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1.
J Endourol ; 34(1): 1-6, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31333065

RESUMO

Introduction: Kidney stones affect 1 in every 11 people in the United States each year. There is a significant high recurrence rate without a stone prevention protocol. Alkali citrate is beneficial in decreasing stone recurrence, but because of the cost and gastrointestinal side effects there is a low adherence rate. This study aims to serve as a review of some of the most commonly used alkalizing over-the-counter supplements that are advertised to prevent and treat kidney stones. Methods: Data were gathered by a comprehensive online literature search and company inquiries for kidney stone prevention supplements. An additional informal poll of the authors selected supplements that are most commonly taken by their patients. A total of eight supplements were evaluated for cost, alkali equivalent provided, dosing, and regulatory information. Results: Eight of the most commonly used supplements were reviewed with a focus on alkalizing agents. Information reviewed revealed dosing recommendations resulting in decreased citrate alkali equivalents per day compared with prescription-strength potassium citrate. Cost, peer-reviewed study results, and regulatory data were reviewed, tabulated, and analyzed. Cost per alkali equivalent was substantially decreased for each supplement compared with the prescribed drug. All supplements were found to be readily available online. Conclusion: Over-the-counter alkalizing agents are available to patients and may be an appropriate alternative to cost-prohibitive potassium citrate when treating urolithiasis patients. Additional testing will be necessary in the future to determine the efficacy of these supplements in the treatment and prevention of urinary stone disease.

2.
Urol Ann ; 11(3): 282-286, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413507

RESUMO

Introduction: Return for unplanned postoperative care is an important quality metric in the United States. Most of our postoperative return visits occur after ureteroscopy. Routine preoperative ureteral stenting is not recommended by the American Urological Association due to its impact on the quality of life, despite its proposed operative advantages. We evaluated the association between preoperative ureteral stenting and the resulting perioperative outcomes in the context of quality measures such as return to the emergency department (ED) and readmission rates. Materials and Methods: After the Institutional Review Board approval, a retrospective review of patients undergoing ureteroscopy from February 2014 to present was conducted. Patient's demographics and perioperative outcomes were compared based on the presence or absence of a ureteral stent before ureteroscopy. Details and rates of nurse calls, returns to the ED, and readmissions within 90 days were also compared. Results: A total of 421 instances of ureteroscopy, 278 prestented ureteroscopy (psURS), and 143 direct ureteroscopy (dURS) were included for analysis. Preoperative demographics were similar. The psURS cohort was more likely to undergo flexible ureteroscopy, utilized an access sheath more often (P < 0.0001), and had less ureteral dilation (P < 0.0001). Prestenting did not influence operative time (P = 0.8534) or stone-free rates (P = 0.2241). dURS patients were more likely to call the nurse; however, psURS versus dURS yielded no difference in return to the ED or readmission within 90 days. Conclusions: In this study, preoperative stenting offered few operative advantages and did not meaningfully influence returns to the ED and readmissions within 90 days after ureteroscopy.

3.
Urology ; 132: 37-42, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31310773

RESUMO

OBJECTIVES: To examine the safety and effectiveness of placing ureteral stents in an office-based setting vs in the operating room (OR). METHODS: A retrospective chart review was performed to examine outcomes, specifically complication rate, unanticipated hospitalizations, and stent failures, when patients received JJ stents in the clinic procedure suite, using local analgesia and/or nitrous oxide gas analgesia, compared to patients who had ureteral stents placed in the OR, typically with general anesthesia. Additionally, multivariable analysis was performed to determine predictors of complications. RESULTS: Around 565 procedures were performed in the clinic and 179 were performed in the OR. The complication rate for the clinic group was 4.1%, compared to 7.8% in the OR group. Unplanned admissions to the hospital occurred after 3.0% of clinic procedures and 9.5% of OR procedures. Stent placements failed in 1.1% of clinic procedures and 0.56% of OR procedures. Clinic procedure time was 10 minutes vs 12 minutes in the OR (P <0.01). Clinic vs OR setting was not predictive of complications (P = 0.99). We did not identify factors that impacted complication rate in ureteral stent placement in the clinic vs OR setting. Notably, the procedure time for a clinic stent placement was significantly shorter than the OR stent placement. CONCLUSIONS: This study demonstrates excellent outcomes with a novel approach to a standard procedure, with shorter procedure time and no difference in complication rates.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Analgésicos não Entorpecentes , Sedação Consciente/métodos , Óxido Nitroso , Salas Cirúrgicas , Stents , Ureter/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Adulto Jovem
4.
Proc (Bayl Univ Med Cent) ; 32(2): 199-201, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31191127

