Dexamethasone and ketorolac compare with ketorolac alone in acute renal colic: A randomized clinical trial.

BACKGROUND: Multidrug pain control can be beneficial in relieving pain and limiting narcotic use in renal colic. The purpose of this study was to evaluate the effects of adding dexamethasone to ketorolac on pain control in acute renal colic. METHODS: One hundred twenty patients with renal colic were randomized into comparison and intervention groups to investigate the effect of 8 mg of dexamethasone with 30 mg ketorolac administered immediately after the patient's admission. The primary outcome was pain intensity based on the visual analog scale (VAS), which was assessed at the baseline and after 30 and 60 min of drugs treatment. Also, grade of vomiting and narcotic or antiemetic requirement were measured at the baseline and after the 60-min intervention. RESULTS: A total of 120 patients were included in the final analysis, with 60 patients (50%) randomized to the comparison group (just ketorolac) and 60 (50%) randomized to the intervention group (ketorolac + dexamethasone). There were no significant demographic differences between groups (P > 0.05 for all). Differences in VAS scores were significantly lower in the intervention group after 30 min of drug administration (P = 0.009, compared with the control). However, there was not a significant difference in the median VAS score between groups at the baseline and end of the study (P > 0.05). At the end of the study, the percent of patients who need to narcotics (35% vs. 58%, P = 0.01) and/or antiemetic (12% vs. 28%, P = 0.022) were significantly lower in the intervention group compared with the controls. CONCLUSIONS: In comparison with the patients who just received ketorolac, adding dexamethasone provided improved pain control after 30 min of therapy. Furthermore, it decreased opioid requirements and decreased an antiemetic need at the end of the study. Dexamethasone should be considered an important multimodal adjunct for controlling pain and nausea in renal colic.

Side effects of Sputnik V, Oxford-AstraZeneca, Sinopharm, and Covaxin and their associations with other variables among healthcare workers of a tertiary hospital in Iran.

BACKGROUND: Misinformation about the prevalence of COVID-19 vaccines' side effects (SEs) has led to concerns about and mistrust of vaccine safety. Thus, this study aimed to evaluate the prevalence of COVID-19 vaccines' SEs. METHODS: In a cross-sectional survey-based study on the healthcare workers (HCWs) of a tertiary hospital in Iran, the SEs of Sputnik V, Oxford-AstraZeneca, Sinopharm, and Covaxin were evaluated through a face-to-face interview by a researcher-made questionnaire. RESULTS: A total of 368 HCWs received at least one dose of a COVID-19 vaccine. The prevalence of people with at least one SE was higher among those who received the Oxford-AstraZeneca (95.8 %) and Sputnik V (92.1 %) vaccines than those who received Covaxin (70.5 %) or Sinopharm (66.7 %). Following the first and second doses, injection site pain (50.3 % and 58.2 %), body/muscle pain (53.5 % and 39.4 %), fever (54.5 % and 32.9 %), headache (41.3 % and 36.5 %), and fatigue (44.4 % and 32.4 %) were the most common SEs. Overall, SEs were often initiated within 12 h and subsided within 72 h of vaccination. The prevalence of SEs after the first dose of Sputnik V was higher among those aged ≤ 31 years (93.3 %) than those aged > 31 years (80.5 %). In the Sputnik V group, the number of SEs experienced after the first dose was higher in women with underlying diseases than those without such diseases. Furthermore, the body mass index of participants with SEs was lower than that of participants without SEs. CONCLUSION: Compared to Sinopharm or Covaxin, the Sputnik V and Oxford-AstraZeneca vaccines were associated with a higher prevalence of SEs, a greater number of SEs per individual, and more severe SEs.

A thorough understanding of the role of lncRNA in prostate cancer pathogenesis; Current knowledge and future research directions.

