Cirugía retrógrada intrarrenal para el tratamiento de cálculos renales bajo anestesia espinal, un método mínimamente invasivo. Análisis retrospectivo de 1.467 casos / Retrograde intrarenal surgery for stone disease under spinal anaesthesia, a minimally invasive technique. A retrospective analysis of 1,467 cases

Introducción y objetivos: El objetivo del presente estudio ha sido comparar los procedimientos de CRIR realizados bajo anestesia general (AG) y anestesia espinal (AE) con respecto a las tasas de éxito y las tasas de complicaciones. Materiales y métodos: Se ha realizado una evaluación retrospectiva de los datos de los pacientes tratados con CRIR bajo AG y AE en 2 centros, entre octubre del 2014 y enero del 2018. Los grupos de AG y AE han sido evaluados con respecto a los parámetros: libre de cálculos, tasa de complicaciones, control del dolor postoperatorio y duración de la estancia en el hospital. Los cirujanos que participaron en el estudio examinaron las tasas de ausencia de cálculos de los procedimientos de CRIR bajo AE. Resultados: Un total de 1.361 pacientes fueron incluidos en el estudio. Se obtuvo una tasa libre de cálculos del 84,4% en toda la muestra, el 85,3% pertenecientes al grupo tratado con AE y el 83,5% al grupo de AG (p = 0,364). No se determinaron diferencias estadísticamente significativas entre los cirujanos que llevaron a cabo la CRIR bajo AE con respecto a las tasas de éxito y complicaciones y el tiempo quirúrgico (p = 0,676). El tiempo quirúrgico se determinó como 44,2 ± 14,2 min en el grupo de AE y 49,7 ± 19,1 min en el grupo de AG (p = 0,014). Conclusiones: La CRIR se puede llevar a cabo de forma segura, tanto con AE como con AG. Se observó que el éxito de la CRIR bajo AE era independiente del factor relacionado con el cirujano, por lo que esta puede considerarse una buena alternativa a la AG

Introduction and objectives: The aim of the present study was to compare RIRS procedures applied under general anaesthesia (GA) and spinal anaesthesia (SA) regarding success and complication rates. Materials and methods: A retrospective evaluation was conducted with the data obtained from patients treated with RIRS under SA and GA at 2 centres from October 2014 until January 2018. The SA and GA groups were evaluated according to the parameters of stone-free and complication rates, postoperative pain control and length of in-hospital stay. The stone-free rates from the RIRS procedures applied with SA were evaluated by the surgeons who participated in the study. Results: A total of 1361 patients were included in the study. A stone-free rate of 84.4% was obtained in the global results: 85.3% in the SA group and 83.5% in the GA group (P = .364). No statistically significant difference was determined regarding surgeons who practiced RIRS under SA with respect to success/complication rates and operating time (P = .676). Operating time was determined as 44.2 ± 14.2 mins in the SA group and 49.7 ± 19.1 mins in the GA group (P = .014). Conclusions: The RIRS method can be applied safely, either under spinal anaesthesia, or under general anaesthesia. The success of RIRS under spinal anaesthesia has been shown as an independent factor regarding surgeon. It can be considered a good alternative to general anaesthesia

Retrograde intrarenal surgery for stone disease under spinal anaesthesia, a minimally invasive technique. A retrospective analysis of 1,467 cases. / Cirugía retrógrada intrarrenal para el tratamiento de cálculos renales bajo anestesia espinal, un método mínimamente invasivo. Análisis retrospectivo de 1.467 casos.

INTRODUCTION AND OBJECTIVES: The aim of the present study was to compare RIRS procedures applied under general anaesthesia (GA) and spinal anaesthesia (SA) regarding success and complication rates. MATERIALS AND METHODS: A retrospective evaluation was conducted with the data obtained from patients treated with RIRS under SA and GA at 2centres from October 2014 until January 2018. The SA and GA groups were evaluated according to the parameters of stone-free and complication rates, postoperative pain control and length of in-hospital stay. The stone-free rates from the RIRS procedures applied with SA were evaluated by the surgeons who participated in the study. RESULTS: A total of 1361 patients were included in the study. A stone-free rate of 84.4% was obtained in the global results: 85.3% in the SA group and 83.5% in the GA group (P=.364). No statistically significant difference was determined regarding surgeons who practiced RIRS under SA with respect to success/complication rates and operating time (P=.676). Operating time was determined as 44.2±14.2 mins in the SA group and 49.7±19.1 mins in the GA group (P=.014). CONCLUSIONS: The RIRS method can be applied safely, either under spinal anaesthesia, or under general anaesthesia. The success of RIRS under spinal anaesthesia has been shown as an independent factor regarding surgeon. It can be considered a good alternative to general anaesthesia.