RESUMO

To determine whether the US Drug Enforcement Agency (DEA) class of narcotics prescribed to patients after ureteroscopy impacts their rate of return for unplanned care, a retrospective analysis of patients from February 2014 through March 2016 was performed. Data were collected for the first 90 days after surgery. Patients were divided into groups based on the narcotics schedule prescribed after surgery. Results showed that there was no statistical difference in return for unplanned care when comparing the groups based on their prescribed pain medication. Among the 475 patients, 17% returned to the emergency department after ureteroscopy, 12% contacted the clinic due to discomfort/pain, and 8% were readmitted to the hospital within 90 days of surgery. The data indicated that patients who were not prescribed a narcotic after surgery sought unplanned care at a slightly higher rate than those who were. In conclusion, the US DEA class of narcotics prescribed after ureteroscopy did not have a statistically significant impact on the rate of return for unplanned care. These findings may improve opioid stewardship in patients undergoing outpatient ureteroscopy.

5.
Urology ; 126: 49-53, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30654140

RESUMO

OBJECTIVE: To further analyze calcium tartrate tetrahydrate stones after a recent case report described this novel stone. Prior to this, there was only one previously reported occurrence of this stone in a human. This unusual stone composition is not tested for routinely. True prevalence and possible causes of this stone are unknown. MATERIALS/METHODS: During the previous case report, micro-CT and Fourier-transform infrared spectroscopy were used to identify a calcium tartrate tetrahydrate stone. This information was applied to urinary stones with previously unidentified compositions in the Mayo Metals laboratory database between 2010 and March 2018. Two additional stones were identified at our institution. Three patients had medical records available for analysis. RESULTS: Between 2010 and March 2018, 35 calcium tartrate stones in 25 patients were identified in the Mayo database as well as 2 at our institution (37 stones in 27 patients). Thirty stones were pure calcium tartrate with the remainder having elements of more common stones. The average age was 46.3 (±14.7) with a slightly higher incidence in females (17 vs 10). Of the 3 medical records investigated, all 3 were males (average age 48.7), and each reported consumption of an energy supplement (Spark) routinely. CONCLUSION: The true prevalence of this relatively unknown stone remains unclear and additional investigation is warranted. We believe all stone laboratories should have access to the IR spectra for calcium tartrate tetrahydrate. Attention should be paid to possible causes of this stone, particularly with relation to oral supplements, to aid with future prevention and treatment.


Assuntos
Tartaratos/análise , Cálculos Urinários/química , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espectroscopia de Infravermelho com Transformada de Fourier , Adulto Jovem
6.
Arab J Urol ; 16(4): 435-440, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30534444

RESUMO

Abstract objectives: To examine the safety and effectiveness of the use of a stent with a string attached after ureteroscopy (URS) for self-removal of the stent by the patient. Patients and methods: After Institutional Review Board approval, a retrospective chart review was performed concerning patients who underwent URS and received an indwelling stent with or without a string attached to the stent (94 vs 349, respectively). Amongst the string group patients received a single- or a double-arm-stringed stent (31 vs 63, respectively). Statistical analyses included chi-squared and Student's t-tests. Results: The string group consisted of 94 procedures, in which 59.6% of the patients were male with a mean (SD) age of 50.0 (16.5) years. In the no-string group, 51.3% of the 349 procedures were performed in males and the mean (SD) age was 54.9 (18.1) years. Complication rates were 12.8% in the string group and 14.0% in the no-string group (P = 0.867). In the string group, 17.0% of the patients returned to the Emergency Department, whilst 15.8% of the no-string patients returned (P = 0.753). The complication rate in the single- and double-arm groups were 12.9% and 12.7%, respectively (P > 0.910). Self-removal of stents was successful in 94.7% of patients (89/94). Conclusions: The use of a stent with a string after URS appears safe and effective. Few patients had difficulty removing their stents and complication rates were similar in the groups with and without a string attached to their stents. Single- and double-arm-stringed stents have similar complication rates.

