Could pain change position choice? Comparison of pain level, analgesic requirement and hospitalization time in supine and prone percutaneous nephrolithotomy

PURPOSE

Investigation of how position affects postoperative pain levels and hospitalization in patients undergoing percutaneous nephrolithotomy (PNL) surgery.

METHODS

Between August 2019 and December 2022, a total of 156 patients who underwent prone (pPNL) and supine percutaneous nephrolithotomy (sPNL) due to kidney stones were included in the study. Demographic data, preoperative CT scans, laboratory results, transfusion rates, operation durations, complication rates, stone-free rates, analgesic use, nephrostomy removal time, hospitalization duration, fluoroscopy time, hemoglobin decrease and postoperative Visual Analog Scale (VAS) scores were evaluated for all patients. By comparing these data between the sPNL and pPNL groups, the effect of position selection in PNL on pain control, analgesic requirement, and hospitalization duration was examined.

RESULTS

In the comparison of the pPNL and sPNL groups, there was a significant difference between the two groups in body mass index, hounsfield unit, complication rate, analgesic rate, nephrostomy remove time, hospitalization time, operation time, fluoroscopy time and VAS score (p = 0.025, p < 0.001, p = 0.012, p = 0.012, p < 0.001, p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively).

CONCLUSION

The shorter operation and hospitalization time in the sPNL group could be attributed to performing surgeries in a physiological position. Additionally, sPNL seems advantageous in terms of patients' pain levels, hospitalization time and VAS scores. One reason for this could be the different areas of access in sPNL and pPNL, which may correspond to different dermatome regions. Considering the low level of pain and reduced analgesic usage, sPNL appears to be advantageous.

Female sexual dysfunction in urinary and double incontinence

OBJECTIVES

To evaluate the sexual function of women with urinary incontinence (UI) and double incontinence (DI) comparing with a healthy control group by using the Female Sexual Function Index (FSFI).

METHODS

This study was designed as a retrospective study consisting of UI, DI, and a control group, each containing age-matched 40 patients. Statistical comparisons were made among the UI, DI, and control groups in terms of the FSFI total score as well as each domain's score.

RESULTS

The FSFI total scores were found to be 22.92, 20.53, and 20.32 for the control, UI, and DI groups, respectively, and no statistically significant difference was found among the groups. A statistically significant difference existed among the groups only in terms of satisfaction and pain. Significantly higher pain was found in the UI and DI groups compared with the control group (p=0.007 and p<0.001). Although there was significantly lower satisfaction in the DI group compared with the control group (p=0.012), no significant difference was found between the UI and control groups.

CONCLUSION

The pain in the UI group and the pain and the low satisfaction in the DI group might be parameters that cause sexual dysfunction.

External validation of a prostate cancer nomogram on magnetic resonance/transrectal ultrasound fusion biopsy in men with prior negative systematic biopsy

OBJECTIVE

To observe how the nomogram, which was created by Truong et al, works in an independent patient group by performing external validation.

PATIENTS AND METHODS

One hundred and eighty-one patients who had at least one prior negative 12-core standard systematic biopsy and lesions with PI-RADS scores of 3 or higher that were detected as a result of mpMRI were included in the study. Targeted biopsy with 12-core standard systematic biopsy was performed on all patients. Clinical and pathological features of the patients were recorded. The discrimination, calibration and decision curve analysis were performed to externally validate the nomogram.

RESULTS

A total of 181 patients with previous negative 12-core systematic biopsies were analysed. One hundred and thirty-four patients (74%) had benign pathology. Radiological volume and PI-RADS scores of 4 and 5 were found as independent predictors of benign pathology. The area under the curve (CI 95%) was found to be 0.80 (0.73-0.87), indicating good discrimination. The median residual was calculated as -0.0873, the intercept as -0.0690, the slope as 0.8927 and r² as 0.2586, indicating good calibration. The standardised net benefit of follow-up decisions was found to be 0.54 and 0.36 at the probability threshold of 0.7 and 0.8, respectively.

CONCLUSION

The original model showed good discrimination and calibration with our data. Defining a high probability threshold for clinical use would be appropriate for centres with high benign biopsy rates similar to our centre.

[Comparison of magnetic resonance imaging-transrectal ultrasound fusion prostate biopsy with standard systematic biopsy: A single center experience.]

