Ultrasound-Guided Erector Spinae Plane Block in Thoracolumbar Spinal Surgery: A Systematic Review and Meta-Analysis.

Introduction: Neurosurgical spinal surgeries such as micro- discectomy and complex fusion surgeries remain the leading causes of disability-adjusted life-year. Major spinal surgeries often result in severe postprocedural pain due to massive dissection of the underlying tissues. While opioids offer effective pain control, they frequently lead to side effects, such as post-operative nausea and vomiting, pruritus, constipation, and respiratory depression. ESPB was successfully used in spinal surgery as a component of a multimodal analgesic regimen and it eliminated the requirements for opioids. The primary purpose of this systematic review and meta-analysis was to compare post-operative opioid consumption between ESPB and placebo. Methods: To conduct this systematic review, we used the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)" guidelines. We conducted a search for relevant articles available in the following databases: Google Scholar, PubMed, and the Cochrane Library published up to March 2022. Results: The total morphine consumption within 24 h after surgery was lower in the ESPB group, the mean difference (in mg of morphine) with 95% CI is -9.27 (-11.63, -6.91). The pain intensity (0-10) at rest measured 24 h after surgery was lower in the ESPB group, the MD with 95% CI is -0.47 (-0.77, -0.17). The pain intensity during movement measured 24 h after surgery was lower in the ESPB group, the MD with 95% CI is -0.73 (-1.00, -0.47). Post-operative nausea and vomiting were significantly lower in the ESPB group, the risk ratio with 95% CI is 0.32 (0.19, 0.53). Conclusion: Ultrasound-guided ESPB was superior to placebo in reducing post-operative opioid consumption, pain intensity, post-operative nausea and vomiting, and prolonging the time to first rescue analgesia. There were no ESPB-related serious complications reported.

Primary vaginal stone associated with vesicovaginal fistula: A case report.

Vesicovaginal fistula with stone is an infrequent condition; therefore, it can be often misdiagnosed. The formation of vaginal stones is mainly due to urinary stasis and infection. We describe the case of a 69-year-old patient who was diagnosed with a vesicovaginal fistula in 2012. The etiology of the disease was related to supravesical amputation of the uterus and radiation therapy. 9 years later a medium-sized stone was found in the fistula. This type of case is rare in practice. The final diagnosis can be made together with gynecologists based on the results of pelvic computed tomography.

[Species composition and molecular-genetic characteristics of antibiotic-resistant strains of gram negative bacteria isolated from patients of a hospitals urology department].

AIM: To analyze the composition and molecular mechanisms of antibiotic resistance of Gram-negative bacteria - pathogens of urinary tract infections (UTIs) in adult patients living in the city of Almaty. MATERIALS AND METHODS: The study examined the etiological composition and antibiotic susceptibility of clinically significant isolates of bacteria and fungi ( more or equal 103) isolated from the urine of the patients of the Department of Urology of the Almaty city Central Clinical Hospital No. 12. The production of extended-spectrum beta-lactamases (ESBL) in antibiotic-resistant strains was determined using a phenotypic method with the double disk test. Detection of class A genes for cultures with confirmed ESBL phenotypes (TEM-1, CTX-M1, SHV, OXA) and carbapenemases of class B metallo--lactamases (VIM-2) genes was performed by PCR. RESULTS: Among the isolates obtained from patients, the species of Enterobacteriaceae family in the etiological composition of the UTI pathogens comprised 44.8% including E. coli (31%), K. pneumoniae (4.6%). The most effective drugs against all types of Enterobacteria were carbapenems (96.3-100%). E.coli showed highest sensitivity to nitrofurantoin (96.3%), amikacin (92.6%) and cefoxitin (81.5%). The high rate of resistance to III-IV generation cephalosporins among of E. coli (44.4%) and K. pneumoniae (50%) species was due to the production of ESBL types CTX-M1 and OXA. The proportion of non-fermenting Gram-negative bacteria in the etiological composition of UTI pathogens was 3.5%. Among them, there was a strain producing the metal -lactamase (VIM-2), characterized by absolute resistance to antibiotics of all classes, including carbapenems. CONCLUSION: The findings on sensitivity profiles and molecular genetic mechanisms of resistance of Gram-negative uropathogens are unique for the Almaty region provides the rationale for developing a local strategy for rational antibiotic therapy. Timely microbiological diagnosis and strict adherence to infection control in a specific hospital are the only way to contain the spread of ESBL and metal -lactamase.

