidreza Baghani Aval
- Urology Research Center, Guilan University of Medical Sciences; and the Razi Hospital, Rasht, Iran
| | - Ali Ghasemi
- Urology Research Center, Guilan University of Medical Sciences; and the Razi Hospital, Rasht, Iran
| | - Elaheh Shahab
- Urology Research Center, Guilan University of Medical Sciences; and the Razi Hospital, Rasht, Iran
| | | | - Reza Motiee
- Urology Research Center, Guilan University of Medical Sciences; and the Razi Hospital, Rasht, Iran
| | | | - Mohadeseh Nemati
- Urology Research Center, Guilan University of Medical Sciences; and the Razi Hospital, Rasht, Iran
| | - Aliakbar Allahkhah
- Urology Research Center, Guilan University of Medical Sciences; and the Razi Hospital, Rasht, Iran
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Is micro-percutaneous nephrolithotomy surgery technically feasible and efficient under spinal anesthesia? Urolithiasis 2015; 43:249-54. [PMID: 25572955 DOI: 10.1007/s00240-015-0752-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 01/01/2015] [Indexed: 10/24/2022]
Abstract
The objective of the study was to present the clinical and operative effects of two types of anesthesia on micro-percutaneous nephrolithotomy ("microperc"). We retrospectively reviewed 116 patients who underwent microperc between August 2011 and September 2013. Patients were sorted into one of the two groups according to the type of anesthesia received: general (Group 1, n:53) or spinal (Group 2, n:63). Perioperative variables (age, stone size, location) and outcomes (operation time, success, complication rate) were evaluated and compared. Although there was a statistically significant difference in the mean age of patients (30.3 ± 22.1 vs. 45.8 ± 14.6, respectively, p < 0.001), mean body mass indexes were similar (p = 0.689). There was no substantial difference in terms of sizes and localizations of stones in the two groups (p = 0.970 and p = 0.795). While a significant difference was found in comparison of operative times (59.62 ± 32.56 vs. 40.98 ± 26.45 min, p < 0.001), there was no statistically significant difference in mean fluoroscopy times (124.92 ± 84.2 vs. 105.2 ± 61.0 s, p = 0.441). Stone-free rates were similar (90.5% vs. 93.6%, p = 0.297). We found no statistical differences between the two groups with respect to mean hemoglobin drop and hospitalization time (p = 0.015 and p = 0.917, respectively). The complication rates and analog pain scores were also similar (p = 0.543 and p = 0.365). Our results show that microperc is a feasible surgical modality in the treatment of kidney stone disease under both spinal and general anesthesia. Spinal anesthesia may be considered for patients at a high risk for general anesthesia, and also may be an alternative for patients who are concerned about and/or fearful of general anesthesia.
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Kuzgunbay B, Turunc T. Re: Cicek et al.: Spinal anesthesia is an efficient and safe anesthetic method for percutaneous nephrolithotomy (Urology 2013;83:50-55). Urology 2014; 83:682. [PMID: 24581538 DOI: 10.1016/j.urology.2013.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 11/13/2013] [Accepted: 11/16/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Baris Kuzgunbay
- Department of Urology, Baskent University, Faculty of Medicine, Ankara, Turkey
| | - Tahsin Turunc
- Department of Urology, Baskent University, Faculty of Medicine, Ankara, Turkey
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Reply by the authors. Urology 2014; 83:682-3. [PMID: 24581537 DOI: 10.1016/j.urology.2013.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 12/09/2013] [Accepted: 12/13/2013] [Indexed: 11/22/2022]
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