Comparative analysis of combined spinal-epidural anesthesia and general anesthesia in percutaneous nephrolithotomy: a prospective study on surgical team and operating room personnel satisfaction.

OBJECTIVE: We aimed to investigate the efficacy and complications of combined spinalepidural anesthesia and general anesthesia in percutaneous stone surgery prospectively. MATERIALS AND METHODS: The study prospectively included patients who underwent percutaneous nephrolithotomy with general anesthesia (Group.1) or combined spinal-epidural anesthesia (Group.2) at the Department of Urology, Training and Research Hospital, Karabuk University. between December 2018 and December 2019. The effect of the anesthesia technique on the comfort and satisfaction of the operating room personnel, surgeon and anesthesia team were prospectively evaluated and recorded. RESULTS: During the postoperative period, the spinal anesthesia group had a significantly lower visual analog score than the general anesthesia group. No patient in either group required narcotic analgesics during the postoperative period. In terms of overall satisfaction scores, the surgeon performing the surgical procedure had a significantly higher satisfaction score in the general anesthesia group than in the CSEA group. The score was considered good in the general anesthesia group and moderate in the CSEA group. Personnel satisfaction was higher in the patient group that underwent CSEA. In the general anesthesia group, the score was considered to be average. In the CSEA group, the satisfaction score was considered good, with a statistically significant difference (p < 0.05). The anesthesia team's satisfaction score was moderate, with no significant difference between the CSEA and general anesthesia groups (p > 0.05). CONCLUSION: PCNL under CSEA can be performed safely in certain individuals. Different anesthetic techniques may have varied levels of satisfaction among the surgical team.

Comparing the Effect of Pre-Biopsy Rectal Cleaning Together with Biopsy Needle Disinfection to Each Technique Alone on Hospitalization Rates because of Post-Biopsy Infections.

INTRODUCTION: To compare the effects of three techniques: biopsy needle disinfection with 10% formalin solution, povidone-iodine rectal cleaning, and the use of both methods to decrease hospitalization due to infectious complications after transrectal prostate biopsy. METHODS: A total of 827 patients were divided into 3 groups. Group 1 patient data were analyzed retrospectively, while patients of groups 2 and 3 were followed up prospectively. Group 1 included 361 patients who underwent biopsy needle disinfection with a 10% formalin solution. Group 2 included 235 patients who underwent biopsy needle disinfection and povidone-iodine rectal cleaning. Group 3 included 231 patients who underwent povidone-iodine rectal cleaning only. The outcome scale was the number of patients hospitalized for biopsy-related infection 30 days after the date of transrectal prostate biopsy. RESULTS: The hospitalization rates due to biopsy-related infectious complications were 3.0%, 0%, and 1.7% in groups 1, 2, and 3, respectively. The only statistically significant difference was found between groups 1 and 2. CONCLUSION: Biopsy needle disinfection and rectal cleaning with povidone-iodine seem to have greater potential to reduce infectious complications when applied together. Further prospective studies are required to confirm these findings.

A different perspective for morbidity related to Fournier's gangrene: which scoring system is more reliable to predict requirement of skin graft and flaps in survivors of Fournier's gangrene?

PURPOSE: To identify the prognostic factors that might predict morbidity related to Fournier's gangrene (FG) and particularly requirement of skin grafting and flaps. We also evaluated the validities of different severity indexes. METHODS: Thirty male patients with complete data who were treated for FG between January 2012 and December 2018 were retrospectively evaluated. Fournier's Gangrene Severity Index (FGSI), Uludag Fournier Gangrene Severity Index (UFGSI) and Age-Adjusted Charlson Comorbidity Index (ACCI), Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, the Combined Urology and Plastics Index (CUPI) and neutrophil-lymphocyte ratio (NLR) were calculated for 27 surviving patients. These patients were divided into two groups: Group I (14 patients with primary skin closure) and Group II (13 patients with requiring skin grafting and flaps). RESULTS: Body temperature (p = 0.026), heart rate (p < 0.001), respiratory rate (p = 0.029), creatinine (p = 0.002), white blood cell count (p = 0.014), hemoglobin levels (p = 0.018), involvement of pelvic floor or beyond (p = 0.018), length of hospital stay (p = 0.049), previous endourologic instrumentation (p = 0.035), requirement of cystostomy (p = 0.041), colostomy (p = 0.046), orchiectomy (p = 0.034) and intensive care unit (p = 0.046) were found to be significantly higher in Group II. All six different scoring systems were significantly higher in the patients who underwent skin grafting and flaps. In multivariate analysis, heart rate, FGSI, UFGSI, NLR, requirement of colostomy and intensive care unit were determined as independent factors for predicting requirement of skin grafting and flaps. CONCLUSION: FGSI, UFGSI and NLR are more reliable parameters for predicting skin reconstruction method (with the threshold values of 4.5, 5.5, and 7.87, respectively).