Stent ureteral Allium®: una nueva alternativa para el tratamiento de estenosis ureterales. Estudio prospectivo de cohortes / Allium® ureteral stent, a new player in the treatment of ureteral stenosis: A prospective cohort study

Introducción y objetivos La estenosis ureteral es una condición crónica que puede provocar la obstrucción del flujo urinario de la unidad renal comprometida, con la consiguiente pérdida de función renal. Los tipos de tratamiento pueden clasificarse en 2categorías principales: endourológicos y reconstructivos. Nuestro objetivo fue investigar la eficacia y seguridad del stent ureteral autoexpandible Allium®, cuyo uso en el tratamiento mínimamente invasivo de la estenosis ureteral se ha extendido en los últimos años. Materiales y métodos El estudio incluyó a 20 pacientes a los que se colocó un stent ureteral autoexpandible entre 2017 y 2021. Se registraron y evaluaron de forma prospectiva sus características clínicas y demográficas, los detalles del tratamiento, las complicaciones perioperatorias y postoperatorias y su tratamiento, y los hallazgos durante el seguimiento. Resultados La etiología incluyó urolitiasis en 16 pacientes (80%), neoplasia en 3 pacientes (15%) y cirugía ginecológica previa en uno (5%). La obstrucción del stent fue la complicación más frecuente en 3 pacientes (15%), seguida de la migración del stent en 2 (10%). Se continúa el seguimiento de 15 pacientes sin obstrucción ni complicaciones relacionadas con el stent. El periodo medio de seguimiento fue de 28±15,7 meses. Conclusiones El stent ureteral constituye una alternativa eficaz y segura para el tratamiento mínimamente invasivo de la estenosis ureteral, con unas tasas de complicaciones aceptables y un manejo sencillo de ellas. (AU)

Introduction and objectives Ureteral stricture is a chronic condition that can result in the obstruction of urinary drainage from the affected renal unit, leading to loss of renal function. reatment methods can be categorized into 2main headings: endourological and reconstructive procedures. We aimed to investigate the efficacy and safety of the self-expandable Allium® ureteral stent, which has been used in the minimally invasive treatment of ureteral stenosis in recent years. Materials and methods Twenty patients who were applied Allium® ureteral stent between 2017-2021 included in the study. The demographic and clinical characteristics of the patients, the details of the treatments applied to the patients, the perioperative and postoperative complications, the treatments applied for the complications and the findings in the follow-up were recorded and evaluated prospectively. Results Etiology included urolithiasis in 16 patients (80%), malignancy in 3 patients (15%), and a previous gynecological operation in one patient (5%). Stent obstruction was found to be the most common complication in 3 patients (15%). Stent migration was the second most common complication in 2 patients (10%). Our follow-up continues with 15 patients without stent-related complications and stent obstruction. The mean follow-up period was 28±15.7 months. Conclusions Allium ureteral stent is an effective and reliable method in the minimally invasive treatment of ureteral stricture with complications seen at acceptable rates and ease of treatment in the management of complications. (AU)

¿Cuándo se debe realizar la fijación testicular contralateral en pacientes pospuberales con torsión testicular? Estudio comparativo / When should contralateral testicular fixation be performed in postpubertal patients with testicular torsion: A comparative study

Objetivo En este estudio nos propusimos averiguar cuál es el momento óptimo para realizar la fijación testicular contralateral evaluando nuestros resultados de diez años en pacientes pospuberales con torsión testicular bajo un enfoque centrado en el paciente. Métodos Los pacientes pospuberales con diagnóstico de torsión testicular en un hospital terciario entre enero de 2012 y septiembre de 2022 se dividieron en dos grupos según los criterios del «enfoque centrado en el paciente» que adoptamos en nuestro centro. En el grupo1 se fijó el testículo contralateral en el mismo acto quirúrgico y en el grupo2 la fijación se realizó de forma diferida. Ambos grupos fueron examinados retrospectivamente, analizados estadísticamente y comparados. Resultados Un total de 41 pacientes se incluyeron en el estudio. En 19 (46,3%) de ellos se realizó fijación en el mismo acto, y en 22 (53,7%) se efectuó la fijación testicular contralateral de forma electiva. Se observó dehiscencia precoz de la herida en un paciente de cada grupo (4,5% grupo1 frente al 5,3% grupo2). En el periodo postoperatorio no se detectó atrofia ni torsión testicular contralateral en ningún grupo del estudio durante el seguimiento de 1año. Conclusión No existe ningún algoritmo para determinar el momento óptimo en que debe realizarse la fijación testicular contralateral en pacientes pospuberales con torsión testicular. Mediante enfoques centrados en el paciente, en los que se da prioridad a las características clínicas del paciente para determinar cuándo realizar la fijación testicular contralateral, se pueden obtener resultados que demuestran su eficacia y su seguridad (AU)

