| 1. |
- Andonian, Sero, et al.
(författare)
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Does Imaging Modality Used for Percutaneous Renal Access Make a Difference? A Matched Case Analysis
- 2013
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Ingår i: Journal of Endourology. - : Mary Ann Liebert Inc. - 0892-7790 .- 1557-900X. ; 27:1, s. 24-28
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess perioperative outcomes of percutaneous nephrolithotomy (PCNL) using ultrasound or fluoroscopic guidance for percutaneous access. Methods: A prospectively collected international Clinical Research Office of the Endourological Society (CROES) database containing 5806 patients treated with PCNL was used for the study. Patients were divided into two groups based on the methods of percutaneous access: ultrasound versus fluoroscopy. Patient characteristics, operative data, and postoperative outcomes were compared. Results: Percutaneous access was obtained using ultrasound guidance only in 453 patients (13.7%) and fluoroscopic guidance only in 2853 patients (86.3%). Comparisons were performed on a matched sample with 453 patients in each group. Frequency and pattern of Clavien complications did not differ between groups (p = 0.333). However, postoperative hemorrhage and transfusions were significantly higher in the fluoroscopy group: 6.0 v 13.1% (p = 0.001) and 3.8 v 11.1% (p = 0.001), respectively. The mean access sheath size was significantly greater in the fluoroscopy group (22.6 v 29.5F; p < 0.001). Multivariate analysis showed that when compared with an access sheath <= 18F, larger access sheaths of 24-26F were associated with 3.04 times increased odds of bleeding and access sheaths of 27-30F were associated with 4.91 times increased odds of bleeding (p < 0.05). Multiple renal punctures were associated with a 2.6 odds of bleeding. There were no significant differences in stone-free rates classified by the imaging method used to check treatment success. However, mean hospitalization was significantly longer in the ultrasound group (5.3 v 3.5 days; p < 0.001). Conclusions: On univariate analysis, fluoroscopic-guided percutaneous access was found to be associated with a higher incidence of hemorrhage. However, on multivariate analysis, this was found to be related to a greater access sheath size (>= 27F) and multiple punctures. Prospective randomized trials are needed to clarify this issue.
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| 2. |
- Burgu, Berk, et al.
(författare)
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Use of neurosurgical patties for dissection in laparoscopic procedures of the urinary tract.
- 2011
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Ingår i: Journal of endourology. - : Mary Ann Liebert Inc. - 1557-900X .- 0892-7790. ; 25:5, s. 737-8
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Tidskriftsartikel (refereegranskat)abstract
- Minimal bleeding during endoscopic surgery of the urinary tract may prevent optimum vision. We used neurosurgical patties for dissection during our laparoscopic procedures in the pediatric population and aimed to describe this technique as an alternative to standard ways of dissection during laparoscopic procedures. We have performed 21 procedures, including pyeloplasties, nephrectomies, and management of duplication anomalies, by using 0.5 inch Codman neurosurgical patties.™ Use of neurosurgical patties during laparoscopic urologic procedures yields a clear vision that enables the surgeon to perform the procedure more comfortably and effectively.
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| 3. |
- Daouacher, Georgios, 1978-, et al.