[Effectiveness of Omnic and Omnic Ocas in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (multi-center observing program)].

AIM: To investigate the effectiveness and safety of six-month treatment course of Omnic and Omnic Ocas in patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) in a routine urology practice in Kazakhstan. DESIGN: This was a multicenter prospective observational program involving the collection of data from patients with LUTS caused by BPH, who received Omnic Ocas or Omnic as the first line treatment. MATERIALS AND METHODS: The program comprised 1513 patients with a verified diagnosis of LUTS/BPH, who received Omnic Ocas or Omnic (tamsulosin) administered by urologists at hospitals in the Republic of Kazakhstan. According to the program protocol, 1381 patients completed the study. The mean age of the patients was 63 years. The study program involved three follow-up visits: Visit 1 (baseline), during which the patient completed the IPSS questionnaire concerning urinary symptoms and quality of life. After that they underwent a baseline examination including maximum urinary flow rate (Qmax) measured by uroflowmetry, prostate volume determined by digital rectal examination and the serum PSA level. Visit 2 and Visits 3 were scheduled on average at three and six months after Visit 1, respectively, and aimed at assessing the treatment outcomes during the follow-up. RESULTS: During the 6-month treatment, patients of different age groups reported an improvement in the prostate symptom score (IPSS). The drug therapy was more effective in patients with a flow rate of <10 ml/s. There was a gradual decrease in the mean scores of both the storage and voiding I-PSS subscales. Uroflowmetry at six months showed a clinically significant increase in the urinary flow rate. Adverse events were reported by1.9% of patients. DISCUSSION: The study findings suggesting a significantly improved voiding function in all study participants with LUTS and BPH who received Omnic Ocas or Omnic (tamsulosin) (n=1381) indicate that: the groups "<55 years", "55-65 years" and ">65 years" showed a decrease in symptoms (the total IPSS score after 6-month treatment decreased by 41.6%), in feeling of incomplete emptying and the need to urinate more often than 2 hours after urination; there was less terminal dribbling. Therapy was well tolerated: adverse events were noted in 1.6% of patients. Thus, it can be concluded that Omnic and Omnic Ocas are effective in all age groups of patients with LUTS/BPH and have a favorable safety profile. CONCLUSION: The findings of this study suggest that Omnic and Omnic Ocas are highly effective in patients with LUTS/BPH of all age groups and have a favorable safety profile.

[Combined endoscopic treatment of patients with prostatic adenoma].

We studied efficacy of combined surgical treatment of patients with prostatic adenoma (PA) including laser vaporization (LV) and transurethral electroresection (TUER). A total of 294 PA patients entered the trial. Photoselective LV was made with GreenLight PVP laser (80 W) in 180 patients and Dornier Urobeam laser on the basis of diode laser (940 nm) in 34 patients. The other 60 and 20 patients after photoselective LV (GreenLight PVP 80-W laser) and (Dornier Urobeam laser), respectively, have undergone TUER of coagulative-necrotic scab after vaporization. The analysis of the treatment results show that laser vaporization on both lasers is followed with dysuria in 26.6 and 32.4% patients, respectively, while in combination of LV with TUER - in 11.25% patients. Thus, the above combined endoscopic treatment can be recommended as most effective as it rapidly improves quality of life of the patients.

[Photoselective laser vaporization of complicated prostatic adenoma].

The aim of the study was to determine indications for use of photoselective laser vaporization of the prostate (PVP) in clinical practice and to evaluate long-term results of this method. Since September 2005 to February 2007 a total of 106 patients aged 55-95 years with prostatic adenoma were operated. The patients were divided into two groups: group 1--patients with PA stage II (n = 45 patients), group 2--with stage III (n = 56 patients). Group 2 patients had complications: acute urinary retention (n = 25), epicystostoma for more than 1 year (n = 16), uroliths (n = 6), other (n = 9). Good results were achieved. All the patients were discharged with recovery (could urinate without help). Hospital stay averaged 7-8 days, duration of catheterization was 2-5 days, bleeding of small intensity was in 1.7%. The 1.5-year follow-up demonstrated that IPSS was decreased and mean peak flow rate was reduced (from 0 to 2,3 points and from 25.1 ml/s to 19.0 ml/s, respectively). Photoselective laser vaporization improves quality of life in prostatic adenoma at all stages of the disease. In patients with severe associated pathology PVP is the only radical treatment today.