The efficacy of peritubal analgesic infiltration in postoperative pain following percutaneous nephrolithotomy – A prospective randomized controlled study

ABSTRACT Objective: To study the efficacy of peritubal infiltration in postoperative pain following percutaneous nephrolithotomy in general PCNL patients and PCNL patients with supracostal renal access. Patients and Methods: A total of 105 PCNL patients were randomized into two groups, 53 patients receiving peritubal analgesic infiltration (study group) and 52 patients as the control group. Of these patients, supracostal access was performed in 22 patients of study group and 23 patients of control group. The study group received peritubal injection with 10mL of bupivacain. Postoperative pain as the primary outcome was assessed by using visual analogue scale at 1, 4, 12, 24 and 48 hours postoperatively. The secondary outcomes were the total postoperative morphine usage in 24 hours and time of the first analgesic demand. Results: The average VAS pain at 1 and 4 hours after the operation in the study group were significant lower in the control group (P≤0.001 and 0.026). Doses of morphine usage for controlling postoperative pain and the first analgesic demand were significantly lower and longer in study group. Among patients submitted to supracostal access, the average VAS pain at 1 hour after operation in the study group was lower (P=0.018). Doses of morphine usage for controlling postoperative pain also was lower in the study group (P=0.012). Conclusion: The peritubal local anesthetic infiltration is effective in alleviating immediate postoperative pain after percutaneous nephrolithotomy even with supracostal access.

The efficacy and safety of oral Tamsulosin controlled absorption system (OCAS) for the treatment of lower urinary tract symptoms due to bladder outlet obstruction associated with benign prostatic hyperplasia: an open-label preliminary study

AIMS: Tamsulosin, a superselective subtype alpha 1a and 1d blocker, is used for the treatment of male lower urinary tract symptoms (LUTS) commonly caused by benign prostatic hyperplasia (BPH). This prospective study evaluated the efficacy and safety of a new formulation, Tamsulosin OCAS® (Oral Controlled Absorption System), for LUTS associated with BPH in Thai patients. MATERIALS AND METHODS: Fifty one patients over 40 years old with complaints of LUTS associated with BPH were recruited. Patients received an 8 week course of once daily 0.4 mg tamsulosin OCAS®, and were followed up at 2 (visit 3), 4 (visit 4) and 8 (visit 5) weeks post-treatment. At each visit, patients were assessed using the International Prostate Symptom Score (IPSS), Nocturia Quality of Life (N-QoL) Questionnaire, QoL Assessment Index (IPSS-QoL), and International Index of Erectile Function (IIEF). The primary outcome was efficacy of Tamsulosin. The secondary outcomes included change in the mean number of nocturia episodes, hours of undisturbed sleep (HUS) and uroflowmetry measurements. RESULTS: Total IPSS significantly decreased at week 8 from baseline (from 19.52 to 6.08; p < 0.001). Similarly, the voiding and storage subscores of IPSS also continued to improve significantly starting from the second and third visits, respectively (p < 0.001 versus baseline). The IPSS-QoL and N-QoL scores significantly improved at visit 3 through end of study. In addition, we observed significant nocturia and HUS improvement in their last clinic visit. Uroflowmetry parameters, Qmax and Qave, improved significantly at 3rd clinic visit . Three patients experienced mild dizziness. CONCLUSION: Tamsulosin OCAS® treatment led to significant improvements in LUTS, HUS and QoL in Thai patients with bladder outlet obstruction from BPH with few side effects.

Supracostal access: does it affect tubeless percutaneous nephrolithotomy efficacy and safety?