Objective In this study, we aimed to describe the timing of contralateral testicular fixation with our ten year results in postpubertal patients with testicular torsion with a patient-based approach. Methods Postpubertal patients diagnosed with testicular torsion in a tertiary hospital between January-2012 and September-2022 were divided into two groups according to the «patient-based approach» criteria we adopted in our clinic. Group1 in whom the contralateral teste was fixed in the same surgical act and group2 in whom the fixation was deferred. Both groups, were retrospectively examined, statistically analyzed and compared. Results A total of 41 patients were included in the study. Among those, 19 (46.3%) were fixed in the same act, and 22 (53.7%) underwent postponed elective contralateral testicular fixation. Early term wound dehiscence was observed in one patient in each group (4.5% group1 vs. 5.3% group2). In the postoperative period, no contralateral testicular atrophy or torsion was detected in the study groups during 1-year follow-up. Conclusion There is no algorithm for when contralateral testicular fixation should be performed in postpubertal patients with testicular torsion. Patient-based approaches, in which the clinical characteristics of the patient are prioritized in determining the timing of contralateral testicular fixation, can produce more effective and safe results (AU)

Allium® ureteral stent, a new player in the treatment of ureteral stenosis: a prospective cohort study.

INTRODUCTION AND OBJECTIVES: Ureteral stricture is a chronic condition that can result in the obstruction of urinary drainage from the affected renal unit, leading to loss of renal function. Treatment methods can be categorized into two main headings: endourological and reconstructive procedures. We aimed to investigate the efficacy and safety of the self-expandable Allium® ureteral stent, which has been used in the minimally invasive treatment of ureteral stenosis in recent years. MATERIALS AND METHODS: Twenty patients who were applied Allium® ureteral stent between 2017 and 2021 included in the study. The demographic and clinical characteristics of the patients, the details of the treatments applied to the patients, the perioperative and postoperative complications, the treatments applied for the complications and the findings in the follow-up were recorded and evaluated prospectively. RESULTS: Etiology included urolithiasis in 16 patients (80%), malignancy in 3 patients (15%), and a previous gynecological operation in 1 patient (5%). Stent obstruction was found to be the most common complication in 3 patients (15%). Stent migration was the second most common complication in 2 patients (10%). Our follow-up continues with 15 patients without stent-related complications and stent obstruction. The mean follow-up period was 28 ± 15.7 months. CONCLUSIONS: Allium ureteral stent is an effective and reliable method in the minimally invasive treatment of ureteral stricture with complications seen at acceptable rates and ease of treatment in the management of complications.

When should contralateral testicular fixation be performed in postpubertal patients with testicular torsion: A comparative study.

OBJECTIVE: In this study, we aimed to describe the timing of contralateral testicular fixation with our ten year results in postpubertal patients with testicular torsion with a patient-based approach. METHODS: Postpubertal patients diagnosed with testicular torsion in a tertiary hospital between January-2012 and September-2022 were divided into 2 groups according to the "patient-based approach" criteria we adopted in our clinic. Group 1 in whom the contralateral teste was fixed in the same surgical act and group 2 in whom the fixation was deferred. Both groups, were retrospectively examined, statistically analyzed and compared. RESULTS: A total of 41 patients were included in the study. Among those, 19 (46.3%) were fixed in the same act, and 22 (53.7%) underwent postponed elective contralateral testicular fixation. Early term wound dehiscence was observed in one patient in each group (4.5% Group 1 vs. 5.3% Group 2). In the postoperative period, no contralateral testicular atrophy or torsion was detected in the study groups during 1-year follow-up. CONCLUSION: There is no algorithm for when contralateral testicular fixation should be performed in postpubertal patients with testicular torsion. Patient-based approaches, in which the clinical characteristics of the patient are prioritized in determining the timing of contralateral testicular fixation, can produce more effective and safe results.

Is a contrast study really necessary prior to ureteroscopy?