7.
Can J Urol ; 25(6): 9596-9600, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30553285

RESUMO

INTRODUCTION: Stent placement is a common procedure for addressing obstructive uropathy. However, lack of operating room (OR) availability can substantially delay this procedure. In this study, we sought to assess the feasibility, safety, and efficacy of this procedure in a clinical setting using nitrous oxide (N2O) and local anesthesia. MATERIALS AND METHODS: Patients included in this study included those who were determined to need management of urinary obstruction with a JJ ("double J") stent and had their procedure performed in the clinic procedure suite with N2O anesthesia. RESULTS: We present a case series of 565 patients undergoing ureteral stent placements in a clinic operative suite with N2O. In this cohort, complications occurred after 4.1% of procedures and unplanned admissions to the hospital occurred after 2.5% of procedures. Stent placements failed in 1.0% of procedures. Failures occurred due to pain in 2/565 patients. No anesthetic complications were encountered. CONCLUSION: We report the feasibility and clinical outcomes of ureteral stent placements for ureteral obstruction in a clinic setting with the use of local anesthetic or N2O anesthesia, with excellent results. A majority of patients tolerated the procedure well and only 2 of 565 had their procedures stopped due to discomfort. To our knowledge, this is the first report of the use of N2O anesthetic for conscious sedation for the placement of ureteral stents.


Assuntos
Stents , Obstrução Ureteral/terapia , Adulto , Idoso , Assistência Ambulatorial/estatística & dados numéricos , Anestésicos Inalatórios , Anestésicos Locais , Estudos de Viabilidade , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Óxido Nitroso , Ambulatório Hospitalar , Dor/etiologia , Estudos Retrospectivos , Stents/efeitos adversos , Resultado do Tratamento
8.
Urology ; 117: 36-40, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29625137

RESUMO

OBJECTIVE: To compare the sensitivity of noncontrast computed tomography (CT) with endoscopy for detection of renal calculi. Imaging modalities for detection of nephrolithiasis have centered on abdominal x-ray, ultrasound, and noncontrast CT. Sensitivities of 58%-62% (abdominal x-ray), 45% (ultrasound), and 95%-100% (CT) have been previously reported. However, these results have never been correlated with endoscopic findings. METHODS: Idiopathic calcium oxalate stone formers with symptomatic calculi requiring ureteroscopy were studied. At the time of surgery, the number and the location of all calculi within the kidney were recorded followed by basket retrieval. Each calculus was measured and sent for micro-CT and infrared spectrophotometry. All CT scans were reviewed by the same genitourinary radiologist who was blinded to the endoscopic findings. The radiologist reported on the number, location, and size of each calculus. RESULTS: Eighteen renal units were studied in 11 patients. Average time from CT scan to ureteroscopy was 28.6 days. The mean number of calculi identified per kidney was 9.2 ± 6.1 for endoscopy and 5.9 ± 4.1 for CT (P <.004). The mean size of total renal calculi (sum of the longest stone diameters) per kidney was 22.4 ± 17.1 mm and 18.2 ± 13.2 mm for endoscopy and CT, respectively (P = .06). CONCLUSION: CT scan underreports the number of renal calculi, probably missing some small stones and being unable to distinguish those lying in close proximity to one another. However, the total stone burden seen by CT is, on average, accurate when compared with that found on endoscopic examination.


