ABSTRACT
INTRODUCTION: Temporary apnoea is often practiced during flexible ureteroscopy and lasertripsy (FURSL) for renal stones to reduce the potential movement of kidney secondary to respiratory excursions. While apnoea can help, it can also lead to respiratory complications, longer operative duration and ultimately prolong the length of hospital stay (LOS). The aim of this study was to look at the outcomes of FURSL without the use of apnoea. MATERIAL AND METHODS: Over a 6-year period from March 2012-June 2018, consecutive cases of adult FURSL were prospectively evaluated. Patients underwent surgical and anaesthetic counselling, pre-operative assessment and protocol-based general anaesthetic without using apnoea. Data on patient and stone demographics, operative details, LOS, stone-free rate (SFR) and complication rates were collected and analysed. RESULTS: A total of 292 patients underwent FURSL, with a mean age of 57 years and male:female ratio of 1.6:1. Pre and post-operative stents were inserted in 28.8% and 81.2%, a ureteral access sheath (UAS) was used in 61.6%. The mean single and cumulative stone sizes were 10.2 ±5.9 mm and 14.3 ±10.4 mm respectively. For a mean operative time of 48.8 ±25.5 minutes, the SFR was 88.7%.The median length of stay was 0 days with 216 (74.0%) patients discharged the same day and a further 48 (16.4%) discharged within 24 hours. There were 11 complications, of which 10 were Clavien I/II, and 1 was Clavien IV. CONCLUSIONS: Ureteroscopy can be safely performed without respiratory apnoea, using anaesthetic and surgical protocols. It improves day-case rates for FURSL and minimizes complications.
ABSTRACT
PURPOSE: To investigate the prospective outcomes of day-case ureterorenoscopy (DC-URS) for stone disease. With the rising prevalence of stone disease in the face of finite resources, there is increasing pressure to undertake procedures as a day case avoiding in-patient stay. There are a limited number of studies reporting on the feasibility of ureteroscopy as a day-case procedure. This study aimed to investigate the prospective outcomes and predictors precluding to DC-URS for stone disease in patients treated in our university teaching hospital. MATERIALS AND METHODS: Between March 2012 and July 2016, consecutive cases of adult stone ureteroscopy performed or supervised by a single surgeon were recorded in a prospective database. Patients underwent pre-operative counselling in a specialist stone clinic and were admitted to a dedicated 'Surgical day unit' on the day of surgery. A standardised anaesthetic protocol was adhered to in all cases. Data on patient demographics, stone parameters, pre-operative assessment, operative details, length of stay, stone-free rate and complication rates were collected and analysed. RESULTS: A total of 544 consecutive adult ureteroscopy for stone disease were conducted over the study period with a day-case rate of 77.7%. Thirty-nine percent of failed day-case ureteroscopy were due to late completion of ureteroscopy and due to associated social circumstances of patients. The mean stone size, operating time duration and post-operative stent insertion rates for DC-URS patients were 14 mm, 46 min and 96.5%, respectively. Post-operatively, the mean stone-free rate (SFR), unplanned re-admissions and complications for DC-URS patients were 95, 4 and 4%, respectively. A higher failure of DC-URS was related to patient's age (p = 0.003), positive pre-operative urine culture (p < 0.001), elevated pre-operative serum creatinine (p < 0.001) and higher mean operating time (p < 0.02). CONCLUSION: Based on our results, a day-case ureteroscopy rate of nearly 78% can be achieved. With its acceptable complication rate, and low re-admission rates, DC-URS is a safe and feasible option in a majority of patients with stone disease.
Subject(s)
Ambulatory Surgical Procedures/methods , Kidney Calculi/surgery , Kidney/surgery , Ureteral Calculi/surgery , Ureteroscopy/methods , Adult , Age Factors , Aged , Aged, 80 and over , Creatinine/blood , Databases, Factual , Endoscopy/methods , Feasibility Studies , Female , Humans , Male , Middle Aged , Operative Time , Patient Readmission/statistics & numerical data , Postoperative Complications/epidemiology , Prospective Studies , Retrospective Studies , Risk Factors , Stents/statistics & numerical data , Treatment Failure , Treatment Outcome , Urinary Tract Infections/epidemiology , Urologic Surgical Procedures/methods , Young AdultABSTRACT
We present two uncommon cases of abnormalities of the pediatric airway, which may present in the first instance to the anesthetist. Glottic scar bands are a result of intubation trauma and are a treatable cause of voice abnormalities and sometimes respiratory distress.
Subject(s)
Bronchoscopy/methods , Cicatrix/etiology , Intubation, Intratracheal/adverse effects , Laryngostenosis/etiology , Child, Preschool , Cicatrix/diagnosis , Female , Glottis , Humans , Infant , Laryngostenosis/diagnosis , Postoperative CareABSTRACT
We report our experience of three cases of intraoperative pneumothorax in neonatal surgical patients. Following a review of the literature, we discuss possible causes for each case and methods of treatment. We emphasize the need for inclusion of pneumothorax as a cause for cardiorespiratory instability even when no predisposition is identifiable and highlight the need for prompt treatment to prevent serious morbidity and mortality.
