Journal of endourology
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Journal of endourology · May 2020
ReviewUrologic surgery and COVID-19: How the pandemic is changing the way we operate.
The coronavirus disease 2019 (COVID-19) pandemic has had a global impact on all aspects of health care, including surgical procedures. For urologists, it has affected and will continue to influence how we approach the care of patients preoperatively, intraoperatively, and postoperatively. A risk-benefit assessment of each patient undergoing surgery should be performed during the COVID-19 pandemic based on the urgency of the surgery and the risk of viral illness and transmission. ⋯ COVID-19 patients should be separated from noninfected patients at all levels of care, including recovery, to decrease the risk of infection. Future directions will be guided by outcomes and infection rates as social distancing guidelines are relaxed and more surgical procedures are reintroduced. Recommendations should be adapted to the local environment and will continue to evolve as more data become available, the shortage of testing and PPE is resolved, and a vaccine and therapeutics for COVID-19 are developed.
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Journal of endourology · Mar 2020
Randomized Controlled TrialEvaluation of the Efficacy of the Erector Spinae Plane Block for Postoperative Pain in Patients Undergoing Percutaneous Nephrolithotomy: A Randomized Controlled Trial.
Purpose: To compare the efficacy of the erector spinae plane block (ESPB) and conventional analgesia (CA) in pain management after percutaneous nephrolithotomy (PCNL). Materials and Methods: After obtaining the approval of the institutional ethics committee and patients' written informed consent, 60 cases ages 18 to 65 years, with the status of American Society of Anesthesia I/II and body mass index of 18.5 to 30, were included in the study. The patients were randomized to receive ESPB or CA by a computer-based list. Results: The demographic parameters were similar in both groups. ⋯ The use of tramadol and paracetamol was less in the ESPB group (60 ± 72.3 mg vs 120 ± 55 mg and 1.8 ± 0.76 g vs 3.2 ± 0.99 g, respectively). (p = 0.001 and <0.001, respectively). Conclusions: ESPB is a safe technique that provides effective postoperative analgesia in patients undergoing PCNL. ESPB decreases the postoperative VAS score, prolongs the salvage analgesia time, and reduces the need for paracetamol and tramadol use compared with general anesthesia with CA.
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Journal of endourology · Feb 2020
Observational StudyLearning Curve for the Tension-Free Vaginal Tape-Obturator Procedure for Female Stress Urinary Incontinence: A Prospective Single-Surgeon Study.
Objective: To evaluate the learning curve in an untrained resident surgeon for the initial case series of tension-free vaginal tape-obturator (TVT-O) to treat stress urinary incontinence. Materials and Methods: A retrospective observational study was conducted in Changhai Hospital, Shanghai, China, between March 2014 and June 2018. All consecutive women included were treated by the TVT-O procedure performed by one surgeon working under the supervision of an expert surgeon. ⋯ Conclusions: The TVT-O procedure showed encouraging objective and subjective outcomes and low complication rates, even at the initial stage of the learning curve. Thirty cases were required for a naïve resident surgeon to learn TVT-O procedures. However, long-term outcome and complications caused by the synthetic sling still need further follow-up.
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Journal of endourology · Nov 2019
Contemporary Perioperative Morbidity and Mortality Rates of Minimally Invasive vs Open Partial Nephrectomy in Obese Patients with Kidney Cancer.
Aims: To compare early postoperative morbidity and mortality rates in obese patients (body mass index ≥30 kg/m2) who underwent minimally invasive partial nephrectomy (MIPN) vs open partial nephrectomy (OPN), utilizing the National Surgical Quality Improvement Program (NSQIP) database. Materials and Methods: The NSQIP database was queried to identify obese patients who underwent either MIPN or OPN between 2008 and 2016. Patient demographics, comorbidities, operative time (OT), length of stay (LOS), and 30-day postoperative complications, readmissions, and mortality rates were recorded and compared between the two groups. ⋯ In the adjusted analysis, the odds of any complication within 30 days in the MIPN group were 61% lower, blood transfusion 73% lower, pneumonia 38% lower, sepsis 70% lower, acute renal failure 64% lower, superficial surgical site infection 40% lower, and reoperation 47% lower, compared with OPN patients. Conclusions: When compared with OPN in obese patients, the likelihood of 30-day postoperative morbidity was significantly lower in MIPN patients. However, the odds of 30-day mortality rates were similar between the groups.