Factors associated with complications after percutaneous nephrolithotomy: an analysis of 1,066 cases

SUMMARY OBJECTIVE: The aim of this study was to identify predictive factors for complications after percutaneous nephrolithotomy. METHODS: We prospectively analyzed patients who underwent percutaneous nephrolithotomy from June 2011 to October 2018. The association of preoperative and intraoperative factors with the presence of complications was assessed using univariate and multivariate analyses. The significance level was set at p<0.05. RESULTS: A total of 1,066 surgeries were evaluated, and the overall complication rate was 14.9%. In all, 105 (9.8%) surgeries were performed in the prone position, and 961 (90.2%) were performed in the supine position. Univariate analysis demonstrated that surgical position, upper pole puncture, surgical time, number of tracts, and Guys Stone Score were associated with complications. In multivariate analyses, prone position (odds ratio [OR] 2.10; p=0.003), surgical time ≥90 min (OR 1.76; p=0.014), upper pole puncture (OR 2.48; p<0.001), and Guys Stone Score 3 or 4 (OR 1.90; p=0.033) were independent predictive factors for complications after percutaneous nephrolithotomy. CONCLUSION: Performing percutaneous nephrolithotomy in the supine position, in under 90 min, and avoiding upper pole punctures may reduce complications during the treatment of large kidney stones.

Comparison beetwen open and laparoscopic radical cistectomy in a latin american reference center: perioperative and oncological results

ABSTRACTObjectives:To evaluate the differences of peri-operatory and oncological outcomes between Laparoscopic Radical Cystectomy and Open Radical Cystectomy in our center.Materials and Methods:Overall, 50 patients were included in this non randomized match-pair analysis: 25 patients who had undergone Laparoscopic Radical Cystectomy for invasive bladder cancer (Group-1) and 25 patients with similar characteristics who had undergone Open Radical Cystectomy (Group-2). The patients were operated from January 2005 to December 2012 in a single Institution.Results:Mean operative time for groups 1 and 2 were 350 and 280 minutes (p=0.03) respectively. Mean blood loss was 330 mL for group 1 and 580 mL for group 2 (p=0.04). Intraoperative transfusion rate was 0% and 36% for groups 1 and 2 respectively (p=0.005). Perioperative complication rate was similar between groups. Mean time to oral intake was 2 days for group 1 and 3 days for group 2 (p=0.08). Median hospital stay was 7 days for group 1 and 13 for group 2 (p=0.04). There were no differences in positive surgical margins and overall survival, between groups.Conclusions:In a reference center with pelvic laparoscopic expertise, Laparoscopic Radical Cystectomy may be considered a safe procedure with similar complication rate of Open Radical Cystectomy. Laparoscopic Radical Cystectomy is more time consuming, with reduced bleeding and transfusion rate. Hospital stay seems to be shorter. Oncologically no difference was observed in our mid-term follow-up.

Quality of life of in patients submitted to anterior abdominal wall laparoscopic hernioplasty / Qualidade de vida de pacientes submetidos a hernioplastias laparoscopicas da parede abdominal anterior

Background - The laparoscopic ventral hernia repair technique made possible surgeries with smaller skin incisions and smaller dissection of the soft tissue around the hernia, therefore with a better wound, a quicker postoperative recovery and a lower complication rate. Aim - To evaluate the applicability of a quality of life survey based on the molds of the American Hernia Society, European Hernia Society and Carolinas Equation for Quality of Life, through telephone in patients submitted to laparoscopic hernioplasty by IPOM technique. Methods - A retrospective cohort study was made to evaluate the quality of life of 21 patients that underwent anterior abdominal wall laparoscopic hernioplasty by intraperitoneal onlay mesh technique. Questionnaire was applied through telephone. Results - Of the 21 patients, 19% felt that the hernia recurred. Also 19% passed through another abdominal wall surgery, and among these, 75% was related to the previously hernia correction. Finally, 81% of patients did not undergo any other abdominal wall surgery. Conclusion - It was possible to apply the quality of life questionnary by telephone on patients who underwent an anterior abdominal wall. The results, in its turn, were satisfactory and showed that patients, in general, were satisfied with the surgical procedure. .

Racional : A técnica de reparo de hérnia ventral via laparoscópica possibilitou operações com menor incisão na pele e menor dissecção dos tecidos moles ao redor da hérnia, portanto, melhor ferida operatória, rápido pós-operatório do paciente, retorno breve às atividades e menor taxa de complicações. Objetivo : Avaliar a aplicabilidade de um questionário de qualidade de vida baseado nos moldes da American Hernia Society, European Hernia Society e Carolinas Equation for Quality of Life em pacientes submetidos à hernioplastias laparoscópicas da parede abdominal anterior (incisional/epigástrica/ umbilical). Método : Em estudo retrospectivo de coorte envolvendo total de 21 pacientes no pós-operatório de 12 meses de hernioplastia laparoscópica da parede abdominal anterior pela técnica de "intraperitoneal onlay mesh" foram submetidos, por via telefônica, ao questionário da qualidade de vida. Resultados - Dos 21 pacientes, 19% sentiram retorno da hérnia e 81% relataram que nada aconteceu. Além disso 19% passaram por outra operação abdominal, sendo que dentre esses, 75% estava relacionada à hérnia previamente corrigida e 81% não passaram por nenhuma outra operação abdominal. Conclusão - Foi possível aplicar o questionário de qualidade de vida por via telefônica; a qualidade referida foi satisfatória e mostrou que os pacientes, de modo geral, ficaram satisfeitos com o procedimento cirúrgico. .