In the entire world, prostate cancer (PCa) is one of the most common and deadly cancers. Treatment failure is still common among patients, despite PCa diagnosis and treatment improvements. Inadequate early diagnostic markers and the emergence of resistance to conventional therapeutic approaches, particularly androgen-deprivation therapy, are the causes of this. Long non-coding RNAs (lncRNAs), as an essential group of regulatory molecules, have been reported to be dysregulated through prostate tumorigenesis and hold great promise as diagnostic targets. Besides, lncRNAs regulate the malignant features of PCa cells, such as proliferation, invasion, metastasis, and drug resistance. These multifunctional RNA molecules interact with other molecular effectors like miRNAs and transcription factors to modulate various signaling pathways, including AR signaling. This study aimed to compile new knowledge regarding the role of lncRNA through prostate tumorigenesis in terms of their effects on the various malignant characteristics of PCa cells; in light of these characteristics and the significant potential of lncRNAs as diagnostic and therapeutic targets for PCa. AVAILABILITY OF DATA AND MATERIALS: Not applicable.

Unexpected urological presentation of COVID-19 in a 41-year-old female: A case report.

Hematuria and urinary discomfort may be the first manifestations of COVID-19 infection. Nevertheless, more researches are needed to be done in this field to clarify the exact mechanism by which SARS-CoV-2 affects the urological system.

Laparoscopy-Assisted Transperitoneal Percutaneous Nephrolithotomy for the Treatment of Renal Stones in a Horseshoe Kidney.

The objective of this case report is to highlight treatment by LAT-PCNL in a patient with horseshoe kidney. A 51-year-man with hematuria presented to the emergency department with moderate abdominal pain starting 7 hrs ago. He did not report a history of previous urological disease. Renal stone and horseshoe kidney malformation were diagnosed based on the plain abdominal film, intravenous urogram (IVU), non-contrast computed tomography (CT-IVU), and ultrasound findings. Due to the larger stone bulk and renal malformation, it was not possible to perform extracorporeal shock wave lithotripsy (ESWL) monotherapy or ESWL sandwich therapy. Moreover, since percutaneous nephrolithotomy (PCNL) had some challenges and limitations due to high skin-to-stone distance, special anatomy, dispersion stones, and possible consequent internal organs injuries, we performed LAT-PCNL on our patient. We did not observe any perioperative complication. Postoperative control abdominal x-ray revealed only a medium ureteral stone that was extracted while removing the Double-J stent a month later. The patient was discharged on the third postoperative day with normal laboratory values. At 3-month follow-up, the patient was stone-free with normal renal function and renal ultrasonography. Laparoscopy-assisted transperitoneal PCNL seems to be a safe and minimally invasive technique that can be used as an alternative approach in the management of renal stones in special cases of horseshoe kidneys.

Ultra-mini-percutaneous nephrolithotomy (PCNL) versus standard PCNL: A randomised clinical trial.

OBJECTIVE: To assess the effectiveness and advantages of ultra-mini-percutaneous nephrolithotomy (UM-PCNL) versus standard PCNL (S-PCNL), as one of the most important differences between the various PCNL techniques is the size of the renal access, which contributes to the broad spectrum of complications and outcomes. PATIENTS AND METHODS: This clinical randomised trial was conducted in 2016. In all, 70 patients with renal or upper ureteric stones of 10-20 mm in diameter, who were candidates for PCNL, were divided equally into two groups. Group A, underwent UM-PCNL using a 9.8-F ureteroscope through a 16-F sheath; and Group B, underwent S-PCNL using a 24-F nephroscope through a 30-F sheath. The stones were fragmented by pneumatic lithotripsy. Any perioperative complications and need for analgesia were recorded, and postoperative pain was assessed in both groups using a visual analogue scale (VAS). RESULTS: There were statistically significant differences in postoperative haemoglobin values, haemoglobin drop, transfusion rate, duration of hospitalisation and postoperative VAS pain score between the groups (P < 0.05). There were no significant differences in operation time, need for auxiliary procedures or stone-free rate. CONCLUSION: A minimally invasive UM-PCNL using a 9.8-F ureteroscope can play an important role in the treatment of symptomatic renal and upper ureteric stones of <20 mm in diameter with lesser blood loss, duration of hospitalisation, need of transfusion, and postoperative pain compared with S-PCNL.

Laparoscopic redo pyeloplasty after failed open surgery.

