Prospective randomized evaluation of gel mat foot pads in the endoscopic suite.

BACKGROUND AND PURPOSE: Several studies that compare open and laparoscopic procedures have demonstrated that the minimally invasive surgeon has greater musculoskeletal pain when compared with open surgeons. The purpose of our study was to demonstrate whether the use of the gel mat in the endoscopic setting offered any ergonomic benefit to the surgeon. MATERIALS AND METHODS: One hundred endoscopic procedures, by 11 different surgeons, were randomized intostudy (use of a gel mat) and control groups. Procedures included both percutaneous nephrolithotomies and ureteroscopies and were randomized without regard to the type or expected length of the procedure. All subjects completed a preoperative, intraoperative, immediate postoperative, and 24-hour postoperative questionnaire. During the procedures, an independent observer recorded the number of intraoperative stretches and positional changes because of discomfort. RESULTS: The mean preoperative metrics for the gel mat and no gel mat groups were similar with the exception of the ≤60-minute group, whose members found the gel mat group starting with greater overall discomfort (1.7 vs 1.3, P=0.0273). In the ≤60 minute group, gel mat use significantly decreased postoperative discomfort (P=0.0435) and improved postoperative energy (P=0.0411). In those procedures >60 minutes, the gel mat improved postoperative discomfort and energy as well as the number of stretches and postural changes during the procedure. CONCLUSION: Application of gel mats in the endoscopic setting improves surgeon overall postoperative discomfort and energy in all cases. For cases >60 minutes duration, gel mats also decrease the number of stretches and postural changes from discomfort. Some of these salutary effects may translate into more efficient surgery and better patient outcomes.

Evaluation of bioimpedance as novel predictor of extracorporeal shockwave lithotripsy success.

BACKGROUND AND PURPOSE: Obesity has been identified as a limitation of extracorporeal shockwave lithotripsy (SWL). The obesity metrics of body mass index (BMI) and skin-to-stone distance (SSD) have been evaluated as predictors of SWL success. While SSD has demonstrated a strong correlation with success, BMI has not. Bioimpedance analysis (BIA) is an accurate way of determining body adiposity. We evaluated fat mass percentage (FMP) as measured by BIA as a predictor of SWL success. PATIENTS AND METHODS: We prospectively collected body composition data using the Imp-DF50 Body Impedance Analyzer on consecutive patients undergoing SWL. All generated variables, including FMP, along with demographics, BMI, stone size, and stone composition, were analyzed. Patients were evaluated for success, defined as no evidence of stones on radiography of the kidneys, ureters, and bladder at follow-up. RESULTS: Fifty-two consecutive patients were enrolled in the study, of which 37 had the necessary metrics to be included in the analysis. Twenty-three (62.2%) patients were stone free while 14 (37.8%) were found to have residual stone at follow-up. There was no difference in sex, stone laterality, mean age, and stone size between the groups. For the success and failure groups, the mean BMI was 25.8 kg/m(2) and 29.8 kg/m(2) (P=0.0091), and mean FMP 24.6% and 32.2% (P=0.0034). On mirrored multivariable analysis, both BMI (OR=0.735, P=0.026) and FMP (OR=0.806, P=0.010) were associated with success. Patients with a FMP ≥35% had a reduced success rate compared with those with a FMP <35% (14% vs 73%, respectively, P=0.0028). CONCLUSIONS: Both BMI and FMP both appear to be independent predictors of success. Based on these findings, a large study examining the relationship between BMI, FMP, SSD, and SWL success is warranted. A preoperative FMP ≥35% is associated with a 14% success rate, and alternative treatment strategies for urolithiasis should be considered.

Can we predict if overactive bladder symptoms will resolve after sling surgery in women with mixed urinary incontinence?

Persistent overactive bladder and urgency urinary incontinence after sling surgery (pubovaginal sling or midurethral sling) in women with mixed urinary incontinence (MUI) is devastating to patients and frustrating to surgeons who perform anti-incontinence surgery. To better predict the outcomes of sling surgery in women with MUI, preoperative parameters need to be examined to accurately predict postsurgical outcomes. In this review article, we will explore recent literature exploring possible preoperative predictors of persistent overactive bladder and urgency urinary incontinence after sling surgery in women with MUI.