1
|
Sener TE, Ozgur G, Cetin M, Pietropaolo A, Tzelves L, Esperto F, Somani B, Tanidir Y. Foley catheter after ureteroscopy and JJ stent placement: a randomised prospective European Association of Urology Section of Urolithiasis-Young Academic Urologists (EULIS-YAU) endourology study. BJU Int 2024. [PMID: 39129326 DOI: 10.1111/bju.16504] [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: 08/13/2024]
Abstract
OBJECTIVES To evaluate the effects of inserting a Foley catheter after ureteroscopy (URS) and JJ stent placement on pain scores, voiding patterns, biochemical parameters and postoperative complications. PATIENTS AND METHODS A randomised clinical trial (1:1) with adult patients following unilateral URS + JJ stent placement was planned. In Group A, no Foley catheter was placed, in Group B, a Foley catheter was placed following URS + JJ stent placement. The primary objective was to evaluate effect of placing a Foley catheter on International Prostate Symptom Score (IPSS), Ureteric Stent Symptom Questionnaire (USSQ) score and postoperative biochemical parameters. The secondary objective was to evaluate postoperative complications. RESULTS A total of 112 patients were included (56/group). A ureteric access sheath was used in each patient. Patients had similar demographic and surgical parameters. The pre- and postoperative biochemical analyses including white blood cell count, C-reactive protein, procalcitonin and creatinine levels were similar between the two groups. The IPSS were similar between the two groups. All the subdomains of the USSQ were similar between two groups except Total Body Pain score, which was lower in Group B. The visual analogue scale scores were similar. Complications were all Clavien-Dindo Grade I and II, and the complication rate was 5.4% and 8.9% in Group A and B, respectively. CONCLUSION Placing a Foley catheter following URS + JJ stent placement did not show significant effects on postoperative biochemical parameters and voiding symptoms. However, a Foley catheter lowered the Total Body Pain score on the USSQ without having significant effects on VAS scores. The practice of placing a Foley catheter following URS and JJ stent placement should be based on surgeon's preference keeping in mind the potential positive effect on pain scores.
Collapse
Affiliation(s)
- Tarik Emre Sener
- Department of Urology, Marmara University Hospital, Istanbul, Turkey
| | - Gunal Ozgur
- Department of Urology, Marmara University Hospital, Istanbul, Turkey
| | - Mehmet Cetin
- Department of Urology, Marmara University Hospital, Istanbul, Turkey
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lazaros Tzelves
- Department of Urology, University College of London Hospital, London, UK
| | | | - Bhaskar Somani
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Yiloren Tanidir
- Department of Urology, Marmara University Hospital, Istanbul, Turkey
| |
Collapse
|
2
|
Watanabe T, Komeya M, Odaka H, Kiuchi H, Saigusa Y, Makiyama K, Matsuzaki J. Ureteral stone volume and female gender predicts perioperative complications after complete ipsilateral upper urinary tract stone removal using flexible ureterorenoscopy. Int Urol Nephrol 2024; 56:1611-1616. [PMID: 38123734 DOI: 10.1007/s11255-023-03899-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To identify the risk factors for perioperative complications to prevent perioperative complications after complete ipsilateral upper urinary stone removal using flexible ureterorenoscopy. MATERIALS AND METHODS We retrospectively examined 111 patients who underwent flexible ureterorenoscopy for ipsilateral renal stones with a diameter ≥ 5 mm at the same time as ureterorenoscopy for ureteric stones. The flexible ureterorenoscopy procedures were performed following the fragmentation technique. Patients who experienced (complication group) and did not experience (non-complication group) perioperative complications were compared. The complication group included 33 patients with Clavien-Dindo classification scores of I, II, III, or IV and/or those with a body temperature of > 37.5 ℃ during hospitalization. RESULTS The overall stone volume, stone-free rate and procedure duration were 1.71 mL, 96.4% and 77 min, respectively. The rate of perioperative complications was 29.7% (grade 1, 2 and 3 was 23.4%, 5.4% and 0.9%, respectively). Severe complications (Clavien-Dindo grade 4) were not observed. Multivariable analysis revealed that ureteral stone volume and female patients were independent predictors of perioperative complications after flexible ureterorenoscopy (p = 0.015 and 0.017, respectively). CONCLUSIONS This study showed that ureteral stone volume and female gender have the possibility to increase perioperative complications. These preliminary data help to select for patients who are at low risk of complications. Therefore, in these selected patients, complete ipsilateral upper urinary tract stone removal using flexible ureterorenoscopy may reduce the recurrence of urolithiasis without increasing perioperative complications.
