Factors associated with complications after percutaneous nephrolithotomy: an analysis of 1,066 cases

SUMMARY OBJECTIVE: The aim of this study was to identify predictive factors for complications after percutaneous nephrolithotomy. METHODS: We prospectively analyzed patients who underwent percutaneous nephrolithotomy from June 2011 to October 2018. The association of preoperative and intraoperative factors with the presence of complications was assessed using univariate and multivariate analyses. The significance level was set at p<0.05. RESULTS: A total of 1,066 surgeries were evaluated, and the overall complication rate was 14.9%. In all, 105 (9.8%) surgeries were performed in the prone position, and 961 (90.2%) were performed in the supine position. Univariate analysis demonstrated that surgical position, upper pole puncture, surgical time, number of tracts, and Guys Stone Score were associated with complications. In multivariate analyses, prone position (odds ratio [OR] 2.10; p=0.003), surgical time ≥90 min (OR 1.76; p=0.014), upper pole puncture (OR 2.48; p<0.001), and Guys Stone Score 3 or 4 (OR 1.90; p=0.033) were independent predictive factors for complications after percutaneous nephrolithotomy. CONCLUSION: Performing percutaneous nephrolithotomy in the supine position, in under 90 min, and avoiding upper pole punctures may reduce complications during the treatment of large kidney stones.

Ultrasound guided endoscopic combined Intrarenal surgery - 10 steps for the success

ABSTRACT Background: Endoscopic combined intrarenal surgery (ECIRS) has been used to treat complex kidney stones (1). The combined use of ultrasound (US) has the potential to improve safety and reduce radiation exposure, however, it is still underutilized (2). Objectives: Our objective is to describe, in a step-by-step manner, the ultrasound-guided ECIRS (USG ECIRS) technique, in order to facilitate learning by urologists. Materials and Methods: We describe the 10 standardized steps that we recommend to achieve a good outcome, based on our previous experience on a high-volume kidney stone center. We recorded a case of a 37-year-old female patient with complex bilateral kidney stones that underwent a left simultaneous combined retrograde and antegrade approach. The 10 described steps are: 1 - case evaluation with CT scan (3); 2 - preoperative care with antibiotics and tranexamic acid; 3 - warm-up and training with phantoms; 4 - patient positioning in Barts flank free position; 5 - retrograde nephroscopy with flexible ureteroscope; 6 - US and endoscopic guided puncture; 7 - tract dilation under endoscopic view; 8 - stone fragmentation; 9 - status free checking and 10, kidney drainage. Images were captured by external and internal cameras, promoting a complete understanding of the procedure. The patient has signed a written informed consent form. Results: Puncture was achieved under US guidance with one attempt. Another puncture was necessary in the lower pole, parallel to the initial puncture, due to a large fragment. Surgical time was 140 min. Stone-free status was verified by retrograde and antegrade view. Kidney drainage was done with ureteral stent on string, removed after 7 days. Hb drop was 1.1 Hb/dL. The first postoperative day CT scan showed no residual stones and no complications. The patient was discharged after the CT and urethral catheter removal. Conclusion: The USG ECIRS seems to be a very efficient and reproducible technique for the treatment of complex kidney stones. Its use should be widespread.

Predictive factors for success after supine percutaneous nephrolithotomy: an analysis of 961 patients

SUMMARY OBJECTIVE: The aim of this study was to evaluate the predictive factors for success following percutaneous nephrolithotomy in the supine position. METHODS: Patients who underwent percutaneous nephrolithotomy in the supine position from June 2011 to October 2018 were evaluated. Age, sex, body mass index, the American Society of Anesthesiologists physical status classification, hemoglobin level, number of previous surgeries, stone size, and the Guy's Stone Score were analyzed. Success was considered if no fragments were observed on the computed tomography scan on the first postoperative day. Univariate and multivariate analyses were performed to determine significant parameters. RESULTS: We evaluated 961 patients; of them, 483 (50.2%) underwent previous stone-related surgery, and 499 (51.9%) had Guy's Stone Score 3 or 4. The overall success rate in a single procedure was 40.7%, and complication rate was 13.7%. The univariate analysis showed that the maximum diameter of the stone (25.10±10 mm; p<0.001), previous percutaneous nephrolithotomy (OR 0.52; p<0.001), number of previous percutaneous nephrolithotomy (OR 0.15; p<0.001), the Guy's Stone Score (OR 0.28; p<0.001), and the number of tracts (OR 0.32; p<0.001) were significant. In the multivariate analysis, the number of previous percutaneous nephrolithotomy (OR 0.54; p<0.001) and the Guy's Stone Score (OR 0.25; p<0.001) were statically significant. CONCLUSIONS: Guy's Stone Score and the number of previous percutaneous nephrolithotomy are predictors of success with the supine position. Complex cases and with previous percutaneous interventions may require technical improvements to achieve higher stone-free rates.

