Journal of endourology
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Journal of endourology · Nov 2009
Comparative Study Clinical TrialPercutaneous nephrolithotomy under general versus combined spinal-epidural anesthesia.
We analyzed the results of patients who underwent percutaneous nephrolithotomy (PCNL) for management of kidney stone disease under combined spinal-epidural anesthesia and compared surgical parameters and outcomes with a matched control group who underwent PCNL under general anesthesia. ⋯ We consider that combined spinal-regional anesthesia is a feasible technique in PCNL operations because the efficacy and safety were not affected. Further investigations with larger series are needed.
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Journal of endourology · Nov 2009
Randomized Controlled TrialEffects of thoracic epidural analgesia combined with general anesthesia on intraoperative ventilation/oxygenation and postoperative pulmonary complications in robot-assisted laparoscopic radical prostatectomy.
The purpose of this study was to evaluate the effects of thoracic epidural analgesia (TEA) on intraoperative ventilation/oxygenation and postoperative pulmonary complications in robot-assisted laparoscopic radical prostatectomy requiring high-pressure pneumoperitoneum and the extreme head-down position. ⋯ TEA combined with general anesthesia improved intraoperative ventilation/oxygenation. Although clinical and radiologic pulmonary complications were not significantly influenced, TEA can be considered an option for patients with limited reserve capacity or preexisting impairments of visceral blood flow.
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Journal of endourology · Oct 2009
ReviewAwake endotracheal intubation and prone patient self-positioning: anesthetic and positioning considerations during percutaneous nephrolithotomy in obese patients.
Obesity is associated with adverse outcomes with certain urologic procedures and may make patient positioning more difficult. We describe our technique of awake intubation and prone patient self-positioning before percutaneous nephrolithotomy (PCNL), and review the literature regarding prone positioning in obese patients and the impact of obesity on PCNL. ⋯ The technique of awake intubation with prone patient self-positioning can be helpful for positioning morbidly obese patients before PCNL and has been safe and effective in properly selected patients. Efficacy of PCNL should not be impacted by obesity or prone positioning and morbidity minimized provided that surgical and anesthesia teams understand and safeguard against potential complications.
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The key requisite of any percutaneous nephrolithotomy technique is access to the collecting system. The kidney has a high degree of vascular network and is liable for vascular injury. Therefore, for an ideal puncture, a percutaneous tract would be developed that leads straight from the skin through a papilla and the target calix into the renal pelvis. ⋯ We think the punctures with this technique are suboptimal. Both methods need a certain degree of training and orientation. The training in US should be structured.
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Journal of endourology · Oct 2009
ReviewLaparoscopic techniques for removal of renal and ureteral calculi.
Although most ureteral and renal stones are managed using endourologic techniques or shockwave lithotripsy in daily clinical practice, stone surgery has not completely disappeared. The increasing experience with laparoscopy in urology poses the question of whether urolithiasis may be an indication for laparoscopy. ⋯ Laparoscopic removal of renal and ureteral calculi plays a role in special cases of urolithiasis. In experienced hands, it can be performed safely and efficiently and may therefore replace open stone surgery in most indications.