The Effect of Local Anesthetic Infiltration Around Nephrostomy Tract on Postoperative Pain Control after Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis.

OBJECTIVES: To assess the safety and efficacy of local anesthetic infiltration around nephrostomy tract on postoperative pain control after percutaneous nephrolithotomy. METHODS: This systematic review was performed based on randomized clinic trials about local anesthetic infiltration around nephrostomy tract on postoperative pain control. The weighted mean difference (WMD), with their corresponding 95% CI, was calculated to compare continuous variables. RESULTS: Our results showed that the consumption of analgesic was less in the experimental group than in the control group (WMD -25.32, 95% CI -48.09 to -2.55, p = 0.003). There was no significant difference between the mean Visual Analog Scale (VAS) in the experimental group than the control group after 6 h while significantly lower after 24 h. The time of first analgesic demand was significantly longer in the experimental group (WMD 2.19, 95% CI 0.98-3.41). There was no significant difference between 2 groups in terms of operation time, hemoglobin (Hb) alteration, and hospital stay. CONCLUSION: Local anesthetic infiltration around nephrostomy tract had similar efficacy in the control group in terms of operation time, Hb alteration, and hospital stay, but offers some potential advantages in terms of analgesia requirement, the time of first analgesic demand, and VAS-24 h. However, good quality and large studies with long-term follow-up are warranted for further research.

The use of adjunctive hemostatic agents in tubeless percutaneous nephrolithotomy: a meta-analysis.

The purpose of the study was to systematically review and assess the safety and efficacy of hemostatic agents in tubeless percutaneous nephrolithotomy. Original studies on the use of hemostatic agents in tubeless percutaneous nephrolithotomy (PCNL) from January 2001 to March 2014 were searched in Ovid, Science Direct, Pubmed, and Embase by two independent reviewers. A drop in hemoglobin (Hb), analgesic requirements, length of hospital stay, and necessity for blood transfusions were compared using Review Manager 5.2. The methods were done according to the Cochrane Handbook for interventional systematic reviews and written based on the PRISMA Statement. Seven studies involving 351 patients met the inclusion criteria for the meta-analysis. The baseline characteristics were comparable in all of the studies. The results showed that the length of hospital stay was less in the experimental group than in the control group (P < 0.05). There were no significant statistical differences in terms of a drop in Hb, analgesic requirements, and the necessity for a blood transfusion between the two groups (P > 0.05). The meta-analysis indicated that the hemostatic agents in tubeless PCNL were not expected to be unsafe or mandatory, but that they were expected to be expensive. We concluded that hemostatic agents might not be necessary in tubeless PCNL.

Risk of bleeding complications after preoperative antiplatelet withdrawal versus continuing antiplatelet drugs during transurethral resection of the prostate and prostate puncture biopsy: a systematic review and meta-analysis.

OBJECTIVE: To systematically evaluate the risk of antiplatelet drugs (APs) on bleeding complications in urological surgery. METHODS: Studies were sought and included in this review if they were clinical controlled trials and involved transurethral resection of the prostate (TURP) and prostate puncture biopsy (PPB), which compared preoperative AP withdrawal (control group) with continuing APs (experimental group) and revealed bleeding complications as outcomes. A literature search was conducted of the electronic databases PubMed, Ovid, ScienceDirect and Embase for studies published between 1990 and 2012. Two reviewers independently screened the studies for eligibility, evaluated the quality and extracted the data from the eligible studies, with confirmation by cross-checking. There was evidence of publication bias based on Egger's test and funnel plot. Data were processed using Cochrane Review Manager 5.0 software. RESULTS: Nine studies involving 3,145 cases met the inclusion criteria and were included in the meta-analysis. The baselines of patients' characteristics were comparable in all studies. The meta-analysis results showed that no differences were found in risk of bleeding after (1) TURP (OR 1.26, 95% CI 0.80-2.00, p = 0.32) or (2) PPB (OR 0.89, 95% CI 0.45-1.76, p = 0.73). CONCLUSION: Preoperative APs do not raise the risk of surgical bleeding complications in prostatectomy and PPB. Because of few studies and small samples, more high-quality trials with larger samples and longer follow-ups are proposed.