Treatment compliance and risk and protective factors for suicide ideation to completed suicide in adolescents: a systematic review

Objective: To review the literature regarding adolescent suicide risk and explore the associations between treatment compliance (expressed as a concept including measured adherence to treatment and/or mental health service utilization) and risk and protective factors for suicidal behavior (SB), as well as the association between treatment compliance and reattempts. Methods: PubMed, LILACS, and Google Scholar were searched using the following terms: (adolescent*) AND (suicide*) AND (risk factor OR protective factors) AND (treatment compliance OR treatment attrition OR treatment adherence OR treatment drop out OR treatment retention OR mental health utilization). We retrieved studies that focused on the relation of treatment compliance to risk and protective factors for SB and that had only adolescent samples. Results: Of 4,841 articles, 30 original articles were selected for review. Most studies indicated high mental health service (MHS) utilization and poor treatment adherence by SB patients. Social minority status and conduct disorder were associated with less treatment adherence, while female sex, parental perceived need for treatment, and major depression were associated with greater treatment adherence. Inpatient and intensive emergency care after SA and family interventions improved MHS utilization and treatment compliance. However, we found no substantial protective effect of treatment compliance against reattempts. Conclusion: Effective treatment planning for compliance requires considering psychopathology, treatment planning, and social, familial, and individual factors.

Administração de BAY 41-2272 previne disfunção vesical em ratos deficientes de oxido nítrico / Administration of BAY 41-2272 prevents bladder dysfunction in nitric-oxide deficient rats

Objective: to evaluate the protective effects of BAY 41-2272, a soluble guanylate cyclase activator, on changes in cystometric parameters in rats deficient in nitric oxide (NO). Methods: Rats were divided into the following groups: (a) control; (b) DMSO; (c) L-NAME; (d) BAY 41-2272 alone; (e) L-NAME + BAY 41-2272. The NO synthase blocker L-NAME (20 mg/rat/day) was given in drinking water concomitantly or not with BAY 41-2272 (10 mg/kg/day, given by gavage). Results: Chronic L-NAME treatment markedly increased the mean arterial blood pressure, and co-treatment with BAY 41-2272 nearly reversed L-NAME-induced rise on mean arterial blood pressure. Non-void contractions were significantly increased in L-NAME group (0.90 ± 0.1 number/minute) compared with either DMSO or control group (0.49 ± 0.1 number/minute), which were prevented by co-treatment with BAY 41-2272 (0.56 ± 025 number/minute; p < 0.05). The threshold and peak pressure increased by 70 and 44%, respectively, after chronic L-NAME treatment, while co-treatment with BAY 41-2272 largely attenuated both effects (27 and 22% increase, respectively). The frequency of micturition cycles decreased by about of 50% in L-NAME-treated rats compared with control animals, and co-treatment with BAY 41-2272 normalized this parameter. Conclusions: Our data show that long-term oral administration of BAY 41-2272 counteracts the bladder dysfunction seen in NO-deficient rats, indicating that restoration of the NO-cGMP pathway by this compound may be of beneficial value to treat bladder symptoms.

Objetivo: avaliar os efeitos protetores do BAY 41-2272, um ativador solúvel da guanilato ciclase, sobre alteração dos parâmetros citométricos em ratos deficientes de óxido nítrico (NO). Métodos: os ratos foram divididos nos seguintes grupos: (a) controle; (b) DMSO (c) L-NAME; (d) BAY 41-2272 isolado; (e) L-NAME + BAY 41-2272. O bloqueador da NO-sintase L-NAME (20 mg/rato/dia) foi ministrado na água de beber, concomitantemente ou não com o BAY 41-2272 (10 mg/kg/dia, ministrado por gavagem). Resultados: o tratamento crônico com L-NAME aumentou de forma acentuada a pressão arterial média, e o co-tratamento com BAY 41-2272 quase reverteu o aumento na pressão arterial média induzido por L-NAME. Contrações não esvaziadoras da bexiga mostraram-se significativamente aumentadas no grupo L-NAME (0,90 ± 0,1 número/minuto) comparadas com DMSO ou grupo controle (0,49 ± 0,1 número/minuto), que foram evitadas pelo co-tratamento com BAY 41-2272 (0,56 ± 0,25 número/minuto; p < 0,05). O limiar e o pico de pressão aumentaram em 70 e 44%, respectivamente, após o tratamento crônico com L-NAME, enquanto o co-tratamento com BAY 41-2272 atenuou muito ambos os efeitos (27 e 22% de aumento, respectivamente). A frequência de ciclos de micção diminuiu em 50% nos ratos tratados com L-NAME em comparação aos animais controle; o cotratamento com BAY 41-2272 normalizou esse parâmetro. Conclusões: nossos dados mostram que a administração oral a longo prazo de BAY 41-2272 contrapõe-se à disfunção de bexiga vista em ratos deficientes de NO, o que sugere que a restauração da via da NO-cGMP por esse composto pode ter valor benéfico para tratar sintomas vesicais.

Fluorescencia inducida por el láser éxcimer (193 nm) en córneas cadavéricas de conejos / 193 nm excimer laser-induced fluoscence in rabbit cadaveric corneas

Observar la fluorescencia durante la ablación pulsada con láser éxcimer en córneas cadavéricas de conejos. Se expusieron 4 córneas cadavéricas de conejo a la energía del láser éxcimer de ArF a 1= 193nm. La fluorescencia resultante se registró a 45º de la incidencia del rayo y fue canalizada por un espectrómetro conectado a un analizador óptico multicanal capaz de leer un detector de diodo. La ablación continuó hasta la perforación. Los espectros obtenidos fueron sometidos a análisis por componentes principales (ACP). Se registraron los espectros del epitelio al endotelio. Se observaron cambios de espectros a medida que la ablación progresó. se evidenció una disminución obvia del pico de longitud de onda más corta a 367 nm. El ACP reveló que el espectro era consistente con datos obtenidos en córneas de humanos. Los resultados obtenidos pueden contribuir al conocimiento de los procesos que ocurren durante la ablación clínica con el láser éxcimer