Assuntos
Cálculos Renais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ureteroscopia , Adulto , Idoso , Feminino , Humanos , Cálculos Renais/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Método Simples-Cego , Adulto Jovem
9.
Proc (Bayl Univ Med Cent) ; 31(4): 432-435, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30948973

RESUMO

This study compared patient outcomes following irrigation applied using an automated pressure system (AP) to hand irrigation utilizing a syringe (HI) during ureteroscopy. Retrospective chart review was performed to evaluate ureteroscopy procedures without a ureteral access sheath. Procedures in which irrigation was applied by AP were compared to those with HI. Statistical analyses included chi-squared tests and Student's t tests. The AP group contained 206 procedures and the HI group, 25. The AP and HI groups were 54.9% and 36% male, respectively. Mean ages were 53.7 ± 18.9 years in the AP group and 44.0 ± 18.5 years in the HI group. Complication rates were 11.2% in the AP and 8.3% in the HI group (P > 0.99). One stone retrieval failure and one stone recurrence occurred in the HI group; one patient had residual stone in the AP group. No urinary tract infections occurred in the HI group; in the AP group, urinary tract infections occurred in 1.9% of cases. The postoperative pain incidence was equivalent (P = 0.498). The AP group had one subcapsular hematoma; no calyceal ruptures occurred in either group. In conclusion, irrigation applied by an automated setup appears safe, with similar outcomes to irrigation applied with a handheld syringe.

10.
Urology ; 111: 48-53, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29024736

RESUMO

OBJECTIVE: To discuss complications of simultaneous bilateral percutaneous nephrolithotomy (SB-PCNL) when compared with unilateral percutaneous nephrolithotomy and survey surgeon preference in bilateral stone disease management. PATIENTS AND METHODS: A database of all participating percutaneous nephrolithotomy (PCNL) patients who underwent treatment at Indiana University Health Methodist Hospital within a 10-year period from 2006 to 2015 by a single surgeon (JL) was utilized. Perioperative data, as well as complications, defined according to the Clavien grading system, were recorded. A survey of members of the Endourological Society was performed regarding surgical management in the setting of bilateral stone disease. RESULTS: A total of 563 patients were identified over the study period with 129 undergoing SB-PCNL. Overall, SB-PCNL patients had a longer procedure (176.9 vs 115.6 minutes, P <.0001), were more likely to undergo a secondary procedure (73% vs 44, P <.001), and had a longer hospital stay (3.2 vs 2.3 days, P <.001). Notably, there were no differences in the number or the severity of complications between the 2 groups. A total of 153 endourologists completed the survey. Of these endourologists, 58 (38%) performed bilateral PCNL under anesthesia. The top reasons for electing not to perform bilateral PCNLs included the duration of bilateral procedures (53%), bilateral renal injury (48%), and rare performance of bilateral surgery (35%). CONCLUSION: Although the procedure length was longer in the SB-PCNL group, there were similar rates of complications and severity between unilateral PCNL and SB-PCNL. A majority of endourologists surveyed do not perform bilateral PCNL but would perform bilateral ureteroscopy with the duration of the procedure and concern for bilateral renal injury representing the most common reasons.


Assuntos
Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Complicações Pós-Operatórias/epidemiologia , Padrões de Prática Médica , Urologia , Adulto , Idoso , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Cálculos Renais/patologia , Masculino , Pessoa de Meia-Idade
11.
J Endourol Case Rep ; 3(1): 192-195, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29279874

RESUMO

Background: Calcium tartrate tetrahydrate has been reported as the main mineral in urinary stones in rats that have significant tartrate in their diet, but in humans, there has been only one mention of calcium tartrate stones in the form of bladder stone, and that case was in Africa. Case Presentation: Patient is a 34-year-old Caucasian male who presented with typical symptoms of nephrolithiasis. CT abd/pelvis (renal stone protocol) revealed a 2 cm nonobstructing stone of the right renal pelvis. Patient underwent an uncomplicated right percutaneous nephrolithotomy and was noted to be stone free after surgery. Stone analysis was difficult with regard to determining composition, but was finally identified as calcium tartrate tetrahydrate. Conclusion: This was an unusual case, as this is the first recorded case of a calcium tartrate tetrahydrate outside of Africa. This type of stone had only been mainly described in rat models with dl-bitartrate in their diet. Our patient was an otherwise healthy, relatively muscular individual with no obvious source for this stone other than a vitamin and amino acid supplement that he takes regularly that contains l-carnitine (as tartrate) and choline (as bitartrate and citrate). The prevalence of this stone type is presently unknown, as stone analysis laboratories have not had the ability to recognize it. Although a connection between the supplement and stone formation is conjecture at this time, we believe this necessitates further investigation.

