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Lei J, Huang K, Dai Y, Yin G. Evaluating outcomes of patient-centered enhanced recovery after surgery (ERAS) in percutaneous nephrolithotomy for staghorn stones: An initial experience. Front Surg 2023; 10:1138814. [PMID: 37025266 PMCID: PMC10071039 DOI: 10.3389/fsurg.2023.1138814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/03/2023] [Indexed: 04/08/2023] Open
Abstract
Objective To evaluate the outcomes of patient-centered enhanced recovery after surgery (ERAS) in -percutaneous nephrolithotomy (PCNL) for staghorn stones. Patients and methods A retrospective analysis of 106 patients with staghorn calculi who underwent PCNL treatment at the Third Xiangya Hospital from October 01, 2018 to September 30, 2021 was performed. The patients were divided into the ERAS group (n = 56) and traditional group (n = 50). The ERAS program focused on a patient-centered concept, with elaboration on aspects, such as patient education, nutritional support, analgesia, body warming, early mobilization, nephrostomy tube removal, and strict follow-up. Results The total stone free rate and total complication rate were similar in both groups. The visual analogue scale (VAS) 6 h after surgery, ambulation off bed time, indwelling fistula time, indwelling catheter time, and postoperative hospital stays were lower in the ERAS group than in the traditional group (P < 0.05). The multiple session rate in the ERAS group (19, 28.57%) was lower than that in the traditional group (30, 60%) (P = 0.007). The 1-year stone recurrence rate in the ERAS group (7, 17.5%) was lower than that in the traditional group (14, 38.9%) (P = 0.037). Conclusion The patient-centered ERAS in PCNL for staghorn stones accelerated rehabilitation by relieving postoperative pain, shortening hospitalization time, accelerating early ambulation, and reducing multiple session rate and 1-year stone recurrence rate, which have socioeconomic benefits.
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Affiliation(s)
- Jun Lei
- Department of Urology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Kai Huang
- Department of Urology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Yingbo Dai
- Department of Urology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Guangming Yin
- Department of Urology, Third Xiangya Hospital, Central South University, Changsha, China
- Correspondence: Guangming Yin
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Oner S, Onen E, Caglayan V, Avci S, Erdogan A, Kilic M, Topal S. The effect of anesthesia type on the outcomes of percutaneous nephrolithotomy in elderly males. Ann Med 2023; 55:2238185. [PMID: 37480584 PMCID: PMC10364566 DOI: 10.1080/07853890.2023.2238185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/08/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023] Open
Abstract
Objective: To compare the anaesthesia methods in percutaneous nephrolithotomy in terms of safety and effectiveness in elderly men.Methods: Elderly male patients who had undergone percutaneous nephrolithotomy were screened retrospectively and divided into 2 groups: percutaneous nephrolithotomy under combined spino-epidural anaesthesia (Group CSEA, n = 70) and percutaneous nephrolithotomy under general anaesthesia (Group GA, n = 114). Preoperative, perioperative and postoperative outcome measures were examined.Results: Between the two groups, there was no statistically significant difference in terms of stone burden, stone location, presence of the previous operation in the same kidney, presence of staghorn stones, mean American Society of Anesthesiologists scores and presence of abnormal kidney (p > 0.05). The mean duration time in the operation room and post-anaesthesia care unit (PACU) was statistically shorter in the Group CSEA (p < 0.01). There was no significant difference between the two groups in terms of Clavien Grade 1 and above complications (p > 0.05). Stone-free rates and success rates were similar in both groups (p = 0.133 and p = 0.273, respectively).Conclusion: The type of anaesthesia does not affect the success rate and complication rate of percutaneous nephrolithotomy in elderly male patients. Patients who underwent percutaneous nephrolithotomy under CSEA needed less analgesic injection during the postoperative period. CSEA can shorten the time a patient spends in the operating room and PACU, which provides more effective use of operation room working hours.
