scholarly journals Retrograde Intrarenal Surgery versus Percutaneous Lithotripsy to Treat Renal Stones 2-3 cm in Diameter

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Kursad Zengin ◽  
Serhat Tanik ◽  
Nihat Karakoyunlu ◽  
Nevzat Can Sener ◽  
Sebahattin Albayrak ◽  
...  
Keyword(s):  
Renal Stones ◽  
Complication Rates ◽  
First Line ◽  
Retrograde Intrarenal Surgery ◽  
Promising Alternative ◽  
New Era ◽  
Randomized Controlled ◽  
Recommended Treatment ◽  
Group 2 ◽  
Group 1

Objective. Retrograde intrarenal surgery (RIRS) performed using a flexible ureterorenoscope marked the beginning of a new era in urology. Today, even staghorn stones are successfully treated via RIRS. The recommended treatment for larger stones is percutaneous nephrolithotomy (PNL). However, the question of whether PNL or RIRS should be the first-line treatment option for larger stones remains controversial. In this study, we contribute to the debate by comparing the success and complication rates of PNL and RIRS that were used to treat renal pelvis stones 2-3 cm in diameter.Materials and Methods. The medical records of 154 patients (74 PNL, 80 RIRS) were retrospectively evaluated. PNL patients were placed in Group 1 and RIRS patients in Group 2.Results. The complete stone-free rates were 95.5% in the PNL group and 80.6% in the RIRS group 1 month postoperatively (P=0.061). The respective complication rates (evaluated using the Clavien system) were 13.5% and 8.8% (P=0.520).Conclusions. RIRS affords a comparable success rate, causes fewer complications than PNL, and seems to be a promising alternative to PNL when larger stones are to be treated. Prospective randomized controlled trials are needed to confirm these findings.

scholarly journals Retrograde Intrarenal Surgery in Patients Who Previously Underwent Open Renal Stone Surgery

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Erdal Alkan ◽  
Ali Saribacak ◽  
Ahmet Oguz Ozkanli ◽  
Mehmet Murad Başar ◽  
Oguz Acar ◽  
...  
Keyword(s):  
Renal Stone ◽  
Perioperative Complications ◽  
Renal Stones ◽  
Control Group ◽  
Complication Rates ◽  
Retrograde Intrarenal Surgery ◽  
Renal Stone Surgery ◽  
Recorded Data ◽  
Group 2 ◽  
Control Group Group

Purpose. To ascertain whether retrograde intrarenal surgery (RIRS) is as effective in patients treated previously with open renal stone surgery (ORSS) on the same kidney as in patients with no previous ORSS.Methods. There were 32 patients with renal stones who had previous ORSS and were treated with RIRS in the study group (Group 1). A total of 38 patients with renal stones who had no previous ORSS and were treated with RIRS were selected as the control group (Group 2). Recorded data regarding preoperative characteristics of the patients, stone properties, surgical parameters, outcomes, SFRs (no fragments or small fragments <4 mm), and complications between groups were compared.Results. Mean age, mean BMI, mean hospital stay, and mean operative time were not statistically different between groups. Mean stone size (10.1 ± 5.6 versus 10.3 ± 4.2;p=0.551) and mean stone burden (25.4 ± 14.7 versus 23.5 ± 9.9;p=0.504) were also similar between groups. After the second procedures, SFRs were 100% and 95% in groups 1 and 2, respectivelyp=0.496. No major perioperative complications were seen.Conclusion. RIRS can be safely and effectively performed with acceptable complication rates in patients treated previously with ORSS as in patients with no previous ORSS.

scholarly journals Super-mini percutaneous nephrolithotomy (SMP) vs retrograde intrarenal surgery (RIRS) in the management of renal calculi ≤ 2 cm: a propensity matched study