12.
J Endourol ; 31(12): 1237-1242, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29020831

RESUMO

OBJECTIVES: To present the first prospective randomized comparison between laparoendoscopic single-site surgery (LESS) and minilaparoscopy (ML) for treatment of upper urinary tract pathologies. PATIENTS AND METHODS: Between January 2013 and June 2015, patients with different upper urinary pathologies were blindly randomized to both LESS and ML. All procedures were done by single experienced surgeon. Both cohorts were compared regarding demographic data, peri and postoperative characteristics, and visual analog pain scale (VAS). Cosmetic outcome was assessed after 12 months using patient scar assessment scale (PSAS) and observer scar assessment scale (OSAS). RESULTS: Sixty patients were randomized into two equal groups with comparable demographic and preoperative characteristics. Indications included nephrectomy, pyeloplasty, cyst marsupialization, adrenalectomy, and repair of retrocaval ureter. Operative time was 167 ± 24 and 145 ± 39 minutes in LESS and ML groups, respectively (p = 0.09). Estimated blood loss was 59 ± 34 and 43 ± 42 mL in both groups, respectively (p = 0.2). VAS was 1.7 ± 0.6 and 2.8 ± 0.5 in both groups, respectively (p = 0.02). PSAS and OSAS were 5.9 ± 0.85 and 10.6 ± 1.98 vs 8.9 ± 0.9 and 13.5 ± 6.3 in both groups, respectively (p > 0.05). There were no intraoperative complications, conversions to open surgery, or conventional laparoscopy in both groups. Mean postoperative Diclofenac Na was 151.7 ± 35.6 and 169.7 ± 47.3 mg in both groups, respectively (p = 0.04). Postoperative complications rate and hospital stay were comparable between both groups. CONCLUSION: Both LESS and ML have comparable operative time, blood loss, complication rate, and hospital stay in treatment of upper urinary tract pathologies. However, LESS is associated with less analgesic requirement and better cosmetic outcome.


Assuntos
Doenças das Glândulas Suprarrenais/cirurgia , Conversão para Cirurgia Aberta/estatística & dados numéricos , Complicações Intraoperatórias/epidemiologia , Nefropatias/cirurgia , Laparoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Adrenalectomia/efeitos adversos , Adrenalectomia/métodos , Adulto , Idoso , Cicatriz/etiologia , Feminino , Humanos , Laparoscopia/efeitos adversos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Nefrectomia/efeitos adversos , Nefrectomia/métodos , Duração da Cirurgia , Estudos Prospectivos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Adulto Jovem
13.
Can Urol Assoc J ; 11(7): E311-E314, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28761594

RESUMO

INTRODUCTION: We sought to provide a technical update on the use of a prostate morcellator device (PMD) to manage organized blood clots of the bladder following laser prostatectomy. METHODS: Herein, we describe our experience in using the Wolf Piranha morcellator in managing organized bladder blood clots supplemented with a retrospective chart review of the patients in whom this procedure was performed. RESULTS: Six patients, all male with a mean age of 75 ± 8.9 years, had organized bladder clots following either holmium laser enucleation or photoselective vaporization of the prostate managed with a PMD. Clots were recognized based on hematuria or urinary retention a median of 3.5 days following the aforementioned procedures. Initial management was attempted with more conservative measures, including a three-way Foley catheter, followed by cystoscopy with an Ellik evacuator, or a glass Tommey syringe. Morcellation times were a mean of 10.2 ± 6.15 minutes (range 2-18). This technique was able to manage clots that were an average of 173.3 ± 115.9 cc in size. The procedure was well-tolerated. No patients experienced intraoperative or morcellator-related complications. CONCLUSIONS: Benign prostatic hypertrophy frequently requires surgical endoscopic management and can be complicated by hematuria and bladder blood clot formation. When these clots become organized, this can lead to urinary retention and the required management, evacuation, may be difficult. The use of a Wolf Piranha PMD is a safe, well-tolerated, and effective in evacuating organized blood clots of the bladder.