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Affiliation(s)
- Sedat Oner
- Department of Urology, University of Health Sciences Bursa City Hospital, Bursa, Turkey
| | - Efe Onen
- Department of Urology, University of Health Sciences Bursa City Hospital, Bursa, Turkey
| | - Volkan Caglayan
- Department of Urology, University of Health Sciences Bursa City Hospital, Bursa, Turkey
| | - Sinan Avci
- Department of Urology, University of Health Sciences Bursa City Hospital, Bursa, Turkey
| | - Abdullah Erdogan
- Department of Urology, University of Health Sciences Bursa City Hospital, Bursa, Turkey
| | - Metin Kilic
- Department of Urology, University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Serra Topal
- Department of Anesthesiology, University of Health Sciences Bursa City Hospital, Bursa, Turkey
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Dau JJ, Rezakahn Khajeh N, Hall TL, Roberts WW. Chilled irrigation for control of temperature elevation during ureteroscopic laser lithotripsy: in vivo porcine model. J Endourol 2021; 36:403-409. [PMID: 34569294 DOI: 10.1089/end.2021.0537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Multiple studies have shown significant heating of fluid within the urinary collecting system with high-power laser settings. Elevated fluid temperatures may cause thermal injury and tissue damage unless appropriately mitigated. A previous in vitro study demonstrated that chilled (4 °C) irrigation slowed temperature rise, decreased plateau temperature, and lowered thermal dose during laser activation with high-power settings. We sought to evaluate the thermal effects of chilled, room temperature, and warmed irrigation during ureteroscopy with laser activation in an in vivo porcine model. MATERIALS AND METHODS Seven female Yorkshire cross pigs (45-55 kg) were anesthetized and positioned supine. Retrograde ureteroscopy was performed with a thermocouple affixed 5 mm from the distal end of the ureteroscope. In two pigs a holmium:YAG laser was activated for 60 seconds at irrigation rates of 8 ml/min, 12 ml/min, and 15 ml/min with chilled, room temperature, or warmed irrigation. In five pigs core body temperature was recorded for one hour with or without continuous chilled irrigation at 15 ml/min. RESULTS At irrigation rates ≥ 12 ml/min, temperature curves appeared uniformly offset, warmed > room temperature > chilled irrigation. The threshold of thermal tissue injury was reached during laser activation for all irrigation temperatures at 8 ml/min. The threshold was not reached with chilled irrigation at 12 ml/min or 15 ml/min, or with room temperature irrigation at 15 ml/min. The threshold was exceeded at all irrigation rates with warmed irrigation. There was no significant change in core body temperature after delivering chilled irrigation at 15 ml/min compared with no irrigation for 60 minutes. CONCLUSION Irrigation with chilled saline solution during ureteroscopic laser lithotripsy slows temperature rise, lowers peak temperature, and lengthens the time to thermal injury compared to irrigation with room temperature or warmed saline solutions. Core body temperature was not significantly impacted by chilled irrigation.
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Affiliation(s)
- Julie J Dau
- University of Michigan, 1259, Urology, 4432 Medical Sciences Bldg I, 1301 Catherine St, Ann Arbor, Michigan, United States, 48109-1382;
| | | | - Timothy L Hall
- University of Michigan, Biomedical Engineering, 2200 Bonisteel Blvd, Ann Arbor, Michigan, United States, 48109;
| | - William W Roberts
- University of Michigan, Urology, 3879 Taubman Center, 1500 East Medical Center Dr,, Ann Arbor, Michigan, United States, 48109-5330.,University of Michigan, Biomedical Engineering, Ann Arbor, Michigan, United States;
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Rai A, Aro T, Lynch E, Tabib C, Mikhail D, Wang D, Abraham A, Hoenig D, Smith A, Okeke Z. Novel Irrigation Protocol for Renal Pelvis Sterilization During Percutaneous Nephrolithotomy: A Pilot Study. J Endourol 2021; 35:1320-1325. [PMID: 33752442 DOI: 10.1089/end.2020.0695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
While percutaneous nephrolithotomy (PCNL) remains the treatment modality of choice for kidney stones larger than 2 cm, infectious complications are most common, ranging from 5% to 32%. We present here a novel technique for potentially improving collecting system sterility during PCNL and initial postoperative outcomes. Retrospective chart analysis data of our irrigation protocol were collected from our first 56 patients between February and July 2019. Traditional prone PCNL was performed in a standard manner using fluoroscopic guidance. Using a ureteral catheter that was placed cystoscopically, a renal pelvis urine culture was taken and subsequently 10 mL of betadine solution was instilled into the collecting system. Gentamicin in normal saline (80 mg/3 L) was