Journal of endourology
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Journal of endourology · Sep 2014
Randomized Controlled TrialAnalgesic efficacy of paravertebral bupivacaine during percutaneous nephrolithotomy: an observer blinded, randomized controlled trial.
A unilateral paravertebral (PVB) block with catheter can provide extendable analgesia without physiological changes. The objective of this study was to assess the efficacy of PVB bupivacaine for providing perioperative pain relief in adults undergoing percutaneous nephrolithotomy (PCNL) under general anesthesia. ⋯ Unilateral PVB block with catheter provided effective perioperative analgesia for PCNL.
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Journal of endourology · Sep 2014
Randomized Controlled Trial Comparative StudyPercutaneous nephrolithotomy in the oblique supine lithotomy position and prone position: a comparative study.
To compare the safety, efficacy, and complications of percutaneous nephrolithotomy (PCNL) in the oblique supine lithotomy position vs the prone position in a randomized comparative study. ⋯ PCNL in both positions was equally successful with no significant differences in complications. PCNL in the oblique supine lithotomy position was superior to PCNL in the prone position regarding operative time, hospital stay, and effects on respiratory and cardiovascular status, making it more comfortable for patients and anesthesiologists. Morbidly obese patients, patients with cardiologic disorders, and patients with pulmonary obstructive airway disease need further studies to show if they would benefit from these differences. Additionally, it is more comfortable for the surgeon with little challenges added in the initial puncture.
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Journal of endourology · Sep 2014
Tracked ultrasonography snapshots enhance needle guidance for percutaneous renal access: a pilot study.
Although ultrasonography-guided percutaneous nephrostomy is relatively safe, a number of factors make it challenging for inexperienced operators. A computerized needle navigation technique using tracked ultrasonography snapshots was investigated to determine whether performance of percutaneous nephrostomy by inexperienced users could be improved. ⋯ Tracked ultrasonography snapshots appear to improve the performance of percutaneous nephrostomy in these preliminary investigations, justifying further validation studies. The presented navigation system is reproducible because of commercially available hardware and open-source software components, facilitating its potential role in clinical practice.
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Journal of endourology · Aug 2014
Randomized Controlled Trial Comparative StudyRandomized controlled trial comparing retroperitoneal laparoscopic pyelolithotomy versus percutaneous nephrolithotomy for the treatment of large renal pelvic calculi: a pilot study.
To evaluate the efficacy and safety of retroperitoneal laparoscopic pyelolithotomy (RLP) versus percutaneous nephrolithotomy (PCNL) for large renal pelvic calculi using a randomized controlled trial. ⋯ Current evidence suggests that PCNL and RLP are both effective and safe for the treatment of large renal pelvic calculi. Our study shows that, compared with the PCNL approach, RLP for large renal pelvic stone resulted in shorter operative time, less bleeding, less postoperative fever, and a higher stone-free rate. Data from larger, multicenter randomized controlled trials of high quality are needed to further confirm our findings.
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Journal of endourology · Jul 2014
Observational StudyIncrease in intracranial pressure during carbon dioxide pneumoperitoneum with steep trendelenburg positioning proven by ultrasonographic measurement of optic nerve sheath diameter.
The purpose of this study was to assess the extent of the increased intracranial pressure (ICP) resulting from CO2 pneumoperitoneum and steep Trendelenburg positioning using ultrasonographic measurement of optic nerve sheath diameter (ONSD) in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALRP). ⋯ In patients undergoing RALRP, the increase of 12.5% in ONSD during CO2 pneumoperitoneum with steep Trendelenburg positioning was observed and thus the increase of ICP corresponding to this change of ONSD could be predicted. In 15% of the enrolled patients, ONSD increased by values equivalent to an ICP above 20 mm Hg without a deterioration of rSO2 or any neurologic complications.