14.
Can Urol Assoc J ; 11(8): 251-253, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28798825

RESUMO

INTRODUCTION: When encountered, the ideal management of lithiasis in deceased donor kidneys is not well-defined. With advances in endourological techniques, minimally invasive treatments are becoming an increasingly viable option. We set out to describe our experience performing ex-vivo ureteroscopy on cadaveric donor kidneys, including one in which the procedure was completed on-pump. METHODS: A retrospective chart review was undertaken to identify patients who had undergone ex-vivo ureteroscopy prior to cadaveric renal transplant. Four patients were identified, including one in which the procedure was done with the kidney remaining on-pump. The surgical technique and subsequent data were reviewed. RESULTS: Ex-vivo ureteroscopy was successfully completed in all four instances without intraoperative complication. All kidneys were endoscopically stone-free. Creatinine nadirs ranged from 0.8-1.4. All four patients remained stone-free at a mean followup of 13 months. CONCLUSIONS: Our series provides further evidence as to the safety and efficacy of ex-vivo ureteroscopy prior to transplantation in cadaveric renal transplants and describes a novel technique in the form of on-pump ex-vivo ureteroscopy.

15.
Proc (Bayl Univ Med Cent) ; 30(3): 338-339, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28670079

RESUMO

Mantle cell lymphoma of the prostate is rare and is seldom encountered in general urologic practice. It either arises primarily from the prostate or is a result of metastatic spread from another site. This specific type of lymphoma has an aggressive course and may respond poorly to traditional chemotherapy with frequent relapses. Mantle cell lymphoma occurs in middle age or older, which is also when symptoms of benign prostatic enlargement begin in men. This overlap makes the diagnosis of lymphoma of the prostate difficult and makes the treatment more complex. We describe a case of mantle cell lymphoma of the prostate that caused significant enlargement and bladder outlet obstruction with urinary retention. The obstruction was treated with holmium laser enucleation of the prostate with good functional results.

16.
J Endourol ; 31(8): 774-779, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28586247

RESUMO

INTRODUCTION AND OBJECTIVE: Ten percent of patients undergoing prostatic urethral lift (PUL) require repeat surgical treatment within 3 years. We describe the feasibility and considerations of performing holmium laser enucleation of the prostate (HoLEP) as a salvage therapy after previous PUL. METHODS: Men who had undergone HoLEP after PUL were retrospectively identified from three institutions with surgeons experienced in HoLEP. Subjects were characterized by age, time from PUL procedure (months) to HoLEP surgery, indication for retreatment, and pre-operative prostate volume by ultrasound. Outcomes of interest included enucleation time, morcellation time, morcellator type, weight of tissue resected, and Clavien complications. We also summarize findings related to the location of PUL device implants, and the effect of the implants on the enucleation and morcellation portions of the procedure. RESULTS: From December 15, 2015 to October 31, 2016, seven men aged 51-78 years underwent HoLEP at a median of 8.6 months (range 3-18) after PUL. The median prostate volume by transrectal ultrasound was 80 cm3 (range 56-160 cm3). For the 7 patients, 6 out of the 22 device implants were found in aberrant locations. Auxiliary maneuvers were required in five cases. Morcellation devices tended to jam with each implant, requiring a pause for withdrawal of the morcellator and manual removal from the blade or requiring grasper retrieval of device components. There were no Clavien complications. CONCLUSIONS: HoLEP can be performed safely and effectively post-PUL; however, device implants may be found in areas other than the intended location, and morcellation of the adenoma tissue is complicated by metallic implants of the PUL device.


