Can trajectory nor-epinephrine infiltration reduce blood loss during percutaneous nephrolithotomy? A double-blinded randomized controlled trial.

PURPOSE: To determine the efficacy and safety of trajectory infiltration with 1:150 000 Norepinephrine (NE) in reducing blood loss during percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: This is a prospective randomized double-blinded placebo-controlled trial. In all, 140 consecutive patients underwent PCNL for the management of large renal calculi. They were randomly assigned (1:1) to one of either study groups, the NE-PCNL group (70 patients whose PCNL-trajectory was infiltrated by NE) or the Placebo group (saline PCNL) (70 patients whose PCNL tracts were infiltrated by normal saline). Procedure-related blood loss (the primary outcome) was assessed and statistically analyzed. Also, all other procedure-related events and complications were recorded and compared. RESULTS: The median blood loss was 378 ml (IQR: 252-504) in the NE-PCNL group versus 592 ml (IQR: 378-756) in the S-PCNL group (p < 0.0001). In addition, Hemoglobin and Hematocrit deficits were lower in NE-PCNL (p < 0.05). Patients who were randomized to the NE-PCNL group had a higher immediate stone-free rate (SFR) (80%) compared with those of the S-PCNL group (70%) (p = 0.034). However, no statistical differences were found in the final SFR. The reported overall complications between the 2 groups were similar (p > 0.05). Indeed, bleeding-related complications were 1 (1.4%) versus 10 (14.3%) for NE-PCNL and S-PCNL, respectively (p = 0.009). CONCLUSIONS: Trajectory infiltration of PCNL tracts by NE was found to be effective and safe in mitigation of PCNL-related blood loss. This step is a timeless and cost-effective as NE is readily available in surgical theaters and of very low cost.

Bipolar Needlescopic Enucleation vs Bipolar Vapoenucleation of the Prostate: A Prospective, Single-Center Randomized Study.

Background: Endoscopic enucleation of the prostate (EEP) is a safe and effective intervention option for management of variable-sized adenomas. Purpose: The aim of this study was to point out the safety and efficacy of bipolar needlescopic enucleation of the prostate (BNEP) in comparison with bipolar vapoenucleation of the prostate (BVEP). Materials and Methods: This is a prospective randomized trial. In all, 214 patients with variable size adenoma were randomly assigned (1:1) to either the BNEP group (108 patients who underwent bipolar endoscopic enucleation of the prostate [BEEP] using a needle electrode) or the vapoenucleation (BVEP) group (106 patients who underwent BEEP using vaporization electrodes). Intra- and intergroup objective and subjective outcomes were compared at different time points for 1 year. In addition, all other procedure-related events and mishaps were registered and compared. Results: The medians (interquartile ranges) for operative time (OT), resected tissue weight, postoperative irrigation time, and hemoglobin drop were 60 (50-88) vs 80 (60-98) minutes, 67 (56-86) vs 46 (40-61) grams, 10 (8-12) vs 12 (10-18) hours, and 1 (0.6-1.3) vs 1.2 (0.88-1.9) g/dL for BNEP and BVEP groups, respectively (p < 0.05). Both subjective and objective parameters were analogously improved in the two groups (p > 0.5). However, the postoperative irritative symptoms and urinary infections were lower in the BNEP group (p < 0.05). Conclusions: Our results revealed that although both BNEP and BVEP are effective and safe in the management of benign prostatic obstruction, BNEP is superior in terms of less OT, intraoperative blood loss, irrigation time, irritative symptoms, and urinary infections.

Minipercutaneous Nephrolithotomy Under Mixture of Local Anesthesia: A Randomized Controlled Study.

Objective: To evaluate the safety, efficacy, and feasibility of minipercutaneous nephrolithotomy (MPCNL) under mixture of local anesthetics (MLA) vs spinal anesthesia (SA) for management of large renal stones. Patients and Methods: This study was a prospective randomized controlled study and approved by IRB (REC-FOMBU). A total of 120 consecutive patients who met the inclusion criteria of the study and agreed to sign the informed consent form were randomized to undergo MPCNL under MLA (60 patients) or SA (60 patients). Intra- and postoperative findings including visual pain analogue scale (VAS), operative time, hospital stay, adverse events (AEs), stone-free rate, and related data were recorded. Results: Baseline characteristics and demography included age and gender; stone's site, size, and density were comparable for both groups (p > 0.05). The average VAS scores in the MLA group at 0, 2, 6, 12, and 24 hours were 2.5, 0, 1, 1, and 0, respectively. The corresponding values in the SA group were 2, 1, 2, 2, and 1, respectively, (p < 0.05). The average operation time was ∼1 hour for both groups and the length of hospital stay was 1.5 days for both groups (p > 0.05). Whereas the mean hemoglobin deficit was 1.04% ± 0.54% vs 1.27 ± 0.46 (p = 0.013) and the primary postoperative stone clearance was 93.4% vs 88.3% (p > 0.05), for MLA and SA groups, respectively. Postoperative analgesic consumption and complications were similar in the MLA and SA groups. Conclusion: Single tract MPCNL is feasible under either MLA or SA with comparable stone clearance and AEs. Perioperative VAS was similar and acceptable for both modalities.

Complete Ultrasound-guided Percutaneous Nephrolithotomy in Prone and Supine Positions: A Randomized Controlled Study.

OBJECTIVES: To evaluate the safety, efficacy, adverse events, and feasibility of ultrasound guided percutaneous nephrolithotomy (US-PCNL) in the management of large renal stones in supine and prone positions and to point out the practical considerations related to these techniques in comparison with standard PCNL. PATIENTS AND METHODS: This study was conducted between August 2013 to September 2018 as a prospective randomized and controlled study. A total of 392 consecutive patients with nephrolithiasis >2 cm were randomly assigned to undergo ultrasound PCNL in prone (P-US-PCNL) (132 patients); supine position (S-US-PCNL) (129 patients) or conventional PCNL (C-PCNL) (131 patients). The preoperative parameters, the intraoperative findings, operative time, hospital stay, perioperative morbidities, stone free rate, and related data were recorded. RESULTS: The demographic and the baseline characteristics were comparable in all study groups. The mean number of trails and time for successful puncture in P-US-PCNL, S-US-PCNL, and C-PCNL were 1.9 ± 1, 2.3 ± 1.2, and 1.7±1, respectively (P < .001), and 15.8 ± 5.8, 19.3 ± 9.4, and 16.5 ± 8.1 seconds, respectively (P < .001). The operation time was 69 ± 22, 75 ± 23, and 72 ± 27 minutes, respectively, (P > .05). The mean nephrostomy time and length of hospital stay were 3 ± 1.3, 3.4 ± 1.5, 3.2 ± 1.2 hours, respectively, and 3.8 ± 1.5, 4.1 ± 1.5, 3.9 ± 1.3 days, respectively (P > .05). The mean percentage decrease in hemoglobin concentration was 1.65 ± 0.66, 1.77 ± 0.78, and 2.1 ± 0.9, respectively (P < .001), overall stone clearance was 88%, 79%, and 85%, respectively (P > .05). Complications were acceptable and similar between groups. CONCLUSION: US-PCNL either in prone or supine position is as effective, feasible, and safe as C-PCNL with zero radiation exposure.