2021 ◽  
Author(s):  
Sunil Bhaskara Pillai ◽  
Arun Chawla ◽  
Jean de la Rosette ◽  
Pilar Laguna ◽  
Rajsekhar Guddeti ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Pain Score ◽  
Final Analysis ◽  
High Volume ◽  
Renal Calculi ◽  
Complication Rates ◽  
Retrograde Intrarenal Surgery ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Abstract Objective To compare the effectiveness and safety of Super-Mini PCNL (SMP) and Retrograde Intrarenal Surgery (RIRS) in the management of renal calculi ≤ 2 cm. Patients and methods A prospective, inter-institutional, observational study of patients presenting with renal calculi ≤ 2 cm. Patients underwent either SMP (Group 1) or RIRS (Group 2) and were performed by 2 experienced high-volume surgeons. Results Between September 2018 and April 2019, 593 patients underwent PCNL and 239 patients had RIRS in two tertiary centers. Among them, 149 patients were included for the final analysis after propensity-score matching out of which 75 patients underwent SMP in one center and 74 patients underwent RIRS in the other. The stone-free rate (SFR) was statistically significantly higher in Group 1 on POD-1 (98.66% vs. 89.19%; p = 0.015), and was still higher in Group 1 on POD-30 (98.66% vs. 93.24%, p = 0.092) SFR on both POD-1 and POD-30 for lower pole calculi was higher in Group 1 (100 vs. 82.61%, p = 0.047 and 100 vs 92.61% p = 0.171). The mean (SD) operative time was significantly shorter in Group 1 at 36.43 min (14.07) vs 51.15 (17.95) mins (p < 0.0001). The mean hemoglobin drop was significantly less in Group 1 (0.31 vs 0.53 gm%; p = 0.020). There were more Clavien–Dindo complications in Group 2 (p = 0.021). The mean VAS pain score was significantly less in Group 2 at 6 and 12 h postoperatively (2.52 vs 3.67, 1.85 vs 2.40, respectively: p < 0.0001), whereas the mean VAS pain score was significantly less in Group 1 at 24 h postoperatively (0.31 vs 1.01, p < 0.0001). The mean hospital stay was significantly shorter in Group 1 (28.37 vs 45.70 h; p < 0.0001). Conclusion SMP has significantly lower operative times, complication rates, shorter hospital stay, with higher stone-free rates compared to RIRS. SMP is associated with more early post-operative pain though.

scholarly journals Influence of Aging in Outcomes of Patients Undergoing Percutaneous Nephrolithotomy for Staghorn Stones : A retrospective comparative study

2021 ◽  
Author(s):  
Murat Sahan ◽  
Serkan Yarımoğlu ◽  
Metin Savun ◽  
Onur Erdemoglu ◽  
Tansu Degirmenci
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Major Complication ◽  
Renal Stones ◽  
The Elderly ◽  
Treatment Method ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Number Of Patients ◽  
Group 2 ◽  
Group 1

Objective: To evaluate the effect of age on the success and complications of percutaneous nephrolithotomy (PCNL) in staghorn renal stones. Materials and Methods: The files of 182 patients who underwent single-access PCNL for staghorn renal stones between 2012 and 2017 were retrospectively analyzed. The patients were divided into two groups according to their age: those aged<65 years were defined as Group-1 and those aged≥65 years as Group-2. The demographic characteristics and perioperative and postoperative results were compared between the two groups. Results: Of the patients with staghorn renal stones,139 were in Group-1 and 43 were in Group-2. The mean age of the patients was 43.9±10.6 years for Group-1 and 67.8±2.1 years for Group-2(p=0.001). The amount of hemoglobin drop was statistically significantly higher in Group-1 (p=0.001). However, blood transfusion rate was higher in Group-2 than in Group-1 (18.6% and 7.2%, respectively). The stone-free rate was 54.7% in Group-1 and 67.4% in Group-2(p=0.139). According to the evaluation of the overall complication rates,34.5% of the patients in Group-1 and 46.5% of those in Group-2 developed complications(p=0.206). According to the Clavien scoring system, the rate of minor complications was found to be 22.3% in Group-1 and 41.9% in Group-2,and the difference was statistically significant (p=0.012). The major complication rates were determined as 4.7% and 12.2% for Group-1 and Group-2, respectively (p=0.155). The number of patients with Clavien grade-2 complications was statistically higher in the elderly patient group (p=0.019). Conclusions: PCNL can be used as an effective and safe treatment method in the treatment of complex stones in elderly patients.

