Impact of modern media on analgesic requirements during extracorporeal shockwave lithotripsy.

BACKGROUND: In Australia, shockwave lithotripsy (SWL) to treat urinary tract stones is routinely performed with general anaesthesia (GA). We have established a SWL service avoiding GA based outside operating theatres and wish to assess the effectiveness of utilizing modern media on patient satisfaction and analgesic requirements during treatment. METHODS: A randomized three-arm trial was performed. Patients were allocated to either watching videos or listening to music on a tablet device, or to getting no media distraction. A total of 95 patients were recruited in a 1:1:1 fashion. Analgesic requirements were recorded during the procedure and patients were asked to fill out a questionnaire with a visual analogue scale to assess their overall pain and satisfaction with the procedure. RESULTS: Overall pain scores were decreased - the sound media group reported a mean pain score of 3.52 (P = 0.005), the visual group was 3.62 (P = 0.007), compared to 5.45 in the control group. Analgesic requirements were significantly decreased when compared to the control group (P = 0.05). Overall satisfaction with the procedure was improved in the treatment groups, with the sound group having the best result (P = 0.04). CONCLUSION: Modern media can be used as a distraction during SWL in a safe and effective way when treating renal tract stones without GA. Analgesic requirements are decreased significantly, therefore decreasing any potential side-effects and complications. Other departments in Australia should consider using this technique.

Evaluation of novel technique for studying ureteral function in vivo.

BACKGROUND AND PURPOSE: Knowledge of the ureteral response to instrumentation is limited. Ureterodynamic parameters such as intraureteral pressure, conduction velocity, direction of peristalsis, and electromyography have been measured using a variety of methods; however, these techniques are impractical for routine clinical use. The aim of this study was to evaluate a new commercial ureteral pressure transducer catheter, which records peristaltic frequency, conduction velocity, and intraureteral pressure. This device was assessed in an animal model and in patients who had undergone ureteroscopy. MATERIALS AND METHODS: An ambulatory urodynamic monitoring system was adapted to record the output from two pressure transducers mounted on a 4F ureteral catheter, which was inserted into the left ureters of six anesthetized pigs to record peristalsis. In six patients who had undergone ureteroscopy with or without stone removal, the recording catheter was inserted at the end of the procedure, and recovery of peristalsis was monitored for as long as 24 hours. RESULTS: The un-instrumented pig ureter showed spontaneous peristalsis immediately on catheter insertion, whereas the instrumented human ureter displayed a variable response that appeared to be related to previous physical or pharmacologic effects. CONCLUSIONS: Peristaltic frequency, pressure, and conduction velocity can be measured with the ureteral catheter described in both the experimental and clinical settings. Within the first 24 hours after ureteroscopy, peristaltic recovery is variable. Such information may enable both elucidation of the underlying mechanisms and improvement in the treatment of a variety of upper urinary-tract disorders.

Improving outcomes in urological cancers: the impact of "multidisciplinary team meetings".

INTRODUCTION: In order to improve the outcomes of urological cancers, guidelines published by the National Institute of Clinical Excellence encourage the management of cancer patients by specific Multi-Disciplinary Teams (MDTs) with discussion of cancer patients at MDT Meetings. The aim of this prospective study was to examine the changes in management resulting from review at MDT Meetings in our unit. METHODS: Over a six month period 124 cancer cases were discussed at 10 meetings. Prior to the meetings consultants completed a form stating their proposed management and whether they thought this would be changed after discussion. At the meeting histological, radiological and clinical data were reviewed and a collective decision about the optimal treatment was made. Any changes were recorded. RESULTS: Two of 124 cases had their clinical management changed as a result of the meeting. These were identified (amongst 10 others) as potential 'change cases' prior to the meeting. Four changes were made to histological reports and 1 to radiology; none of these affected clinical management. CONCLUSION: Discussion of cancer cases at MDMs made no difference to the clinical management in over 98% of cases. Consultants correctly identified cases requiring discussion, indicating that a selective rather than blanket approach would be appropriate. This has the potential to reduce the considerable costs involved without affecting patient care.