Collapse
Affiliation(s)
- Takahiko Watanabe
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-Ku, Yokohama, Kanagawa, 221-0014, Japan
| | - Mitsuru Komeya
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-Ku, Yokohama, Kanagawa, 221-0014, Japan.
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Hisakazu Odaka
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-Ku, Yokohama, Kanagawa, 221-0014, Japan
| | - Hirokazu Kiuchi
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-Ku, Yokohama, Kanagawa, 221-0014, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Kazuhide Makiyama
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-Ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Junichi Matsuzaki
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-Ku, Yokohama, Kanagawa, 221-0014, Japan
| |
Collapse
|
3
|
Tamalvanan V, Rajandram R, Kuppusamy S. Reduction of pre-procedural anxiety for repeat sessions in extracorporeal shockwave lithotripsy (ESWL) reduces pain intensity: A prospective observational study. Medicine (Baltimore) 2022; 101:e30425. [PMID: 36123909 PMCID: PMC9478226 DOI: 10.1097/md.0000000000030425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Pain control is a major determinant for successful stone clearance in extracorporeal shockwave lithotripsy (ESWL) for urolithiasis. Pain perception during ESWL may be influenced by patient factors like gender, age, body habitus and anxiety level, and stone related factors like size, laterality and location of stone. We investigated in general, the confounding patient and stone factors influencing pain perception during ESWL with importance given to procedural anxiety in first and the subsequent session of ESWL. This was a prospective observational study of all new consecutive patients who underwent ESWL for a period of 1 year at a tertiary Urological Centre. Demographic and stone anthropometry were analyzed. Pre-procedural anxiety was assessed prior to procedure using hospital anxiety and depression score (HADS) and pain was scored using numerical rating scale-11 at baseline, 30-minutes (i.e., during) and 24 hours after ESWL. Univariate and multivariate analysis for confounding factors included HADs were performed for pain perception. A P value < .05 was considered to be statistically significant. For the study duration, 119 patients were recruited and 72 of them returned for a second session. Procedural anxiety was the only independent factor affecting pain score in ESWL for the first session in multivariate analysis. A statistically significant reduction of mean procedural anxiety score from 6.7 ± 4.5 to 3.2 ± 2.7 (P < .05) for the second ESWL session was observed (n = 72). This was in conjunction with statistical reduction of mean pain score 30 minutes after ESWL from 5.2 ± 2.1 to 4.2 ± 2.1 (P < .05). Patients with HADS ≥ 8 had statistically significant higher mean pain score at all 3 intervals in the first ESWL session. This study has shown that pre-procedural anxiety mainly anticipatory, reduces and shows reduction in pain intensity among patients undergoing repeat ESWL. Hence, anxiety reducing methods should be explored in patients undergoing ESWL to avoid unnecessary analgesic use.
Collapse
Affiliation(s)
- Vethunan Tamalvanan
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Retnagowri Rajandram
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shanggar Kuppusamy
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Division of Urology, Department of Surgery, University Malaya Medical Centre, Kuala Lumpur, Malaysia
- * Correspondence: Shanggar Kuppusamy, Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia (e-mail: )
| |
Collapse
|
4
|
Johnson BA, Akhtar A, Crivelli J, Steinberg RL, Sasaki J, Street A, Antonelli JA, Pearle MS. Impact of an Enhanced Recovery After Surgery Protocol on Unplanned Patient Encounters in the Early Postoperative Period After Ureteroscopy. J Endourol 2022; 36:298-302. [PMID: 34569278 DOI: 10.1089/end.2021.0435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction: Ureteroscopy (URS) is associated with substantial patient-perceived morbidity. To improve the patient experience, we developed an enhanced recovery after surgery (ERAS) protocol for URS. We sought to determine if an ERAS protocol could reduce unplanned patient-initiated encounters. Materials and Methods: The ERAS protocol involves the preoperative administration of four medications to patients undergoing URS. We reviewed data on 100 consecutive patients undergoing URS with ureteral stent placement between April 2018 and August 2018. All unplanned postoperative encounters, including phone calls and electronic medical record messages, unplanned urology outpatient visits, emergency department (ED) visits, and re-admissions within 30 days of surgery, were recorded. A control group of patients undergoing URS between July 2013 and November 2014 served as a comparison group. Propensity score matching was performed. Statistical analysis included Mann-Whitney U test, Student's t-test, and Fischer's exact test. Univariable and multivariable (MVA) analyses were performed. Results: Using propensity score matching, 71 pre-ERAS (median age 57 years, interquartile range [IQR] 44-65) and 71 post-ERAS (median age 56 years, IQR 47-68) patients were compared. Although ED visits and postoperative readmissions were comparable between the two groups, significantly more unplanned phone calls/messages occurred in the pre-ERAS group than in the post-ERAS group (71 vs 27, respectively, p < 0.001). MVA regression analysis identified the ERAS protocol as a significant independent predictor of fewer patient calls (odds ratio 0.24, 95% confidence interval 0.12-0.50, p < 0.001). Conclusions: Analysis of an ERAS protocol for patients undergoing URS showed a reduction in unplanned patient-initiated communication, with implementation of the protocol. ClinicalTrials.gov: NCT04112160.
