The effect of anaesthesia on flank incisional pain: infiltration versus intercostal nerve block, a comparative study.

The object of this study is to determine which local wound analgesic option is superior, local anaesthetic infiltration or intercostal nerve block, by combined local anaesthetic agents (0.5% bupivacaine + 2% lidocaine) and to detect which option can best alleviate the post-operative pain management and significantly prolong the time to the first rescue analgesic requirement and the total consumption of opioids in the first post-operative 72 hrs. The medical records of 1458 patients who underwent flank incision procedures by two different surgeons in our institute were retrospectively reviewed. Each surgeon used a different type of local incisional pain management; the first one used infiltration of flank incision routinely, the second surgeon used an intercostal block with all his patients. These elective procedures were carried out in our Urology Centre between June 2007 and June 2019. The duration of follow-up was from the recovery transfer until the end of the third post-operative day. Patients were divided into two groups: group 1 (729 patients-infiltration of flank incision) and group 2 (729 patients-intercostal nerve block). Patients were aged between 19-78 years. No significant differences were seen regarding the demographic data between both groups, P > 0.05. On the other hand, there were significant differences between group 1 and group 2 according to the mean visual analogue scale score (lower in group 1, P < 0.05), the total mean analgesic requirements during the first post-operative 72 hrs (lower in group 1, P < 0.05) and the time to the first analgesic demand (higher in group 1, P < 0.05). There were no statistically significant differences in post-operative complications between both groups, P > 0.05. The infiltration of flank incision with combined local anaesthetic agents (0.5% Bupivacaine + 2% lidocaine) is more effective in alleviating post-operative pain, decreasing total analgesic consumption during the first post-operative 72 hrs and prolonging the time required for the first rescue opioid.

The impact of nephrostomy balloon inflation volume on post percutaneous nephrolithotomy hemorrhage.

INTRODUCTION: the study aims to match different volumes of nephrostomy balloon inflation to point out the foremost effective volume size of post percutaneous nephrolithotomy (PCNL) bleeding control. METHODS: we have retrospectively reviewed "560" medical records of patients who underwent percutaneous nephrolithotomy between (the years 2017 and 2018) at Prince Hussein Urology Center. The Patients were divided into two teams, group-1 (a number of 280 patients) with nephrostomy balloon inflated concerning three ml and group-2 (a number of 280 patients) the balloon inflated concerning one ml. The preoperative and postoperative hematocrit, the operation duration, the stone size, the postoperative pain severity, the transfusion rate and the duration of hematuria between the two groups were compared during hospitalization. RESULTS: regarding patients with ages (between 18 and 68 years); the preoperative hematocrit (mean values ± SDs) was (40.35% ± 3.57) vs (39.95% ± 3.43) for groups-1 and 2, respectively; the p value=0.066. The postoperative hematocrit was (37.91% ± 3.96) vs (34.38 ± 2.78), respectively; the p value was (0.008); the blood transfusion rate was 11.2% vs 13.4% (the p value was 0.039), respectively. The Postoperative pain score was (4.93 ± 1.44) vs (3.89 ± 1.45) (the p value was 0.012), respectively. CONCLUSION: increasing the nephrostomy balloon volume to a "3cc" competes for a task to decrease bleeding which was found to be as a secure and considerable effective procedure-related factor. However, the disadvantage of this technique resulted in increasing the postoperative pain in patients undergoing such a procedure.

Management of Idiopathic Retroperitoneal Fibrosis, a Retrospective Study at Prince Hussein Urology and Organ transplantation center (PHUO), Jordan.

INTRODUCTION: to study the presentation, clinical course, laboratoryresults, imaging findings, medical and urological treatments ofidiopathic retroperitoneal fibrosis at our institution. METHODS: Between January 2006 and December 2017, medical recordsand operatives' notes of 116 patients with idiopathic retroperitonealfibrosis (IPRF) were reviewed retrospectively. Diagnosis was doneby clinical and radiological imaging that fulfilled a strict criterion.All patients were initiated on Prednisolone 60 mg for two months,and reduced until reaching 10 mg daily, with a total duration of24 months in the responding patients. Renal drainage was done incases of obstructed kidneys. To assess response, both laboratoryresults and imaging studies at initiation and after 4 months werereviewed and compared. RESULTS: Of 116 patients diagnosed with IRPF, eighty five (73.3%)were male and thirty one (26.7%) female, with mean ± SD age atpresentation was (50.5 ± 10.6) years. 79% of the patients complaintof abdominal and low back pain, 27% uremic symptoms, 10.3% hada new onset of hypertension, 3.4% presented with anejaculation,and 13.8% were totally asymptomatic. Uretric obstruction hadbeen resolved in 132 ureters after a mean of 152 days of treatment.Almost 30 % reduction in the fibrotic mass size was achieved in82 % of patients. CONCLUSION: Glucocorticoids is the the mainstay of treatment. Therenal function tests, of the vast majority of patients, normalizedwith treatment. Relapse may occur, so a follow-up over a longperiod of time is required. A high index of suspicion is neededfor diagnosis in asymptomatic patients.