(författare)
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A simple reconstruction of the posterior aspect of rhabdosphincter and sparing of puboprostatic collar reduces the time to early continence after laparoscopic radical prostatectomy
- 2014
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Ingår i: Journal of endourology. - : Mary Ann Liebert. - 0892-7790 .- 1557-900X. ; 28:4, s. 481-486
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Incontinence is a drawback after radical prostatectomy for prostate cancer. Several surgical methods to improve continence have been described however with contradictory results.OBJECTIVE: To determine whether a modified surgical technique during laparoscopic radical prostatectomy (LRP) improves postoperative continence.PATIENTS AND METHODS: This is a prospective nonrandomized study with two consecutive series of 100 patients in each group. The first group from 2005 to 2008 underwent a standard LRP. The second group from 2009 to 2011 was subjected to a modified LRP by sparing of puboprostatic ligaments, including the preservation of arcus tendineous, and using a simple posterior tension-releasing suture adapting the urethra stump to the bladder before the anastomosis. The patients had the same preoperative work-up and comparable preoperative baseline characteristics. The 2-year follow-up of the patients included a continence questionnaire and International Prostate Symptom Score (IPSS). Urinary peak flow (Qmax) and post-void residual (PVR) volume were assessed at 3 months. Continence was defined as 0-1 pad/day.RESULTS: Only 99 patients were evaluated in each group. The patients had comparable operative characteristics. The continence rates after the modified technique vs the standard were 33% vs 16%, p=0.007 at 1 month; 66% vs 44%, p=0.002 at 3 months; 81% vs 67%, p=0.034 at 6 months; 92% vs 80%, p=0.024 at 12 months; and 95% vs 86%, p=0.05 at 2 years. No significant differences were found regarding voiding functions, the Qmax, the PVR volume, or the IPSS. Three patients developed urethral stricture in the standard group compared with none in the modified group. The negative margin rates were unchanged.CONCLUSIONS: The anterior preservation and posterior suture technique studied is a simple, safe, and efficient method to shorten the time to continence after LRP without adverse effects on voiding or compromising the margin rates.
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| 4. |
- DasGupta, Ranan, et al.
(författare)
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Preoperative Antibiotics Before Endourologic Surgery: Current Recommendations
- 2009
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Ingår i: Journal of Endourology. - : Mary Ann Liebert Inc. - 0892-7790 .- 1557-900X. ; 23:10, s. 1567-1570
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Tidskriftsartikel (refereegranskat)abstract
- The use of antibiotic prophylaxis is an accepted and widely practiced feature of modern surgery. The prevention and control of infection is a priority in healthcare worldwide, and the emergence of antibiotic resistance is a global phenomenon. Hence, rational use of antibiotics is essential. We discuss the guidelines published with regard to endourologic procedures and review the limited evidence currently available. There should be subclassification of endourologic procedures based on infection risk to guide sensible use of antibiotics before surgery.
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| 5. |
- Elwood, Chelsea N., et al.
(författare)
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Triclosan Inhibits Uropathogenic Escherichia coli-Stimulated Tumor Necrosis Factor-α Secretion in T24 Bladder Cells in Vitro
- 2007
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Ingår i: Journal of endourology. - New York : Mary Ann Liebert. - 0892-7790 .- 1557-900X. ; 21:10, s. 1217-1222
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Triclosan is an antimicrobial agent commonly used in consumer and medical products that inhibits bacterial fatty acid synthesis. In addition to its bactericidal effects, sublethal concentrations of triclosan reduce local inflammation, inhibit the growth of bacterial uropathogens, induce membrane stress, and inhibit P-fimbrial expression in uropathogenic Escherichia coli (UPEC). We tested whether sublethal concentrations of triclosan could reduce the adherence of UPEC to bladder and kidney cells and reduce the amount of the pro-inflammatory cytokine tumor necrosis factor-alpha (TNF-alpha) produced by these cells during bacterial challenge in vitro. MATERIALS AND METHODS: Assays of bacterial growth, adhesion, and intracellularization were performed using UPEC GR12 incubated for 4 hours on monolayers of human T24 bladder cells or A498 kidney cells with various sublethal concentrations of triclosan. The expression profile of TNF-alpha from bladder cells was evaluated using ELISA. RESULTS: No significant decreases were observed in the adherence or invasion percentages of UPEC GR12 with either cell line when treated with sublethal amounts of triclosan. However, treatment with triclosan 0.5 microg/mL led to a significant decrease in the total number of UPEC GR12 recovered from T24 monolayers (P < 0.05). Importantly, a reduction in the expression of TNF-alpha by T24 cells was shown when UPEC GR12 was treated with triclosan (P < 0.05). CONCLUSIONS: Sublethal concentrations of triclosan did not inhibit the adhesion or intracellularization of UPEC into kidney or bladder cell lines but did significantly reduce the amount of TNF-alpha secreted by bladder cells. Therefore, the use of triclosan on ureteral stents may prove clinically beneficial, not only by inhibiting bacterial survival and growth within the urinary tract, but by reducing local inflammation as well.