Collapse
Affiliation(s)
- Brett A Johnson
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Abdulhadi Akhtar
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joseph Crivelli
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ryan L Steinberg
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jun Sasaki
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Austin Street
- Department of Anesthesiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jodi A Antonelli
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Margaret S Pearle
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Charles and Jane Pak Center for Mineral Metabolism, Dallas, Texas, USA
| |
Collapse
|
5
|
Bevill MD, Schubbe ME, Flynn KJ, Said MA, Ten Eyck P, Tracy CR. PROSPECTIVE COMPARISON OF OPIOID VERSUS NON-OPIOID PAIN REGIMEN AFTER URETEROSCOPY. J Endourol 2022; 36:734-739. [DOI: 10.1089/end.2021.0719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mark D Bevill
- University of Iowa, Urology, Iowa City, Iowa, United States
| | | | - Kevin J. Flynn
- University of Iowa, Urology, Iowa City, Iowa, United States
| | | | - Patrick Ten Eyck
- University of Iowa, Biostatistics, Iowa City, Iowa, United States
| | - Chad Robert Tracy
- University of Iowa, Urology, 200 Hawkins Dr., 3 RCP, Iowa City, Iowa, United States, 52242-1089, ,
| |
Collapse
|
6
|
Batra R, Batra P, Garg S, Yadav S. Evaluation of ureterorenoscopy with semirigid ureteroscope and laser lithotripsy as a treatment modality for upper ureteric stones less than 20 mm. JOURNAL OF MAHATMA GANDHI INSTITUTE OF MEDICAL SCIENCES 2021. [DOI: 10.4103/jmgims.jmgims_80_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
7
|
Pergolizzi JV, Magnusson P, Raffa RB, LeQuang JA, Coluzzi F. Developments in combined analgesic regimens for improved safety in postoperative pain management. Expert Rev Neurother 2020; 20:981-990. [PMID: 32749896 DOI: 10.1080/14737175.2020.1806058] [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] [Indexed: 10/23/2022]
Abstract
Introduction: Fixed-dose combination analgesic regimens may be similarly effective to opioid monotherapy but with potentially less risk. A number of individualized combination regimens can be created, including nonopioid agents such as acetaminophen and nonsteroidal anti-inflammatory drugs, opioids, and adjunctive agents such as gabapentin, pregabalin, and muscle relaxants. Areas covered: When such combinations have a synergistic effect, analgesic benefits may be enhanced. Many combination analgesic regimens are opioid sparing, which sometimes but not always results in reduced opioid-associated side effects. Safety concerns for all analgesics must be considered but postoperative analgesia is typically administered for a brief period (days), reducing risks that may occur with prolonged exposure. Expert opinion: Judiciously considered combination analgesic regimens can be effective postoperative analgesics that reduce opioid consumption without compromising pain control, which are important factors for patient recovery and satisfaction. The specific combinations used must be based on the patient, the type and duration of the surgical procedure, and complementary mechanisms of action of the agents used. In opioid-sparing combination analgesic regimens, the short-term use of small doses of opioids in this setting may be helpful for appropriate patients.