Immediate and long-term results of the first line chemotherapy in patients with metastatic triple negative breast cancer. Final analysis of randomized study

2020 ◽  
pp. 75-80
Author(s):  
S.A. Lyalkin ◽  
◽  
L.A. Syvak ◽  
N.O. Verevkina ◽  
◽  
...  
Keyword(s):  
Breast Cancer ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Randomized Study ◽  
Progression Free Survival ◽  
First Line ◽  
Free Survival ◽  
Group 2 ◽  
Line Chemotherapy ◽  
Group 1

The objective: was to evaluate the efficacy of the first line chemotherapy in patients with metastatic triple negative breast cancer (TNBC). Materials and methods. Open randomized study was performed including 122 patients with metastatic TNBC. The efficacy and safety of the first line chemotherapy of regimens АТ (n=59) – group 1, patients received doxorubicine 60 мг/м2 and paclitaxel 175 мг/м2 and ТР (n=63) – group 2, patients received paclitaxel 175 мг/м2 and carboplatin AUC 5 were evaluated. Results. The median duration of response was 9.5 months (4.5–13.25 months) in patients received AT regimen and 8.5 months (4.7–12.25 months), in TP regimen; no statistically significant differences were observed, р=0.836. The median progression free survival was 7 months (95% CI 5–26 months) in group 1 and 7.5 months (95% CI 6–35 months) in group 2, p=0.85. Both chemotherapy regimens (AT and TP) had mild or moderate toxicity profiles (grade 1 or 2 in most patients). No significant difference in gastrointestinal toxicity was observed. The incidence of grade 3–4 neutropenia was higher in patients of group 2 (TP regimen): 42.8% versus 27% (р<0.05). Conclusions. Both regimens of chemotherapy (AT and TP) are appropriate to use in the first line setting in patients with metastatic TNBC. Key words: metastatic triple negative breast cancer, chemotherapy, progression free survival, chemotherapy toxicity.

scholarly journals Pre-stenting for Retrograde Intrarenal Surgery: Need and Duration: a Prospective Randomized Clinical Study

2020 ◽  
Vol 3 (2) ◽  
pp. 361-365
Author(s):  
Prakash Chhettri ◽  
Anil Shrestha ◽  
Robin Bahadur Basnet ◽  
Parash Mani Shrestha
Keyword(s):  
Controlled Study ◽  
Retrograde Intrarenal Surgery ◽  
Ureteral Access Sheath ◽  
Access Sheath ◽  
Randomized Clinical Study ◽  
Institutional Review ◽  
Group 3 ◽  
Group 2 ◽  
Wall Injury ◽  
Group 1

Introduction: To evaluate if retrograde intrarenal surgery with ureteral access sheath requires prestenting. In case pre-stenting becomes an option, how long does it need to be stented.  Materials and Methods: After obtaining approval from Institutional Review Board and informed consent, a prospective randomized controlled study was conducted in the Department of Urology, Bir Hospital for 18 months. All the patients enrolled for retrograde intrarenal surgery were grouped into 3 groups: Group 1 – without pre-stenting, Group 2 – one week of pre-stenting, and Group 3 – two weeks of pre-stenting. Success was defi ned as an ability to accommodate a 10/12 F ureteral access sheath during retrograde intrarenal surgery. Ureteral access sheath induced ureteric wall injury was also taken into consideration.Results: Among 179 cases, 152 cases were included in the study. In 36 patients out of 53 (67.92%) in group 1, 10/12 F ureteral access sheath was negotiable without pre-stenting, marking the frequency of distensible ureters. In 44 patients out of 47 (93.66%) from group 2 and all 52 patients (100%) from group 3, ureteral access sheath placement was successful after one and two weeks of pre-stenting respectively. Ureteric wall injury of grade1 and 2, was found in 9 patients (5.9%).Conclusions: The majority of ureters (67.92%) are distensible, not requiring pre-stenting before retrograde intrarenal surgery. One and two weeks of pre-stenting carries a success rate of 93.66% and 100% respectively.