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| 6. |
- Fagerstrom, Tim, et al.
(författare)
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Complications and Clinical Outcome 18 Months After Bipolar and Monopolar Transurethral Resection of the Prostate
- 2011
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Ingår i: Journal of endourology. - : Mary Ann Liebert, Inc.. - 0892-7790 .- 1557-900X. ; 25:6, s. 1043-1049
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To compare bipolar resection with the conventional monopolar transurethral resection of the prostate (TURP) with respect to peri- and postoperative complications and long-term outcome. Patients and Methods: Patients with consecutive benign prostatic hyperplasia needing surgery (n = 185) from the hospitals waiting list were randomized to TURP using either a bipolar or a monopolar system. Peri-and postoperative parameters were monitored, complications were registered, and timed micturition/International Prostate Symptom Score (TM/IPSS) forms were collected at 3 and 6 weeks and at 6 and 18 months. Results: Bipolar surgery was followed by a 16% to 20% higher percentage of the patients reporting ongoing improvement (fractional IPSS change greater than2) at 3 and 6 weeks after the surgery (p less than 0.05). There were fewer readmissions in the bipolar group than in the monopolar (5 vs. 13, p less than 0.05). No differences between the groups with respect to hospital stay and catheter duration was recorded. Bipolar and monopolar TURP resulted in marked and sustained improvements of IPSS, bother score, and TM. Conclusions: Bipolar TURP, using the transurethral resection in saline (TURis) system, resulted in significantly fewer postoperative readmissions, faster postoperative recovery, and equally long-lasting good results in TM/IPSS and bother score, as in monopolar TURP.
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| 7. |
- Fagerstrom, Tim, et al.
(författare)
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Degree of Vaporization in Bipolar and Monopolar Resection
- 2012
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Ingår i: Journal of endourology. - : Mary Ann Liebert. - 0892-7790 .- 1557-900X. ; 26:11, s. 1473-1477
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To compare the in vitro degree of vaporization in bipolar and monopolar resection. less thanbrgreater than less thanbrgreater thanMaterials and Methods: Using either a bipolar system or a monopolar system, samples of chicken muscle and lamb kidney were resected in an isolated basin and then desiccated in an incubator. The percentual degree of vaporization for each sample was obtained as a difference between the total fresh weight of the sample and the calculated fresh weights of the resected tissue and remains. less thanbrgreater than less thanbrgreater thanResults: Reference samples showed that the water content was 73% in muscle and 77% in kidney. More muscle (mean 52%) than kidney (32%; P andlt; 0.0001) tissue was vaporized. The fraction of vaporized tissue was significantly higher in the bipolar technique. In muscle, the differences between monopolar and bipolar were 17% (P andlt; 0.05) and 26% (P andlt; 0.001), respectively, depending on the type of irrigation used. For kidney, the differences were 27% (P andlt; 0.01) and 34% (P andlt; 0.01), respectively. Further exploration of the degree of vaporization when using the bipolar resection showed that the choice of loop (P andlt; 0.0001), fluid (P andlt; 0.03), and tissue (P andlt; 0.0001) were all independently associated with the degree of vaporization. less thanbrgreater than less thanbrgreater thanConclusions: This study indicated that vaporization removes 50% more tissue than the weight of the resected tissue during conventional tissue resection. Bipolar standard loop resection resulted in a significantly higher degree of vaporization in both muscle and kidney than did monopolar technique. Bipolar resection worked satisfactorily in Ringers acetate.
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