Assuntos
Adenoma/cirurgia , Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Morcelação/métodos , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Idoso , Hólmio , Humanos , Terapia a Laser/instrumentação , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Prostatectomia/instrumentação , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Uretra/cirurgia
17.
J Endourol ; 31(9): 847-850, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28637364

RESUMO

OBJECTIVES: To compare perioperative outcomes for patients undergoing holmium laser enucleation of the prostate (HoLEP) and robotic-assisted simple prostatectomy (RSP) for benign prostatic hypertrophy (BPH). METHODS: Patient demographics and perioperative outcomes were compared between 600 patients undergoing HoLEP and 32 patients undergoing RSP at two separate academic institutions between 2008 and 2015. RESULTS: Patients undergoing HoLEP and RSP had comparable ages (71 vs 71, p = 0.96) and baseline American Urological Association Symptom Scores (20 vs 24, p = 0.21). There was no difference in mean specimen weight (96 g vs 110 g, p = 0.15). Mean operative time was reduced in the HoLEP cohort (103 minutes vs 274 minutes, p < 0.001). Patients undergoing HoLEP had lesser decreases in hemoglobin, decreased transfusions rates, shorter hospital stays, and decreased mean duration of catheterization. There was no difference in the rate of complications Clavien grade 3 or greater (p = 0.33). CONCLUSIONS: HoLEP and RSP are both efficacious treatments for large gland BPH. In expert hands, HoLEP appears to have a favorable perioperative profile. Further studies are necessary to compare long-term efficacy, cost, and learning curve influences, especially as minimally invasive approaches become more widespread.


Assuntos
Terapia a Laser/métodos , Complicações Pós-Operatórias/epidemiologia , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/métodos , Idoso , Anemia/epidemiologia , Anemia/metabolismo , Anemia/terapia , Transfusão de Sangue/estatística & dados numéricos , Hemoglobinas/metabolismo , Hólmio , Humanos , Lasers de Estado Sólido/uso terapêutico , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Tamanho do Órgão , Próstata/patologia , Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos , Fatores de Tempo , Resultado do Tratamento , Cateterismo Urinário/estatística & dados numéricos
18.
Urology ; 103: 251-255, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28108324

RESUMO

OBJECTIVE: To describe our experience with the circle nephrostomy tube (NT) (Cook Medical), a drainage system uniquely designed for use after multiple-access percutaneous nephrolithotomy (PNL). METHODS: A retrospective review of 1317 consecutive patients undergoing 1599 PNLs at IU Health Methodist Hospital was performed. All multiple access cases utilizing circle NTs were reviewed and analyzed. The method of insertion of circle NT was demonstrated. RESULTS: A total of 1843 accesses were obtained in 1599 renal units (RUs): 380 upper pole, 129 interpolar, and 1334 lower pole. Multiple accesses in this series were required in 282 RUs (17.6%). Following multiple-access PNL, circle NTs, Cope loop, and reentry Malecot NTs were inserted in 91 RUs (32.3%), 208 RUs (73.8%), and 31 RUs (11%), respectively. None of the patients who had circle NT experienced clogging, dislodgement, or obstruction of the tube. The cost of circle, Cope loop, and Malecot NTs are 121.73 USD, 95.20 USD, and 81 USD, respectively. CONCLUSION: Circle NTs are easy to insert, secure, cost-effective compared with inserting two NTs. Circle NTs provide excellent drainage and facilitate secondary procedures.


Assuntos
Drenagem , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea/métodos , Nefrotomia , Cuidados Pós-Operatórios , Adulto , Análise Custo-Benefício , Drenagem/instrumentação , Drenagem/métodos , Desenho de Equipamento , Feminino , Humanos , Rim/diagnóstico por imagem , Cálculos Renais/diagnóstico , Masculino , Pessoa de Meia-Idade , Nefrotomia/instrumentação , Nefrotomia/métodos , Cuidados Pós-Operatórios/instrumentação , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
19.
J Endourol ; 30(7): 805-9, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27065437

