Predictive factors for intraoperative blood Loss during percutaneous nephrolithotomy

Objective: To evaluate the factors that may increase bleeding during Percutaneous nephrolithotomy [PCNL] and correlate them with outcome

Study Design: Analytical study

Place and Duration of Study: The Kidney Centre postgraduate Training Institute, Karachi, Pakistan, from July to December 2016

Methodology: Consecutive patients who underwent PCNL from July to December 2016 were prospectively enrolled. Drop in hemoglobin was divided into three groups: mild <1 gm/dl, moderate 1-2 gm/dl and major > 2 gm/dl. Factors such as age, gender, comorbidities, body mass index [BMI], operative time, creatinine levels, renal cortical thickness, stone size, its characteristics and location, puncture type and site, and need for blood transfusion were assessed by Chi-square/ Fisher exact test and Kruskal Wallis test. Predictive factors were assessed by multinomial logistic-regression analyses

Results: Total 305 patients were enrolled in the study. Median age was 37 [27.5-49.1] years with predominantly males [n=217, 71.8%]. Median BMI was 27.3 [24.6-31.4] Kg/m[2] and mean stone size was 2.7 [2.1-3.4] cm. Two hundred and ninety-seven [97.7%] stones were radio-opaque. Operative time was 95 [60-127] minutes. There were 50.8% patients who had moderate drop in hemoglobin [1-2 gm/dl]. Stone size, BMI and operative time were strongly associated with significant drop in hemoglobin. Complete stone clearance was achieved in 256 [84%] patients. Thirty [9.8%] patients needed blood transfusion. None of the patients required angioembolisation

Conclusion: BMI, stone size, and operative time were strongly associated with intraoperative blood loss during PCNL

Postoperative pain score of bupivacaine versusplacebo in patients undergoing percutaneous nephrolithotomy

Objective: to compare postoperative mean pain score of bupivacaine versusplacebo in patients undergoing percutaneous nephrolithotomy

Study Design: an experimental study

Place and Duration of Study: department of Urology, The Kidney Centre, Postgraduate Training Institute [PGTI], Karachi, from November 2014 to December 2015

Methodology: a total of 94 patients who underwent standard percutaneous nephrolithotomy, clinically diagnosed renal stone by CT scan, KUB, X-ray or ultrasound were included in the study. Patients were randomly divided into two groups. Forty-seven patients in-group A were treated with 20ml/50mg of 0.25% bupivacaine; and 47 patient's in-group B were treated with normal saline. Postoperatively, visual analog score was used to assess the pain at 6, 12 and 24 hours. Data was analysed using SPSS version 20.0 and student t-test was applied for comparison between the groups

Results: the average age of the patients was 37.23 +/- 11.31 years. Mean pain score in 24 hours was low in group A as compared to group B [5.22 +/- 0.76 vs. 7.85 +/- 0.78; p<0.001]

Conclusion: bupivacaine infiltration into the nephrostomy tract is a highly effective and safe in postoperative pain management for patients undergoing standard PCNL

Ureteroscopy under spinal versus general anaesthesia: morbidity and stone clearance

To compare morbidity and stone clearance by ureteroscopy carried out under spinal anaesthesia with that carried out under general anaesthesia. Quasi-experimental study. The study was conducted at the Kidney Centre, Postgraduate Training Institute, Karachi, from September 2005 to December 2006. A total number of 60 patients were enrolled for the study. All patients underwent ureteroscopic procedure for a calculus disease, using a semi-rigid ureteroscope of 10 Fr. These patients were divided in 2 groups of 30 patients, receiving general or spinal anaesthesia. Operative time, stone clearance, hospital stay, intra- and postoperative complications and visual analogue score for pain were noted in each case. There were 30 patients each in both groups, with 73% males and 27% females in group A [general anaesthesia] and 93% males and 7% females in group B [spinal anaesthesia]. Mean age of the patients were 33.9 and 36.9 years in groups A and B respectively. The average stone size was 0.79 cm in group A and 1.14 cm in group B [p=0.001]. Duration of surgery was 41.4 +/- 1.29 minutes in group A and 30.5 +/- 2.13 minutes in group B [p=0.033]. Mean hospital stay was 21.6 and 18.1 hours in group A and B respectively [p= 0.073]. Mean visual analogue score for pain in group A was 3.1 and group B was 1.8. Ureteroscopy under spinal anaesthesia resulted in decreased length of operative time and shortened hospital stay in this series and did not carry any additional risk of major complications