Comparing the effect of peri-operative antibiotic prophylaxis only with continuous low-dose antibiotic treatment on the incidence of urinary tract infection and stent related-symptoms in patients undergoing Double-J (DJ) stent insertion following transurethral lithotripsy (TUL).

PURPOSE: There are some controversial data about the peri operative use of antibiotics after double-J (DJ) insertion. This study aimed to compare the rates of urinary tract infections (UTI) and stent-related symptoms (SRSs) in patients who received only perioperative antibiotic prophylaxis and those given continuous low-dose antibiotic therapy for the entire stent-indwelling time following transurethral lithotripsy (TUL). METHODS: In this randomized clinical trial 178 patients received intravenous antibiotic prophylaxis (ciprofloxacin 400 mg) before the TUL and then randomly divided into two groups to either receive no antibiotic treatment after procedure (group A, 90 patients) or to additionally receive a continuous low-dose antibiotic treatment with one ciprofloxacin 500 mg every 12 h for 3 days and then ciprofloxacin 250 mg once daily for the entire stent-indwelling time (group B, 88 patients). The rates of UTIs, SRSs and incidence of drug side-effects were evaluated in groups. RESULTS: A total of 7 patients had positive urine culture [group A: 4 (4.4%) vs. group B: 3 (3.4%); P = 0.722]. Only 1 patient in group B had febrile UTI in the mean duration of indwelling stent in situ. The rate of SRSs was 92.2% and 89.8% in Group A and B, respectively, with no significant difference (P = 0.609). A total of 4 patients in Group B complained of gastrointestinal side effects of ciprofloxacin. CONCLUSION: Continuous low-dose antibiotic treatment has no role in reducing the incidence of UTIs and SRSs during the indwelling time of ureteral stents compared with the peri-operative antibiotic prophylaxis only.

Comparing spinal anesthesia approaches for transurethral lithotripsy in patients with proximal ureteral stones: A randomized clinical trial of bupivacaine alone versus bupivacaine with fentanyl.

Despite the benefits of spinal anesthesia and the preference of anesthesiologists for this technique, it is less accepted by urologists due to the proximity of the stone place in the ureter and the possibility of pain, restlessness, and occasional movements of the patient during surgery. The current study investigated the success of bupivacaine plus intrathecal fentanyl in patients undergoing transurethral lithotripsy (TUL). In this randomized clinical trial, from April 2021 to September 2021, 54 patients with proximal urolithiasis candidates for TUL were enrolled. Patients were randomly categorized into two groups: group A received bupivacaine 10 mg and 0.5 ml of normal saline, while group B received bupivacaine 10 mg with 0.5 ml (25µg) of intrathecal fentanyl. According to our findings, about 74% of the patients were men, and the mean age of the patients was 66.14±22.46 years. The onset time of the sensory block, sensory block level, pain score, degree of relaxation, depth of the motor block, occurrence of anesthesia complications, oxygen saturation, and mean arterial blood pressure were not significantly different between the two groups. However, the duration of the motor block in group B was longer than in group A (p<0.001). Also, retropulsion was observed only in five patients (18.5%) in group A, significantly higher than in group B (p=0.019). Bupivacaine with fentanyl 25µg provided adequate spinal anesthesia with lower retropulsion in patients with urolithiasis who are candidates for TUL.