utilized as the irrigant fluid for the first 6 L of irrigation. From this cohort, 57% patients were women and mean age was 60 ± 14 years. About 23% of patients were diabetic and 55% were hypertensive. Seventy percent of patients had stone burden >2 cm and no patients had stone burden <1 cm. Fifteen patients had positive urine cultures treated preoperatively, while four patients had contaminated cultures. All patients were treated with our antibiotic irrigation and betadine protocol regardless of preoperative cultures or antibiotics. Mean baseline creatinine level was 0.95 ± 0.41, with a mean change of 0.18 at postoperative day 1. Of the 15 (26%) of 56 patients with a systemic inflammatory response syndrome response (two of following four criteria: white blood cells <4 or >12; heart rate >90; hypothermia <96.8°F or hyperthermia >100.4°F; and respiratory rate >20), only six patients (11%) were febrile and two patients had positive blood cultures (3%). There were no adverse reactions to the betadine or antibiotic irrigation. We present here our initial experience of a new technique for renal pelvis sterilization and its safety and feasibility using intrarenal instillation of betadine and antibiotic irrigation. No Clinical Trial Registration number applicable.
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Affiliation(s)
- Arun Rai
- Smith Institute for Urology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA
| | - Tareq Aro
- Smith Institute for Urology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA
| | - Elizabeth Lynch
- Smith Institute for Urology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA
| | - Christian Tabib
- Smith Institute for Urology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA
| | - David Mikhail
- Smith Institute for Urology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA
| | - Danielle Wang
- Smith Institute for Urology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA
| | - Alan Abraham
- Smith Institute for Urology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA
| | - David Hoenig
- Smith Institute for Urology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA
| | - Arthur Smith
- Smith Institute for Urology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA
| | - Zeph Okeke
- Smith Institute for Urology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, New Hyde Park, New York, USA
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He Y, Feng YG, He J, Liang B, Jiang MD, Liu J, Kang YM, Ma LP, Zhang Q, Peng QJ, Yang T, Liu Y, Luo L, Zhang M. Effects of irrigation fluid temperature during flexible ureteroscopic holmium laser lithotripsy on postoperative fever and shivering: a randomized controlled trial. BMC Urol 2021; 21:72. [PMID: 33906652 PMCID: PMC8077842 DOI: 10.1186/s12894-021-00841-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 04/20/2021] [Indexed: 02/08/2023] Open
Abstract
Background Flexible ureteroscopic holmium laser lithotripsy is used to treat urinary tract calculi, but postoperative complications include shivering, fever and infection. To investigate the effects of irrigation fluid temperature on postoperative complications. Methods This randomized controlled trial included 120 consecutive patients undergoing flexible ureteroscopic holmium laser lithotripsy at the Urology Department, Suining Central Hospital, Sichuan, China between January 2017 and July 2019. Patients were randomized 1:1:1 into three groups (17 °C, 27 °C or 37 °C). Primary outcome was fever incidence (body temperature > 37.5 °C) within 48 h after surgery. Secondary outcomes included shivering incidence during recovery from anesthesia, white blood cell count (WBC), serum procalcitonin (PCT) and incidence of suspected infection (temperature > 38.5 °C and PCT > 0.5 µg/L). Results There were 108 patients, (17 °C group, n = 36; 27 °C group, n = 35; 37 °C group, n = 37), received flexible ureteroscopic holmium laser lithotripsy and analyzed. Age, gender distribution, body mass index, ASA grade, stone burden, preoperative creatinine, preoperative core temperature and irrigation fluid volume did not differ significantly between groups. 17 °C, 27 °C and 37 °C groups exhibited significant differences in the incidences of postoperative fever (38.9% vs. 17.1% vs. 13.5%) and shivering (22.2% vs. 5.7% vs. 2.7%) (p < 0.05 for all pairwise comparisons). There was no significant difference of WBC, PCT and incidence of suspected infection in 37 °C or 27 °C group compared with 17 °C group. One case each of flash pulmonary edema and bleeding occurred in 37 °C group. Conclusion Warming the irrigation fluid can reduce the incidence of postoperative fever and shivering, but further studies are needed to determine the optimal temperature. Trial registration The trial was registered at the Chinese Clinical Trials Registry and allocated as ChiCTR2000031683. The trial was registered on 07/04/2020 and this was a retrospective registration.
