Assuntos
Carcinoma Papilar , Cistoscopia/métodos , Dissecação/métodos , Piúria/diagnóstico , Neoplasias da Bexiga Urinária , Urotélio/patologia , Idoso , Biópsia/métodos , Carcinoma Papilar/patologia , Carcinoma Papilar/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Gradação de Tumores , Estadiamento de Neoplasias , Prognóstico , Piúria/etiologia , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgiaRESUMO
Nitrous oxide (N2O) is underutilized in ambulatory urology. Here, we review available data regarding application, efficacy, and side effect profile of N2O in ambulatory urologic procedures. Data were available from 11 studies. N2O has been described in the setting of transrectal ultrasound-guided prostate biopsies, flexible cystoscopy, ureteral stent placement, and extracorporeal shockwave lithotripsy in adult patients and catheterization in children. Studies showed significant improvements in peri-procedural pain and anxiety relative to alternative (or none) forms of analgesia. Adverse effects were rare and self-limited. More widespread use of N2O may result in cost savings and better patient tolerance with outpatient procedures.
Assuntos
Procedimentos Cirúrgicos Ambulatórios , Anestésicos Inalatórios , Óxido Nitroso , Procedimentos Cirúrgicos Urológicos , Adulto , Anestésicos Inalatórios/administração & dosagem , Anestésicos Inalatórios/efeitos adversos , Ansiedade/prevenção & controle , Biópsia/métodos , Criança , Cistoscopia/métodos , Humanos , Litotripsia/métodos , Masculino , Óxido Nitroso/administração & dosagem , Óxido Nitroso/efeitos adversos , Próstata/patologia , Prostatectomia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Stents , Ureter , Cateterismo Urinário/métodosRESUMO
Background: We report the first case of instillation of alteplase, a tissue plasminogen activator, to dissolve occlusive upper urinary tract blood clot. Case Presentation: A 67-year-old Caucasian man with a solitary kidney became dialysis dependent because of upper urinary tract clot obstruction after ureteral stent placement for obstructing ureterolithiasis. After failure of more conservative measures, 10 mg of alteplase was instilled through nephrostomy tube daily for 2 consecutive days 30 minutes before manual irrigation with physiologic saline. After alteplase instillation, the occlusive blood clot dissolved with rapid improvement in urinary output and creatinine. Conclusions: Alteplase instillation through nephrostomy tube is a viable option to dissolve obstructing upper urinary tract blood clots.