PURPOSE: To report our experience in treating patients with failed previous open pyeloplasty by transperitoneal laparoscopic pyeloplasty. MATERIALS AND METHODS: Eleven patients with previous failed open pyeloplasty were reviewed, all of whom had undergone transperitoneal laparascopic pyeloplasty. All procedures were performed by a single team. Depending on the anatomic situation, either dismembered or a flap technique was utilized. Subsequent follow-up was by ultrasonography initially, and diuretic renal scintigraphy and/or intravenous urography at least 12 months after the re-operation. Data were collected from the medical records. RESULTS: The study group consisted of 7 men and 4 women with the mean age of 41.4 years (range, 27 to 55 years). Mean operation time was 208 minutes (range, 165 to 250 minutes) and mean hospital stay was 3.6 days (range, 3 to 5 days). Mean follow-up was 24.1 months (range, 12 to 42 months). The overall success rate for these salvage laparoscopic pyeloplasties was 90.9%. Only one female patient developed dull flank pain 3 months after stent removal. There was no conversion to open surgery. None experienced major complications or required blood transfusion. CONCLUSION: Laparoscopic pyeloplasty can be a valid and feasible option in treating patients with failed prior open pyeloplasty.

Does bleeding during percutaneous nephrolithotomy necessitate keeping the nephrostomy tube? A randomized controlled clinical trial.

PURPOSE: To compare outcomes in two groups of patients with kept and discarded nephrostomy tube after percutaneous nephrolithotomy (PCNL) complicated with bleeding. MATERIALS AND METHODS: Two hundred patients who had undergone PCNL complicated with hemorrhage were recruited in this study. Patients were randomly allocated to two groups: group A, who underwent tubeless PCNL and tract port was packed for 3 to 4 minutes after removing Amplatz sheath, and group B, for whom a 24-F nephrostomy tube was left in place at the end of the procedure. Patients were followed up for 3 months to check if bleeding occurred. RESULTS: The mean operation time was 68 ± 4.3 minutes in group A and 74 ± 5.6 minutes in group B (P = .098). The mean stone size was similar in groups A and B (36.26 ± 5.3 mm versus 35.35 ± 5.85 mm; P = .613). The mean hemoglobin drop was 3.65 ± 1.20 g/dL in group A and 3.13 ± 1.06 g/dL in group B. There was no significant difference between the mean of stone free rate in groups A and B (92.58% ± 5.97 versus 89.60% ± 8.3; P = .210). Patients in group A experienced a significantly less duration of hospitalization than group B (2.42 ± 0.84 days versus 3.70 ± 0.80 days; P < .001). CONCLUSION: In the absence of clear indication, nephrostomy tube insertion after PCNL does not seem to be beneficial, and its removal does not pose patients at any additional risk.

Delayed versus same-day percutaneous nephrolithotomy in patients with aspirated cloudy urine.

INTRODUCTION: We present our experience in continuing percutaneous nephrolithotomy (PCNL) versus delayed PCNL when purulent fluid is aspirated during access to the pyelocaliceal system. MATERIALS AND METHODS: This randomized controlled study was carried out on patients who had purulent urine in the pyelocaliceal system at the initial puncturing during PCNL. Patients with recent untreated urinary tract infection, thick or foul pus in aspirated urine, fever, and immunocompromised condition were excluded. Thirty-one patients were randomly divided into 2 groups. In group 1, PCNL was continued, but in group 2, nephrostomy tube was placed and PCNL was performed 10 days later after documented sterile nephrostomy urine. The preoperative and postoperative findings were compared. RESULTS: There were 16 and 15 patients in groups 1 and 2, respectively. All patients had negative urine cultures for microorganisms, preoperatively. The purulent aspirated fluid was infected in 43.8% and 40.0% of the patients in groups 1 and 2, respectively. Postoperative fever was seen in 25.0% and 26.7% of the patients, respectively. No statistical differences were observed between the two groups in terms of bacteriuria, bacteremia, positive calculus cultures, or stone-free rates, and duration of hospitalization between groups 1 and 2, respectively. More analysis with linear regression model showed that postoperative positive blood culture (P < .001), fever (P = .001), and postoperative positive urine culture (P = .02) correlated with duration of hospitalization. CONCLUSION: In the absence of untreated recent UTI and aspiration of thick or foul pus, continuing PCNL can be safe while purulent urine is encountered.