RESUMO

INTRODUCTION: Holmium laser enucleation of the prostate (HoLEP) is a well-established technique for the surgical management of benign prostatic hyperplasia (BPH). A significant number of patients who require surgery for BPH are being treated with anticoagulation (AC) or antiplatelet (AP) therapy. We evaluated the efficacy and morbidity of HoLEP in this population. MATERIALS AND METHODS: One hundred sixteen patients who required AC/AP therapy undergoing HoLEP from 1999 to 2014 were compared with 1558 HoLEP patients who were not on AC/AP therapy (no AC/AP). Patients on intermittent vs continuous AC/AP therapy were also compared. RESULTS: No significant differences in preoperative characteristics were found between patients who did and did not receive AC/AP therapy. Intraoperative characteristics were similar except for enucleation time (51 minutes vs 65 minutes, AC/AP vs no AC/AP, respectively, p < 0.001) and morcellation rate (5 g/min vs 4.5 g/min, AC/AP vs no AC/AP, respectively, p = 0.02). Postoperative outcomes were comparable in all aspects except for length of hospital stay (27.8 hours vs 24 hours, p < 0.001) and duration of continuous bladder irrigation (15 hours vs 13.5 hours, p < 0.001), both of which were longer in the AC/AP group. There was no difference between cohorts in the lowest postoperative hemoglobin or transfusion rate. Two patients (1.9%) in the AC/AP cohort required clot evacuation vs 10 patients (0.7%) in the no AC/AP cohort. Pre-, intra-, and postoperative characteristics between patients on continuous vs intermittent AC/AP were not statistically significant, except for specimen weight (55.5 g vs 74.5 g, p = 0.028), which was greater in the intermittent AC group. CONCLUSION: Other than slight prolongation of duration of bladder irrigation and hospital stay, the intermittent or continuous use of anticoagulant therapy did not adversely affect outcomes of HoLEP, suggesting that this approach is an attractive approach for such patients, especially when the prostate is extremely large.


Assuntos
Anticoagulantes/uso terapêutico , Transfusão de Sangue/estatística & dados numéricos , Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Inibidores da Agregação de Plaquetas/uso terapêutico , Complicações Pós-Operatórias/epidemiologia , Hiperplasia Prostática/cirurgia , Idoso , Perda Sanguínea Cirúrgica , Hemoglobinas/metabolismo , Hólmio , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Irrigação Terapêutica , Ressecção Transuretral da Próstata/métodos
20.
J Urol ; 195(2): 413-7, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26307163

RESUMO

PURPOSE: Holmium laser enucleation of the prostate for the management of benign prostatic hyperplasia involves the 2 steps of enucleation and morcellation. Few prostate morcellation devices are available. In this study we compare the Wolf Piranha and Lumenis® VersaCut™ prostate morcellation devices. MATERIALS AND METHODS: After institutional review board approval and patient informed consent, a prospective, randomized trial was initiated for patients with symptomatic benign prostatic hyperplasia undergoing holmium laser enucleation of the prostate. All procedures were performed by a single surgeon (JEL) at Indiana University Health Methodist Hospital using the Piranha or VersaCut prostate morcellation device. Patient demographics, and preoperative, intraoperative and postoperative data for patients in the 2 treatment groups were analyzed and compared in a prospective fashion. RESULTS: A total of 74 patients were enrolled and randomized for the treatment device. Both groups were comparable in terms of age, prostate specific antigen and prostate size. There was no difference in patient demographic and preoperative characteristics. The Piranha achieved a slightly higher morcellation rate at 5.6 gm per minute (range 1.4 to 18), compared to the VersaCut at 4.8 gm per minute (range 1.3 to 9.5). However, the difference was not statistically significant (p = 0.14). Cost analysis (USD per patient) favored the VersaCut ($241 vs $471, p <0.001). CONCLUSIONS: Morcellation rates for the Piranha and VersaCut prostate morcellation devices are comparable, with the Piranha having a statistically significant increased cost. The Wolf Piranha also has a more complicated design, making it less user-friendly for the operating room staff and, therefore, more difficult to troubleshoot than the Lumenis VersaCut. Nevertheless, 75% of urology faculty, fellows and residents preferred the Piranha over the VersaCut, reporting that when working properly, it was more efficient in tissue removal.


Assuntos
Lasers de Estado Sólido/uso terapêutico , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata/instrumentação , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Equipamentos Cirúrgicos , Resultado do Tratamento
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