Collapse
Affiliation(s)
| | - Peter Magnusson
- Centre for Research and Development, Uppsala/Region Gävleborg , Gävle, Sweden.,Department of Medicine, Cardiology Research Unit, Karolinska Institutet , Stockholm, Sweden
| | - Robert B Raffa
- Professor Emeritus and past Chair, Temple University School of Pharmacy , Philadelphia, Pennsylvania, USA.,Department of Pharmacology, University of Arizona College of Pharmacy , Tucson, Arizona, USA.,CSO, Neumentum , Palo Alto, California, USA
| | - Jo Ann LeQuang
- Pain Medicine, NEMA Research, Inc , Naples, Florida, USA
| | - Flaminia Coluzzi
- Department Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome , Rome, Italy
| |
Collapse
|
8
|
Singh NP, Boyd CJ, Poore W, Wood K, Assimos DG. Obesity and Kidney Stone Procedures. Rev Urol 2020; 22:24-29. [PMID: 32523468 PMCID: PMC7265183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Obesity is a chronic disease that has increased in prevalence in the United States and is a risk factor for the development of nephrolithiasis. As with other medical conditions, obesity should be considered when optimizing surgical management and choosing kidney stone procedures for patients. In this review, we outline the various procedures available for treating stone disease and discuss any discrepancies in outcomes or complications for the obese cohort.
Collapse
Affiliation(s)
- Nikhi P Singh
- University of Alabama-Birmingham School of Medicine Birmingham, AL
| | - Carter J Boyd
- University of Alabama-Birmingham School of Medicine Birmingham, AL
| | - William Poore
- University of Alabama-Birmingham School of Medicine Birmingham, AL
| | - Kyle Wood
- Department of Urology, University of Alabama-Birmingham Birmingham, AL
| | - Dean G Assimos
- Department of Urology, University of Alabama-Birmingham Birmingham, AL
| |
Collapse
|
9
|
Komeya M, Odaka H, Asano J, Asai T, Saigusa Y, Ogawa T, Yao M, Matsuzaki J. Development and internal validation of a nomogram to predict perioperative complications after flexible ureteroscopy for renal stones in overnight ureteral catheterization cases. World J Urol 2019; 38:2307-2312. [PMID: 31784774 DOI: 10.1007/s00345-019-03023-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/12/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To identify risk factors by developing and internally validating a nomogram for preventing perioperative complications in overnight ureteral catheterization cases after fURS for kidney stones. METHODS We retrospectively examined 309 patients with overnight ureteral catheterization after single fURS procedures for renal stones. fURS procedures were performed based on the fragmentation technique. The ureteral catheter was removed on postoperative day 1. Within this group, patients who experienced perioperative complications (complication group) were compared with those who did not experience complications (non-complication group). The complication group included 77 patients whose Clavien-Dindo classification score was I, II, III, or IV and/or those whose body temperature during hospitalization was over 37.5 °C. RESULTS The overall stone volume, stone-free rate, incidence of perioperative complications, and procedure duration were 1.39 mL, 94.8%, 24.9%, and 62 min, respectively. Severe complications of a Clavien-Dindo level III or IV were observed in only four cases (1.3%). Multivariate assessment revealed five independent predictors of perioperative complications after fURS with overnight catheterization: age (p = 0.11), sex (p = 0.067), stone volume (p = 0.33), Hounsfield units (p = 0.16), and narrow ureter (p = 0.018). We developed a nomogram to predict perioperative complications after fURS using these parameters. CONCLUSIONS We developed a predictive model for perioperative complications of patients with overnight catheterization after fURS for renal stones. This model could select patients who were at a low risk of complications.
Collapse
Affiliation(s)
- Mitsuru Komeya
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan. .,Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-ku, Yokohama, Kanagawa, 221-0014, Japan.
| | - Hisakazu Odaka
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-ku, Yokohama, Kanagawa, 221-0014, Japan
| | - Jun Asano
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-ku, Yokohama, Kanagawa, 221-0014, Japan
| | - Takuo Asai
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-ku, Yokohama, Kanagawa, 221-0014, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Takehiko Ogawa
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
| | - Junichi Matsuzaki
- Department of Urology, Ohguchi East General Hospital, 2-19-1 Irie, Kanagawa-ku, Yokohama, Kanagawa, 221-0014, Japan
| |
Collapse
|
10
|
New Persistent Opioid Use After Outpatient Ureteroscopy for Upper Tract Stone Treatment. Urology 2019; 134:103-108. [PMID: 31536742 DOI: 10.1016/j.urology.2019.08.042] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To measure the incidence of persistent opioid use following ureteroscopy (URS). Over 100 Americans die every day from opioid overdose. Recent studies suggest that many opioid addictions surface after surgery. METHODS Using claims data, we identified adults who underwent outpatient URS for treatment of upper tract stones between January 2008 and December 2016 and filled an opioid prescription attributable to URS. We then measured the rate of new persistent opioid use-defined as continued use of opioids 91-180 days after URS among those who were previously opioid-naive. Finally, we fit multivariable models to assess whether new persistent opioid use was associated with the amount of opioid prescribed at the time of URS. RESULTS In total, 27,740 patients underwent outpatient URS, 51.2% of whom were opioid-naïve. Nearly 1 in 16 (6.2%) opioid-naïve patients developed new persistent opioid use after URS. Six months following surgery, beneficiaries with new persistent opioid use continued to fill prescriptions with daily doses of 4.2 oral morphine equivalents. Adjusting for measured sociodemographic and clinical differences, patients in the highest tercile of opioids prescribed at the time of URS had 69% higher odds of new persistent opioid use compared to those in the lowest tercile (odds ratio, 1.69; 95% CI, 1.41-2.03). CONCLUSION Nearly 1 in 16 opioid-naive patients develop new persistent opioid use after URS. New persistent opioid use is associated with the amount of opioid prescribed at the time of URS. Given these findings, urologists should re-evaluate their post-URS opioid prescribing patterns.