This study aimed to evaluate the effect of preoperative imaging techniques on the success and complication rates of ureteroscopy. We performed a retrospective analysis of 736 patients (455 males and 281 females), with a mean age of 45.5±15.2 years (range, 1-88 years), who underwent rigid ureteroscopic procedures for removal of ureteral stones. Patients were divided into 4 groups according to the type of imaging modality used: group I, intravenous urography (n=116); group II, computed tomography (n=381); group III, computed tomography and intravenous urography (n=91), and group IV, ultrasonography and abdominal plain film (n=148). Patients' demographics, stone size and location, prior shock wave lithotripsy, lithotripsy technique, operation time, success rate, and rate of intraoperative complications were compared among the groups. There were no significant differences in success and complication rates among the groups. The stone-free rate after primary ureteroscopy was 87.1% in group I, 88.2% in group II, 96.7% in group III, and 89.9% in group IV (P=0.093). The overall incidence of intraoperative complications was 11.8%. According to the modified Satava classification system, 6.1% of patients had grade 1, 5.1% had grade 2, and 0.54% had grade 3 complications. Intraoperative complications developed in 12.1% of patients in group I, 12.6% of patients in group II, 7.7% of patients in group III, and 12.2% of patients in group IV (P=0.625). Our findings clearly demonstrate that ureteroscopic treatment of ureteral stones can be safely and effectively performed with no use of contrast study imaging, except in doubtful cases of anatomical abnormalities.

Is a contrast study really necessary prior to ureteroscopy?

This study aimed to evaluate the effect of preoperative imaging techniques on the success and complication rates of ureteroscopy. We performed a retrospective analysis of 736 patients (455 males and 281 females), with a mean age of 45.5±15.2 years (range, 1-88 years), who underwent rigid ureteroscopic procedures for removal of ureteral stones. Patients were divided into 4 groups according to the type of imaging modality used: group I, intravenous urography (n=116); group II, computed tomography (n=381); group III, computed tomography and intravenous urography (n=91), and group IV, ultrasonography and abdominal plain film (n=148). Patients’ demographics, stone size and location, prior shock wave lithotripsy, lithotripsy technique, operation time, success rate, and rate of intraoperative complications were compared among the groups. There were no significant differences in success and complication rates among the groups. The stone-free rate after primary ureteroscopy was 87.1% in group I, 88.2% in group II, 96.7% in group III, and 89.9% in group IV (P=0.093). The overall incidence of intraoperative complications was 11.8%. According to the modified Satava classification system, 6.1% of patients had grade 1, 5.1% had grade 2, and 0.54% had grade 3 complications. Intraoperative complications developed in 12.1% of patients in group I, 12.6% of patients in group II, 7.7% of patients in group III, and 12.2% of patients in group IV (P=0.625). Our findings clearly demonstrate that ureteroscopic treatment of ureteral stones can be safely and effectively performed with no use of contrast study imaging, except in doubtful cases of anatomical abnormalities.

The effect of intravenous preemptive paracetamol on postoperative fentanyl consumption in patients undergoing open nephrectomy: a prospective randomized study.

AIM: We investigated the efficacy of intravenous (IV) preemptive paracetamol on postoperative total fentanyl consumption and fentanyl-related side effects in patients undergoing open nephrectomy. MATERIALS AND METHODS: A total of 60 patients scheduled for elective open nephrectomy under general anesthesia were included. All patients received Patient-controlled IV analgesia with fentanyl postoperatively. Patients were randomly allocated into three equal groups: The fentanyl group received 100 mL of IV normal saline as a placebo, with the first dose ending 30 min before intubation. In paracetamol group, IV 1 g paracetamol was given to the patients 30 min after extubation with repeated doses every 6 h totally 4 times a day. In preemptive paracetamol group, patients received IV 1 g paracetamol every 6 h, with the first dose ending 30 min before intubation. RESULTS: Postoperative cumulative fentanyl consumption for 24 h was significantly higher in the fentanyl group (1009 ± 139.361 µg) than those of paracetamol (752.25 ± 112.665 µg) and preemptive paracetamol groups (761.10 ± 226.625 µg) (P = 0.001 for both). In early postoperative period (0-4 h); whereas total fentanyl consumption showed no statistically significant difference among groups (P = 0.186), the nausea-vomiting scores were significantly higher in the fentanyl group compared with other groups (P = 0.012). CONCLUSION: In patients undergoing open nephrectomy, use of preemptive or postoperative paracetamol reduces fentanyl related nausea-vomiting without a decrease in total fentanyl consumption in the early postoperative period. Furthermore, use of preemptive or postoperative paracetamol reduces total fentanyl requirements in the first 24 h postoperatively providing a safe and effective postoperative analgesia.