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Affiliation(s)
- Yue He
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China. .,Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu City, 610041, Sichuan Province, People's Republic of China.
| | - You-Gang Feng
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Jun He
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Bo Liang
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Ming-Dong Jiang
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Jun Liu
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Yong-Ming Kang
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Li-Ping Ma
- Operation Room, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Qin Zhang
- Operation Room, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Qi-Jia Peng
- Operation Room, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Tao Yang
- Department of Urology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Yao Liu
- Operation Room, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Li Luo
- Department of Anesthesiology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
| | - Min Zhang
- Department of Anesthesiology, Suining Central Hospital, No. 127 Desheng W. Rd., Chuanshan District, Suining City, 629000, Sichuan Province, People's Republic of China
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6
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Zhu L, Jiang R, Pei L, Li X, Kong X, Wang X. Risk factors for the fever after percutaneous nephrolithotomy: a retrospective analysis. Transl Androl Urol 2020; 9:1262-1269. [PMID: 32676409 PMCID: PMC7354332 DOI: 10.21037/tau.2020.03.37] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background It’s very common to see the onset of fever after percutaneous nephrolithotomy (PCNL), it’s necessary to analyze the risk factors for the fever following PCNL, and to provide evidence for infection prevention after PCNL. Methods A total of 546 adult PCNL patients were included as study subjects and retrospective studies were performed. We collected clinical data of patients using a prospectively designed database. Univariate and multivariate logistic regression analyses were performed to identify the potential risk factors for the fever after PCNL. Results Of the included 546 PCNL patients, there were 82 fever patients and 464 no-fever patients following PCNL. Escherichia coli and Proteus mirabilis are the two most common infectious bacteria. Preoperative urinary tract infection (OR =4.38, 95% CI: 1.15–9.53), multiple access (OR =5.31, 95% CI: 1.23–10.75), diabetes (OR =4.97, 95% CI: 1.37–9.86), length of operation ≥60 min (OR =5.67, 95% CI: 2.24–13.42), estimated blood loss in PCNL ≥500 mL (OR=2.78, 95% CI: 2.32–3.61) were the independent risk factors associated with postoperative infection. Conclusions Effective control of urinary tract infection, reduction of access number, strict control of blood glucose, length of operation control, reduction of intraoperative bleeding should be considered as measures to prevent postoperative fever for patients with PCNL.
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Affiliation(s)
- Likun Zhu
- Department of Urology Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.,Nephropathy Clinical Medical Research Center of Sichuan Province, Luzhou 646000, China
| | - Rui Jiang
- Department of Urology Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.,Nephropathy Clinical Medical Research Center of Sichuan Province, Luzhou 646000, China
| | - Lijun Pei
- Department of Urology Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.,Nephropathy Clinical Medical Research Center of Sichuan Province, Luzhou 646000, China
| | - Xu Li
- Department of Urology Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.,Nephropathy Clinical Medical Research Center of Sichuan Province, Luzhou 646000, China
| | - Xiangjun Kong
- Department of Urology Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.,Nephropathy Clinical Medical Research Center of Sichuan Province, Luzhou 646000, China
| | - Xinwei Wang
- Department of Urology Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.,Nephropathy Clinical Medical Research Center of Sichuan Province, Luzhou 646000, China
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