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Agrawal-Patel S, Brar H, Elia M, Fulla J, Li B, Prasanchaimontri P, Li J, De S. Is it Safe to Continue Aspirin in Patients Undergoing Percutaneous Nephrolithotomy? Urology 2024; 183:32-38. [PMID: 37778475 DOI: 10.1016/j.urology.2023.09.022] [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: 05/11/2023] [Revised: 09/11/2023] [Accepted: 09/23/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE To evaluate peri-operative outcomes in patients on chronic aspirin therapy undergoing percutaneous nephrolithotomy (PCNL), with and without discontinuation of aspirin. Anti-coagulation and anti-platelet therapy are contraindications for PCNL per American Urological Association guidelines due to bleeding risk. However, there is potentially increased cardiovascular risk with peri-procedural aspirin withdrawal. METHODS Patients on chronic aspirin undergoing PCNL between January 2014 and May 2019 were retrospectively reviewed and stratified by continued or discontinued aspirin >5 days preoperatively. Hematologic complications, transfusions, and thrombotic complications were assessed with logistic regression model. RESULTS Three hundred twenty-five patients on chronic aspirin therapy underwent PCNL-85 continued and 240 discontinued aspirin. There were no significant differences in hemoglobin change, estimated blood loss, transfusions, creatinine change, thrombotic complications, 30-days re-admissions, complications, or 30-day emergency department visits. Patients who continued aspirin had longer length of stay (1.6 vs 1.9 days, P = .03). American Society of Anesthesiologists (ASA) score of 3 (OR 3.2, P = .02, 95% confidence intervals (CI) [1.2-8.4]), ASA score of 4 (OR 4.0, P = .02, 95% CI [1.2-13.1]), Black race, and previous smoking (OR 2.1, P = .02, 95% CI [1.1-3.9]) was associated with continued aspirin. Body mass index ≥30 was associated with aspirin discontinuation (OR 0.9, P = .004, 95% CI [0.9-1.0]). Increased postoperative hematologic complications were associated with additional anticoagulation medication (OR 2.9, P = .04, 95% CI [1.0-4.4]). CONCLUSION Continued aspirin use did not increase in postoperative complications in patients undergoing PCNL. Patients who are on additional anticoagulation medication are at risk of hematologic complications.
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Affiliation(s)
| | - Harmenjit Brar
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH
| | - Marlie Elia
- SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Juan Fulla
- Department of Urology, University of Chile, Santiago, Chile
| | - Becky Li
- Nova Southeastern University, College of Allopathic Medicine, Davie, FL
| | | | - Jianbo Li
- Cleveland Clinic, Department of Quantitative Health Sciences, Cleveland, OH
| | - Smita De
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, OH
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Falahatkar S, Esmaeili S, Rastjou Herfeh N, Kazemnezhad E, Falahatkar R, Yeganeh M, Jafari A. The safety of continued low dose aspirin therapy during Complete Supine Percutaneous Nephrolithotomy (csPCNL). Prog Urol 2021; 32:458-464. [PMID: 34154964 DOI: 10.1016/j.purol.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 02/24/2021] [Accepted: 04/02/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Using anticoagulants and antiplatelet drugs in patients with cardiovascular and medical comorbidities is prevalent. Because of hyper vascular nature of kidney, physicians tend to stop using aspirin before percutaneous nephrolithotomy (PCNL). We have shown the effects of remaining on low dose aspirin in complete supine PCNL (csPCNL). MATERIAL AND METHODS The records of 643 patients who underwent csPCNL between 2012 and 2018 were analyzed. Surgical outcomes and complications of patients who were on aspirin therapy and continued it daily (group A) were compared with those not taking aspirin (group B). RESULTS Of the 643 csPCNLs, 40 (6%) were performed in patients of group A and the rest of 603 (94%) cases were in group B. The differences between the mean age of groups were statistically significant (60.08±9.45, group A and 48.66±12.32, group B) (P<0.001). Thirty-nine (97.5%) of patients in group A and 548 (90.9%) of group B were stone free by the end of the study which was not statistically significant (P=0.118). The mean operative time between groups A and B (43.20±21.37 and 44.83±16.83, respectively) was not considered significant (P=0.561). There was also no significant difference between 2 groups in any types of complications. Multivariate analysis showed that, perioperative aspirin use was not a significant predictor of transfusion, Hb drop, operative time and other complications. CONCLUSIONS Remaining on aspirin does not increase the risk of bleeding, transfusionand other complications. Consequently, continuing aspirin prioperatively in csPCNL appears safe. There is no fear for continuing aspirin in csPCNL. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- S Falahatkar
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - S Esmaeili
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - N Rastjou Herfeh
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - E Kazemnezhad
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - R Falahatkar