Evaluation of erectile dysfunction in permanent pacemaker implanted patients with cardiac rhythm disorder prediagnosis.

BACKGROUND AND AIMS: To evaluate the anxiety, depression and related psychogenic erectile dysfunction that might be developed before and after pacemaker implantation in patients with cardiac arrhythmias. MATERIAL AND METHODS: Thirty permanent pacemaker implanted male patients, were enrolled to study between September 2006 and September 2008. Erectile function domain questions of International Index of Erectile Function (IIEF-6) and Hospital Anxiety and Depression Scale (HAD) questionnaires were applied to patients, 6 months before pacemaker implantation (BP6) and on month 1 (AP1) and 6 after application (AP6). Patients were included in a multidisciplinary cardiac rehabilitation-adaptation program with a duration of 1-2 months. Patients were evaluated in subgroups. RESULTS: Mean age was 51.5 ± 10.3. Most frequent diagnosis was observed as AV block in etiology. The mean IIEF values were changed 22.8→20.2→24.6 in BP6, AP1 and AP6 time frames consecutively. However, the mean HAD-Anxiety scores were evaluated as 8.1→17.0→7.3 and the mean HAD-Depression as 3.9→7.9→8.9 consecutively in the same time frames. CONCLUSION: Cardiac arrhythmia plus permanent pacemaker implantation, increased anxiety and depression of patients and decreased erectile function at AP1; however, the improvement in cardiac symptoms at AP6 with the possible positive effects of rehabilitation program, helps to reduce anxiety and increased IIEF scores, although there was still a slight increase in depression levels.

Lymphangioma of pyeloureteral junction: an extremely rare case.

Benign tumors of the proximal ureter are very rare. Many of them could be confused with urothelial carcinoma and unnecessarily treated by nephrectomy. In this case, we present the treatment of a lymphangioma localized in the upper ureter, which is an example of benign tumor. During treatment percutaneous tumor resection, an organ-sparing approach, was employed.

Use of terazosine in patients with chronic pelvic pain syndrome and evaluation by prostatitis symptom score index.

PURPOSE: Chronic Pelvic Pain Syndromes (CPPS) affect an important percentage (5-9%) of the patients in urology practice; however there has been no consensus as to how the treatment should be planned in these patients. The purpose of our study is to evaluate the effectiveness of terazosine in the treatment of CPPS patients. MATERIALS AND METHODS: In our outpatient department, between May 1997 and October 1999, 91 patients were diagnosed as CPPS. These patients were first evaluated by Prostatitis Symptom Score Index (PSSI) and then randomized into two treatment groups. The first group received 2 mg/day terazosine (47 patients), and the others received placebo (42 patients). After three months of treatment, 69 patients came back for the control visit (terazosine 39, placebo 30). They were reexamined by PSSI and their results were evaluated by Wilcoxon analysis. RESULTS: Before the treatment PSSI of the 39 patients who received terazosine were 9.61 +/- 1.61, after the treatment they were 6.25 +/- 1.60. For the placebo group, PSSI values before the treatment were 9.27 +/- 1.88 and after the treatment they were 8.81 +/- 2.66. In the terazosine group, the difference between the pretreatment and post treatment PSSI values was statistically significant (p = 0.0002). In the placebo group, on the other hand, this difference was statistically insignificant (p = 0.701)). After the treatment, the difference between the terazosine and placebo groups was also statistically significant (p = 0.001). In the terazosine group (as the recommendation was to take the medication at night) postural hypotension did not develop. CONCLUSION: Terazosine was effective for the treatment of CPPS. However it was concluded that three months of treatment was insufficient.