OBJECTIVE

To compare systematic biopsy with MRI-TRUS fusion prostate biopsy in terms of cancer detection rates.

PATIENTS AND METHODS

The data of the patients who had a Prostate Imaging Reporting and Data System (PI-RADS) score of 3 or more lesions on mpMRI and underwent MRI-TRUS fusion biopsy with simultaneous 12-core standard systematic biopsy from June 2016 to June 2019 in our tertiary center were retrospectively reviewed. Clinical, radiological and pathological data were recorded. Statistical difference among the groups was determined by using McNemar tests.

RESULTS

A total of 344 patients were included in the study. As a result of transrectal targeted and systematic combined biopsy, 117 patients were diagnosed with prostate cancer. Benign pathology rates in patients with PI-RADS 3, PI-RADS 4, and PI-RADS 5 lesions were 93.8%, 68.5%, and 46.4%, respectively. Patients were divided into two groups as ISUP grade 1 and ISUP grade ≥2 and cancer detection rates (CDRs) were found significantly higher in transrectal targeted biopsy compared with the systematic biopsy (12.5% vs. %6.4, p=0.007 and 17.4% vs. 8.7%, p<0.001, respectively). Targeted biopsy CDRs were found significantly higher in the high PSA density group (24.5% vs. 41.4%, p=0.001) unlike the systematic biopsy.

CONCLUSION

Transrectal targeted biopsy was superior to systematic biopsy in the diagnosis of prostate cancer. Clinicians should be more selective when making a biopsy decision for patients with PI-RADS 3 lesions. PSA density can be used as a criterion for patient selection for targeted biopsy.

Which of us were more affected by the pandemic? The psychiatric impacts of the COVID-19 pandemic on healthcare professionals in the province where the first quarantine units were established in Turkey

INTRODUCTION

Psychiatric problems, such as stress and anxiety disorders, are encountered amongst healthcare professionals fighting epidemics. Considering that COVID-19 suddenly became a pandemic and healthcare professionals have not had access to sufficient information, it is a fact that healthcare professionals have been affected on a large scale. Heavy workloads, insufficient equipment and anxiety over families increase this impact. We aimed to investigate the extent to which healthcare professionals have been psychologically affected by COVID-19 and related factors.

METHODOLOGY

Data obtained through questionnaires completed by 348 healthcare professionals working during the COVID-19 pandemic and 350 participants who are in the control group were investigated. The Impact of Event Scale-revised (IES-R) for post-traumatic stress disorder (PTSD) and the Severity Index (ISI) for insomnia were used. Differences regarding gender, occupation, age group, marital status and sub-groups were statistically analysed.

RESULTS

Of the 348 healthcare professionals, 176 (50.6%) were women and 172 (49.4%) men, while 190 (54.6%) were doctors and 158 (45.4%) nurses. The incidence of PTSD was statistically significantly higher in the healthcare professionals group than in the control group (P < .001). The incidence of PTSD was statistically significantly higher amongst nurses (P = .001), women (P = .002) and those who were married (P = .007). Both PTSD and insomnia were found to be statistically significantly higher amongst those working in the "area of final diagnosis" (P = .016 and P = .002, respectively).

CONCLUSIONS

The determination of the groups most affected amongst professionals working in epidemics is important for the planning of in-service training and psychological support studies. If the fight against pandemics includes health teams with strong psychological grounding, it leads to qualified medical care for patients.

The effect of COVID-19 epidemic on the sexual function of healthcare professionals

Studies have shown that healthcare professionals struggling with epidemics develop symptoms of post‐traumatic stress disorder. The aim of this study is to show how often and severely erectile dysfunction, one of the components of post‐traumatic stress disorder, is seen among healthcare professionals during COVID‐19 outbreak. The Impact of Event Scale‐Revised (IES‐R) and the Index of Erectile Function‐5 (IIEF‐5) were applied to 159 male healthcare professionals working in COVID‐19 units and a control group of 200 people. Healthcare professional group was divided into subgroups according to occupation (physician, nurse), age‐group (18–25, 26–30, >30), marital status and unit of work (Suspected Patient Area, Diagnosed Patient Area). Both stress disorder and erectile dysfunction were seen at higher rates in healthcare professionals group (p < .001). The median IIEF‐5 scores of nurses, married subjects and those working in the Diagnosed Patient Area, were found to be higher (p < .001, p = .014, p = .011 respectively). During the COVID‐19 outbreak, healthcare professionals are exposed to psychological trauma and their sexual function may be negatively affected. The measures to be taken are important to estimate which groups are more affected.

