Comparison of general anesthesia and combined spinal-epidural anesthesia for retrograde intrarenal surgery.

BACKGROUND: To investigate the applicability of the combined spinal-epidural anesthesia (CSEA) method in RIRS for the treatment of kidney stone disease and also to compare with general anesthesia (GA) in terms of their effects on early postoperative pain levels and their cost. METHODS: A hundred consecutive patients who were scheduled for RIRS were enrolled in this study and were prospectively evaluated according to the anesthesia methods. Patients were divided into 2 groups randomly: the GA (N.=50) and CSEA (N.=50) groups. Five patients were excluded due to patient incompatibility or inadequate anesthesia. The pain levels of patients in the Group 2 were recorded during the operation using the Visual Analog Scale (VAS) at minutes 1, 5, 10, 15, 30 and 60. Peak pain levels within the first 24 hours following the operation were recorded for both groups. RESULTS: Ninety five patients in the two groups were determined to be similar in terms of demographic characteristics. The mean VAS score at the postoperative 1st day was found as 1.20±0.9 for Group 1 and 0.82±1.3 for Group 2. No statistically significant differences were identified between the VAS-nram and VAS-ram groups (P=0.450). The total cost of anesthesia medications was similar between the both groups. CONCLUSIONS: Combined spinal-epidural anesthesia, which produces favorable outcomes in the intraoperative and postoperative periods, will become an alternative to general anesthesia. Also, the costs associated with these two anesthesia methods were calculated, it was found that the total cost of anesthesia medications and materials per operation was similar both methods.

The preventive role of transurethral antibiotic delivery in a rat model.

PURPOSE: There is currently an emerging need for developing improved approaches for preventing urinary tract infections (UTIs) occurring during diagnostic or interventional procedures of the lower urinary tract. We aimed to establish a rat model to assess the use of transurethral antibiotic administration and to provide evidence that this could be used as a preventive therapy. METHODS: Animals received fosfomycin trometamol (FOF) either urethrally or orally prior to the procedure. A third group was generated as treatment controls and did not receive any medication. Urethral dilation was conducted to recapitulate an interventional procedure prior to intravesical Escherichia coli administration in all three groups. Finally, sham-operated animals were introduced as a fourth group which did not receive antibiotics or E. coli. Colony counts of urine and tissue cultures for the identification of E. coli and histopathological examinations of the bladder and prostate were conducted. RESULTS: Evaluation of infection intensities in cultures as well as histopathological examination of the bladder and prostate demonstrated a preventative role of transurethral FOF administration. In terms of efficiency, local administration of FOF was similar to oral administration. CONCLUSIONS: These results suggest that transurethral antibiotic administration is a promising alternative for preventing UTIs occurring during diagnostic or interventional procedures of the lower urinary tract.

The efficiency of a sedative or analgesic supplement to periprostatic nerve blockage for pain control during transrectal ultrasound-guided prostate biopsy - a prospective, randomized, controlled, double blind study.

INTRODUCTION: The aim was to examine the effect of a sedative or analgesic supplement to periprostatic nerve blockage (PNB) on pain reduction during probe insertion and needle penetration in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy. We also investigated the effects of this procedure on the positive response rate in re-biopsy. MATERIAL AND METHODS: One hundred TRUS-guided prostate biopsy patients due to prostate-specific antigen (PSA) levels higher than 2.5 ng/ml and/or abnormal rectal examination findings were evaluated. Group 1 (PNB) was given periprostatic lidocaine injection before the procedure. Group 2 (analgesic) was given tramadol and PNB. Group 3 (sedative) was given midazolam and PNB. Group 4 (control) was not given any anaesthesia or analgesics. Pain scores were assessed during probe insertion and needle penetration by a visual analogue scale. RESULTS: During probe insertion, the mean pain score of the sedative group was lower than that of the control, analgesic and PNB groups (p < 0.001, p = 0.009, and p < 0.001, respectively). During needle penetration, the mean pain score of the control group was higher than that of the other groups (p < 0.001). The rate of positive response to re-biopsy was found to be 56% in the control group and between 92% and 100% in the other three groups (p < 0.001). CONCLUSION: According to our results, it can be concluded that midazolam, given supplementary to PNB, contributes as an effective and safe alternative for pain control during both probe insertion and penetration of the biopsy needle into the prostate capsule; however, tramadol supplement does not provide any additional contributions.