Assessment of clinical efficacy of intranasal desmopressin spray and diclofenac sodium suppository in treatment of renal colic versus diclofenac sodium alone.

OBJECTIVES: To determine the effect of the combination of intranasal desmopressin spray and diclofenac sodium suppository on acute renal colic and compare it with diclofenac sodium suppository alone. METHODS: A total of 150 patients aged 15-65 years referred to our hospital with acute renal colic were included in a double-blind controlled clinical trial study. Patients in group 1 received desmopressin, 40 microg intranasally plus diclofenac sodium suppository 100 mg, and patients in group 2 received diclofenac sodium suppository 100 mg plus a placebo spray consisting of normal saline 0.9%. RESULTS: Significant differences were found in the pain scores at 15 and 30 minutes between the 2 groups (P < .05). Also, significant differences were found in the mean pain scores in the first 15 and first 30 minutes after treatment between the 2 groups (P < .05). Of the patients in group 1, 37.3% had no pain relief and required pethidine. However, this rate in group 2 was 69.3%. In 17 cases, we prescribed pethidine within 20 minutes after treatment, and these patients were excluded from our study. CONCLUSIONS: According to our results, intranasal desmopressin plus diclofenac sodium suppository caused prompt pain relief with significant decreases in pain scores after 15 and 30 minutes. We suggest that intranasal desmopressin spray is a useful supplemental therapy for renal colic in combination with nonsteroidal anti-inflammatory drugs, especially to reduce the use of opioids.

What is the difference between percutaneous nephrolithotomy in patients with and without previous open renal surgery?

BACKGROUND AND PURPOSE: In this study we aimed to determine the effects of previous open renal surgery on the results and complications of subsequent percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: From October 2005 to October 2007, 104 patients underwent PCNL in our hospital. We compared the patients who undergone previous open surgery on the same kidney (group 1; n = 36) with those who had undergone no previous surgery (group 2; n = 68). We extracted requested information such as age, sex, stone number, stone burden, intraoperative and postoperative complications, hospital stay, access time, operative time, and success rate. The results of the study were analyzed using SPSS 10 software. RESULTS: Intraoperative complications were seen in 11.11% of the group 1 patients and in 11.8% of the group 2 patients. Postoperative fever was seen in 33.3% of the patients in group 1 and in 26.5% of the patients in group 2. Mean hospital stay was 85.88 +/- 17.25 hours and 80.20 +/- 17.71 hours in group 1 and group 2, respectively. Mean operating time was 75.41 +/- 17.2 minutes in group 1 and 67.42 +/- 26.25 minutes in group 2. Stone-free rate was 88.9% in the group 1 patients and 79.4% in the group 2 patients. Step 1 access time in group 1 and group 2 was 120.02 +/- 68 seconds and 117.80 +/- 80.52 seconds, respectively (p = 0.002). CONCLUSIONS: PCNL in patients who previously underwent open renal surgery is effective and safe. We found no difference in results between the two groups based on the number of stones and the number of accesses. The step 1 of dilatation was the only difference between the two groups.

One-shot versus metal telescopic dilation technique for tract creation in percutaneous nephrolithotomy: comparison of safety and efficacy.

PURPOSE: The aim of this study was to assess the feasibility and morbidity of single-step acute dilation, named "one-shot" technique, including a single dilation of the nephrostomy tract with a 28F or 30F Amplatz dilator compared with metal telescopic dilation technique. PATIENTS AND METHODS: Two hundred fourteen patients who underwent percutaneous nephrolithotomy (PNL) for stone disease from September 2005 to October 2007 were included in the study, and they were randomly divided into two groups according to the type of tract dilation technique: in group 1 (112 patients), Alken telescopic dilators were used; in group 2 (102 patients), one-shot technique was used. Access tract dilation time, X-ray exposure time, success rate, and blood loss and other complications were evaluated. RESULTS: One-shot technique was compared using Alken telescopic dilators without an increase in morbidity and with significant reduction in X-ray exposure (p = 0.003). There was no significant difference in the procedural success rate between groups 1 and 2 (100% v 96.07%, respectively) (p = 0.765). There was no any significant difference in complications. Access time was similar in both groups (p = 0.14). CONCLUSION: One-shot dilation was proved to be safe and effective like metal telescopic dilation even in patients with a history of ipsilateral open renal surgery. In this procedure, X-ray exposure is lower.

Complete supine percutaneous nephrolithotripsy comparison with the prone standard technique.

PURPOSE: PCNL (percutaneous nephrolithotripsy) is usually performed in the prone position. The supine position has potential advantages comparing with the prone position. Our objective is comparison between the outcome of PCNL in the complete supine position and the standard prone position. MATERIAL AND METHODS: A total of 80 patients who underwent PCNL from February 2008 to June 2008 evaluated in a prospective manner, were randomly divided into two groups: 40 patients underwent prone PCNL and 40 patients underwent complete supine PCNL. We performed complete supine PCNL with no rolled towel under the flank and no change in leg position. Results in both positions were compared regarding technical aspects, operative time, stone free rate, complications and hospital stay, and were analyzed using t-test and chi-square. We considered P < 0.05 as significant. RESULTS: Regardless the position, the pelvicaliceal system could be successfully approached in all patients. Mean operative time in supine group was 74.7 +/- 25.1 min and less than prone group (106.87 +/- 17.5) with a significant statistical difference (P < 0.0001). Stone free rate was 80% and 77.5% in prone and supine position respectively. Mean hospital stay was similar in both groups. Bleeding requiring transfusion in two groups had not significant statistical difference. We had not colon injury. CONCLUSION: PCNL in supine position is safe, effective and suitable for the patients. It offers the potential advantages of better urethral access, less patient handling, needing drape only once, ability to perform simultaneous PCNL and ureteroscopic procedures, better control of the airway during procedures, thus reducing over-all operative time compared to traditional prone position and performing PCNL while the surgeon is sitting. It may be considered for most patients requiring PCNL.