Collapse
|
11
|
Hamidi N, Ozturk E, Yikilmaz TN, Atmaca AF, Basar H. The effect of corticosteroid on postoperative early pain, renal colic and total analgesic consumption after uncomplicated and unstented ureteroscopy: a matched-pair analysis. World J Urol 2018; 36:979-984. [PMID: 29396787 DOI: 10.1007/s00345-018-2210-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 01/24/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To evaluate the effect of corticosteroid (CS) on early postoperative pain, renal colic and total analgesic consumption after uncomplicated and unstented ureteroscopy (URS). METHODS Data of 397 patients who underwent URS and stone fragmentation for symptomatic distal ureteral stone (≤ 15 mm) were retrospectively evaluated. After exclusion, 72 patients who received methylprednisolone (Group I) after non-stenting uncomplicated URS were matched with another 72 patients who did not receive CS (Group II). Cases were matched 1:1 ratio and the matched-pair criteria were age, stone diameter, and duration of surgery. RESULTS Both groups were statistically similar in terms of mean age, operative time, stone size and preoperative pain score. However, the mean postoperative pain score was statistically significantly lower in group I than group II on the day of surgery (3.3 ± 1.7 vs. 3.9 ± 1.3, p = 0.012) and postoperative day 1 (2.8 ± 1.8 vs. 3.4 ± 1.3, p = 0.02), respectively. Renal colic episode development rate (4.2 vs. 13.2%, p = 0.036), parenteral analgesic requirement rate (18.1 vs. 33.3%, p = 0.001) and total parenteral analgesic consumption per patient (18 vs. 36mg, p = 0.009) were statistically lower in group I than group II on the day of surgery; however, there were no statistically significant differences on postoperative day 1. There were no statistically significant differences between groups in terms of ureteral stenting requirement and late unplanned urgent room visit rates. CONCLUSIONS Corticosteroid after uncomplicated URS can be offered to reduce early postoperative pain, renal colic episode and total analgesic consumption.
Collapse
Affiliation(s)
- Nurullah Hamidi
- Department of Urology, Atatürk Training and Research Hospital, Ankara, Turkey.
| | - Erdem Ozturk
- Department of Urology, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Taha Numan Yikilmaz
- Department of Urology, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| | - Ali Fuat Atmaca
- Department of Urology, Atatürk Training and Research Hospital, Ankara Yildirim Beyazit University School of Medicine, Ankara, Turkey
| | - Halil Basar
- Department of Urology, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
12
|
Gul Z, Alazem K, Li I, Monga M. Predicting procedural pain after ureteroscopy: does hydrodistention play a role? Int Braz J Urol 2017; 42:734-9. [PMID: 27564284 PMCID: PMC5006769 DOI: 10.1590/s1677-5538.ibju.2015.0275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 10/15/2015] [Indexed: 11/29/2022] Open
Abstract
Purpose: To identify perioperative predictors of immediate pain after ureteroscopy, specifically evaluating the impact of hydrodistention from irrigation on pain. Materials and Methods: We retrospectively identified patients who underwent ureteroscopy for the treatment of calculi. Data recorded for these patients included their maximum pain score in the post-anesthesia care unit (PACU), average flow rate of irrigant used during the procedure, patient and stone characteristics, operative procedure, and details of patients' immediate, post-operative course. Spearman's rho was used to determine the relationship between non-parametric, continuous variables. Then, a linear regression was performed to assess which variables could predict the peak pain score. Results: A total of 131 patients were included in the study. A non-parametric correlation analysis revealed that maximum pain score was negatively correlated with being male (r = −0.18, p=0.04), age (r = −0.34, p<0.001), and post-op foley placement (r = −0.20, p=0.02) but positively correlated with the preoperative pain score (r = 0.41, p<0.001), time in the PACU (r = 0.19, p = 0.03), and the morphine equivalent dose (MED) of narcotics administered in the PACU (r = 0.67, p<0.001). On linear regression, the significant variables were age, preoperative pain score, and stent placement. For every ten-year increase in age post-operative pain score decreased by 4/10 of a point (p = 0.03). For every 1 point increase in preoperative pain score there was a 3/10 of a point increase in the maximum pain score (p = 0.01), and leaving a stent in place post-operatively was associated with a 1.6 point increase in the maximum pain score. Conclusions: Hydrodistention does not play a role in post-ureteroscopy pain. Patients who are younger, have higher preoperative pain scores, or who are stented will experience more post-operative pain after ureteroscopy.