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - M Yeganeh
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - A Jafari
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
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Li JK, Teoh JY, Ng CF. Updates in endourological management of urolithiasis. Int J Urol 2018; 26:172-183. [PMID: 30575154 DOI: 10.1111/iju.13885] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/21/2018] [Indexed: 12/23/2022]
Abstract
Urinary stone disease, or urolithiasis, is a very common disease with increasing prevalence and incidence. With the advancement of endoscopic techniques, the treatment outcomes of ureteroscopy (or transureteral lithotripsy) and percutaneous nephrolithotomy are continuously improving. In recent years, there have been many new developments in the field, including new endoscopy design, more effective auxiliary tools, improvement in treatment protocols, introduction of robotic technology, combining both ureteroscopy and percutaneous nephrolithotomy (endoscopic combined intrarenal surgery or transureteral lithotripsy-assisted percutaneous nephrolithotomy), improvement in laser technology, and so on. All these new inputs will further improve the treatment efficacy and safety of the procedures, thus benefiting our patients. In the present review, we briefly go through the main steps of ureteroscopy and percutaneous nephrolithotomy, with a concise description and application of these new advances.
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Affiliation(s)
- Joseph Km Li
- S. H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jeremy Yc Teoh
- S. H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chi-Fai Ng
- S. H. Ho Urology Center, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
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Otto BJ, Terry RS, Lutfi FG, Syed JS, Hamann HC, Gupta M, Bird VG. The Effect of Continued Low Dose Aspirin Therapy in Patients Undergoing Percutaneous Nephrolithotomy. J Urol 2018; 199:748-753. [DOI: 10.1016/j.juro.2017.10.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Brandon J. Otto
- Department of Urology, University of Florida College of Medicine, Gainesville, Florida
| | - Russell S. Terry
- Department of Urology, University of Florida College of Medicine, Gainesville, Florida
| | - Forat G. Lutfi
- University of Florida College of Medicine, Gainesville, Florida
| | - Jamil S. Syed
- University of Florida College of Medicine, Gainesville, Florida
| | | | - Mohit Gupta
- Department of Urology, University of Florida College of Medicine, Gainesville, Florida
| | - Vincent G. Bird
- Department of Urology, University of Florida College of Medicine, Gainesville, Florida
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Leavitt DA, Keheila M, Siev M, Shah PH, Moreira DM, George AK, Salami SS, Schwartz MJ, Richstone L, Vira MA, Kavoussi LR. Outcomes of Laparoscopic Partial Nephrectomy in Patients Continuing Aspirin Therapy. J Urol 2016; 195:859-64. [DOI: 10.1016/j.juro.2015.10.132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2015] [Indexed: 01/20/2023]
Affiliation(s)
- David A. Leavitt
- Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York
| | - Mohamed Keheila
- Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York
| | - Michael Siev
- Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York
| | - Paras H. Shah
- Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York
| | - Daniel M. Moreira
- Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York
| | - Arvin K. George
- Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York
| | - Simpa S. Salami
- Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York
| | - Michael J. Schwartz
- Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York
| | - Lee Richstone
- Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York
| | - Manish A. Vira
- Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York
| | - Louis R. Kavoussi
- Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York
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Cho SY. Current status of flexible ureteroscopy in urology. Korean J Urol 2015; 56:680-8. [PMID: 26495068 PMCID: PMC4610894 DOI: 10.4111/kju.2015.56.10.680] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 08/21/2015] [Indexed: 12/23/2022] Open
Abstract
Retrograde intrarenal surgery (RIRS) is being performed for the surgical management of upper urinary tract pathology. With the development of surgical instruments with improved deflection mechanisms, visuality, and durability, the role of RIRS has expanded to the treatment of urinary calculi located in the upper urinary tract, which compensates for the shortcomings of shock wave lithotripsy and percutaneous nephrolithotomy. RIRS can be considered a conservative treatment of upper urinary tract urothelial cancer (UTUC) or for postoperative surveillance after radical treatment of UTUC under an intensive surveillance program. RIRS has a steep learning curve and various surgical techniques can be used. The choice of instruments during RIRS should be based on increased surgical efficiency, decreased complications, and improved cost-benefit ratio.
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Affiliation(s)
- Sung Yong Cho
- Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
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