INTRODUCTION: Tubeless percutaneous nephrolithotomy (PCNL) in selected patients has been found to be safe and can reduce postoperative discomfort without increasing complications. The challenges of tubeless PCNL via supracostal access are inadequate drainage and postoperative bleeding, conditions that may increase pulmonary complications. We compare the efficacy and safety of the tubeless supracostal versus the standard supracostal PCNL. MATERIALS AND METHODS: Supracostal PCNL with one percutaneous renal access, no significant bleeding, extravasation and residual stone was performed in 95 patients. Of these, 43 were tubeless PCNL (Group-I) and 52 were PCNL with standard routine postoperative nephrostomy tube (Group-II). In group-I, PCNL was done by the standard supracostal technique with the placement of a postoperative external ureteral catheter for 48 hours. The operative time, success rate, hospital stay and ensuing complications were compared between group-I and group-II. RESULTS: Patients in the tubeless PCNL group (Group-I) were 90.7 percent stone -free while those with standard routine postoperative nephrostomy tube(Group-II) were 84.6 percent stone -free. Additionally, stone fragments of less than 4 mm in diameter were found in 9.3 percent of patients in group-I and 25.4 percent in group-II. The success rate, hematocrit change and complication were not significantly different between both groups. The analgesic requirement, operative time and hospital stay were all significantly less in the tubeless supracostal group (Group-I). None of group I and only one patient of group II needed intercostal drainage. CONCLUSION: Tubeless supracostal percutaneous nephrolithotomy in selected patients is effective with acceptable complications. This technique offers the advantage of lower analgesic requirement, shorter operative time and hospital stay. The pulmonary complication is the same as the standard supracostal percutaneous nephrolithotomy.

Cystic echinococcosis in Thailand with a special note on detection by serology in one family.

Thailand is a nonendemic area of echinococcosis. We report, herein, 3 cases with a special note on the use of serology in detection of the disease in one family. All cases were Thais. The first case was a man, having a cystic mass in the liver. He was subsequently diagnosed as having echinococcosis following positive serology. The second case, a male, had a renal hydatid cyst revealed by histopathology, and a positive serological test. The third case, a wife of case 2, was positive by serological screening for echinococcosis and subsequently proven to have splenic and liver echinococcal cysts. The present findings support the use of serology in the case detection of echinococcosis in Thailand.

Endourologic management of severely encrusted ureteral stents.

BACKGROUND: Ureteral stents are in common use in urologic practice. Even though the stent is a valuable urological tool, its use has two widely encountered complications, namely, stent encrustation and stone formation. These complications are difficult to manage; but endourologic surgery, which is minimally invasive, has become the first choice in the treatment for encrustation and stone formation. MATERIAL AND METHOD: Eight patients with severely encrusted ureteral stents were treated by endourologic techniques. One patient had severe encrustation at all sites of the stent and was treated by percutaneuos nephrolithotomy, ureteroscopy with intracorporeal lithotripsy and cystolitholapaxy. Five patients with severe encrustation at both ends of the stent were treated with percutaneous nephrolithotomy and cystolitholapaxy (4 cases) and with extracorporeal shock wave lithotripsy (ESWL) and cystolitholapaxy. The last two patients with severely encrusted ureteral stents at the bladder end were treated with percutaneous cystolithotomy with intracorporeal lithotripsy and by optical lithotrite, respectively. RESULTS: All cases were stone free and stent free in one session without complication. The average approaches were 1.9 (range 1-3). All stents were removed intact and no subsequent stent was required following the removal of the problematic stent. CONCLUSION: Endourologic surgery which is minimally invasive surgery, is the first choice of treatment for the management of severely encrusted ureteral stents with good results in one session without complications and no subsequent stent is necessary. The authors recommend removing the stent as soon as possible or change the new stent every 3 months for decreasing the incidence of these complications.

Percutaneous endopyelotomy in the treatment of ureteropelvic junction obstruction.

INTRODUCTION: Current advances in endourology, percutaneous endopyelotomy has now become the preferred treatment for ureteropelvic junction obstruction. Many advantages of endopyelotomy compared to open correction are decreasing postoperative pain, shorter operative time and short recovery time. PATIENTS AND METHOD: Percutaneous endopyelotomy was performed in 15 patients. Nine patients had previous open kidney and upper ureteral surgery. 11 patients had associated renal calculi. The incised ureteropelvic junction was stented with an endopyelotomy stent size 14/7 F. The stent was removed 6 weeks postoperatively. RESULTS: 14 patients (93%) remain symptom-free and 11 (73%) had improvement of their symptoms and postoperative intravenous pyelogram or renogram after follow up at 12-38 months (over 18 months). CONCLUSION: Percutaneous endopyelotomy is widely accepted as the first choice for correction of ureteropelvic junction obstruction due to less morbidity and with a high success rate.