Collapse
Affiliation(s)
- Zeynep Gul
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Kareem Alazem
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, Ohio, USA
| | - Ina Li
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, Ohio, USA
| | - Manoj Monga
- Cleveland Clinic, Glickman Urological and Kidney Institute, Cleveland, Ohio, USA
| |
Collapse
|
13
|
Determinants of health-related quality of life for patients after urinary lithotripsy: ureteroscopic vs. shock wave lithotripsy. Urolithiasis 2017; 46:203-210. [DOI: 10.1007/s00240-017-0972-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 03/03/2017] [Indexed: 10/19/2022]
|
14
|
Kim SW, Ahn JH, Yim SU, Cho YH, Shin BS, Chung HS, Hwang EC, Yu HS, Oh KJ, Kim SO, Jung SI, Kang TW, Kwon DD, Park K. Clinical factors associated with postoperative hydronephrosis after ureteroscopic lithotripsy. Investig Clin Urol 2016; 57:343-50. [PMID: 27617316 PMCID: PMC5017563 DOI: 10.4111/icu.2016.57.5.343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/04/2016] [Indexed: 12/29/2022] Open
Abstract
Purpose This study aimed to determine the predictors of ipsilateral hydronephrosis after ureteroscopic lithotripsy for ureteral calculi. Materials and Methods From January 2010 to December 2014, a total of 204 patients with ureteral calculi who underwent ureteroscopic lithotripsy were reviewed. Patients with lack of clinical data, presence of ureteral rupture, and who underwent simultaneous percutaneous nephrolithotomy (PNL) were excluded. Postoperative hydronephrosis was determined via computed tomographic scan or renal ultrasonography, at 6 months after ureteroscopic lithotripsy. Multivariable analysis was performed to determine clinical factors associated with ipsilateral hydronephrosis. Results A total of 137 patients were enrolled in this study. The mean age of the patients was 58.8±14.2 years and the mean stone size was 10.0±4.6 mm. The stone-free rate was 85.4%. Overall, 44 of the 137 patients (32.1%) had postoperative hydronephrosis. Significant differences between the hydronephrosis and nonhydronephrosis groups were noted in terms of stone location, preoperative hydronephrosis, impacted stone, operation time, and ureteral stent duration (all, p<0.05). On multivariable analysis, increasing preoperative diameter of the hydronephrotic kidney (adjusted odds ratio [OR], 1.21; 95% confidence interval [CI], 1.12–1.31; p=0.001) and impacted stone (adjusted OR, 3.01; 95% CI, 1.15–7.61; p=0.031) independently predicted the occurrence of postoperative hydronpehrosis. Conclusions Large preoperative diameter of the hydronephrotic kidney and presence of impacted stones were associated with hydronephrosis after ureteroscopic stone removal. Therefore, patients with these predictive factors undergo more intensive imaging follow-up in order to prevent renal deterioration due to postoperative hydronephrosis.
Collapse
Affiliation(s)
- Sun Woo Kim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Ji Hoon Ahn
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Sang Un Yim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Yang Hyun Cho
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Bo Sung Shin
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Seok Chung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Ho Song Yu
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Jin Oh
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Sun-Ouck Kim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Il Jung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Taek Won Kang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Kwangsung Park
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| |
Collapse
|
15
|
Shipton EA. The transition of acute postoperative pain to chronic pain: Part 1 – Risk factors for the development of postoperative acute persistent pain. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2014. [DOI: 10.1016/j.tacc.2014.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|