Efficiency of radiation-free retrograde intrarenal surgery (RIRS) in children and evaluation of factors affecting surgical success

OBJECTIVE

To investigate the factors affecting surgical success rates and duration of operation in retrograde intrarenal surgery (RIRS) without fluoroscopy in children. The aim of the study was to demonstrate the efficacy of RIRS without fluoroscopy on the treatment of renal stones in children. MATERIALS AND METHODS: All RIRS procedures were performed on pediatric patients at our clinic from August 2013 to January 2017. We studied 52 pediatric patients who had one stone in one kidney and under went one session. We mapped the kidney collecting system anatomically, and stone localization was defined according to this mapping. Size and localization of the stone, placement of preoperative J stent, use of ureteral access sheath (UAS), and surgical success rates were recorded. The effects of these factors on surgical success rates and the duration of the operations were analyzed.

RESULTS

Each patient underwent RIRS once. Of these 52 pediatric patients, 23 (44%) were between 0-5 years of age children (Group 1), 13 (25%) were between 6-11 years of age children (Group 2), and 16 (31%) were between 11-17 years of age children (Group 3). The surgical success rates for each group were 65%, 77%, and 81%, respectively (73% overall). The surgical success rates were found to be affected only by stone size (p<0.01). The durations of the operations were found to be affected by stone size, stone localization, passive dilatation of ureter, and the application of an UAS (p<0.05).

CONCLUSION

RIRS is a safe and effective method for the treatment of intrarenal stones in pediatric patients. High success rates can be achieved using kidney mapping without the use of fluoroscopy.

The efficacy of Tadalafil 5mg in the treatment of lower urinary tract symptoms in patients where alpha blocker treatments have failed in terms of lower urinary tract symptoms

OBJECTIVES

To investigate the efficacy of tadalafil 5mg in patients with lower urinary tract symptoms who failed alpha blocker treatment.

PATIENTS AND METHODS

Twenty-three patients were included. Patient consent was obtained after explaining the efficacy of tadalafil 5mg in lower urinary tract symptoms. Before initiating tadalafil 5mg treatment, prostate cancer and urinary tract infection in the patients were eliminated. IPSS, IIEF-5 and Qmax values were assessed before and one month after tadalafil 5mg treatment. Difference between two assessments was evaluated by the Wilcoxon method.

RESULTS

After 1 month of Tadalafil 5mg treatment, IPSS decreased and IIEF-5 and Qmax increased. The difference between two assessments were statistically significant.

CONCLUSION

Tadalafil 5mg once daily in the treatment of BPH/LUTS is found to be successful in patients who failed previous alpha blocker treatment.

Prognostic role of preoperative albumin to globulin ratio in predicting survival of clear cell renal cell carcinoma

Purpose:

To investigate the prognostic role of preoperative albumin/globulin ratio (AGR) in predicting disease-free survival (DFS) and overall survival (OS) in localized and locally advanced clear cell renal cell carcinoma (RCC) patients.

Patients and Methods:

162 patients who met the criteria specified were included in the study. The DFS and OS ratios were determined using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed to determine the prognostic factors affecting DFS and OS.

Results:

Median follow-up period was 27.5 (6-89) months. There was a statistically significant relationship between low AGR and high pathological tumor (pT) stage, presence of collecting system invasion, presence of tumor necrosis, and a high platelet count (p = 0.012, p = 0.01, p = 0.001, and p = 0.004, respectively). According to the Kaplan-Meier survival analysis, both OS and DFS were found to be significantly lower in the low AGR group (p = 0.006 and p = 0.012). In the multivariate Cox regression analysis, collecting system invasion and tumor necrosis were found to be independent prognostic factors in predicting OS and pT stage was found to be an independent prognostic factor in predicting DFS (HR: 4.08, p = 0.043; HR: 8.64, p = 0.003 and HR: 7.78, p = 0.041, respectively).

Conclusion:

In our study, low AGR was found to be associated with increased mortality and disease recurrence in localized and locally advanced RCC.