scholarly journals Effect of vitamin D supplementation on growth parameters of children with vitamin D deficiency: a community based randomized controlled trial

2017 ◽  
Vol 4 (6) ◽  
pp. 2070
Author(s):  
Sagul R. Mugunthan ◽  
Yashwant K. Rao ◽  
Tanu Midha ◽  
Anurag Bajpai
Keyword(s):  
Vitamin D ◽  
Alkaline Phosphatase ◽  
Vitamin D Deficiency ◽  
Growth Parameters ◽  
Controlled Trial ◽  
Vitamin D Supplementation ◽  
Community Based ◽  
Randomized Controlled ◽  
Group 2 ◽  
Group 1

Background: Vitamin D deficiency remains the most common cause of rickets globally and is highly prevalent in developing countries including India. This study aimed to compare the efficacy of vitamin D and calcium together with calcium alone on growth parameters of children with vitamin D deficiency in community based setting.Methods: A randomized controlled trial was conducted in community based setting in Kanpur district. Multistage random sampling technique was used to select a total of 395 children between 2 years to 5 years from 5 villages of block Vidhunu. Of these, 138 children were randomized into two groups using balanced block randomization technique. Group 1 received vitamin D with calcium together and group 2 received calcium alone for a period of 12 months. Anthropometry, serum vitamin D, calcium, alkaline phosphatase levels were estimated at baseline and after 12 months. Data was analyzed using SPSS 20. Student’s t test was used to analyze the differences in growth and laboratory parameters in the two groups. Multiple linear regression analysis was used to assess the effect of various factors on the growth parameters.Results: Prevalence of vitamin D deficiency was 78.7%. Baseline characteristics of both groups were similar. After 12 months, group 1 demonstrated significantly greater improvement in weight SD score (21.4%) and height SD score (10.3%) and growth velocity (9.1 cm/year) compared to group 2 (14.3%, 7.8% and 6.9 cm/ year respectively). Also subjects in group 1 showed significantly greater improvement in serum levels of vitamin D, calcium and alkaline phosphatase than group 2.Conclusions: Vitamin D supplementation along with calcium improves the growth of children. Regular supplementation of all children with vitamin D can be considered as a policy for prevention of malnutrition. 

scholarly journals Age-Independent Clinical Outcome in Proximal Humeral Fractures: 2-Year Results Using the Example of a Precontoured Locking Plate

2022 ◽  
Vol 11 (2) ◽  
pp. 408
Author(s):  
Rony-Orijit Dey Hazra ◽  
Johanna Illner ◽  
Karol Szewczyk ◽  
Mara Warnhoff ◽  
Alexander Ellwein ◽  
...  
Keyword(s):  
Treatment Strategy ◽  
Locking Plate ◽  
Plate Osteosynthesis ◽  
Fracture Reduction ◽  
Complication Rates ◽  
Locking Plate Osteosynthesis ◽  
Group 2 ◽  
Group 1

Introduction: The optimal treatment strategy for the proximal humeral fracture (PHF) remains controversial. The debate is centered around the correct treatment strategy in the elderly patient population. The present study investigated whether age predicts the functional outcome of locking plate osteosynthesis for this fracture entity. Methods: A consecutive series of patients with surgically treated displaced PHF between 01/2017 and 01/2018 was retrospectively analyzed. Patients were treated by locking plate osteosynthesis. The cohort was divided into two groups: Group 1 (≥65 years) and Group 2 (<65 years). At the follow-up examination, the SSV, CMS, ASES, and Oxford Shoulder Score (OS), as well as a radiological follow-up, was obtained. The quality of fracture reduction is evaluated according to Schnetzke et al. Results: Of the 95 patients, 79 were followed up (83.1%). Group 1 consists of 42 patients (age range: 65–89 years, FU: 25 months) and Group 2 of 37 patients (28–64 years, FU: 24 months). The clinical results showed no significant differences between both groups: SSV 73.4 ± 23.4% (Group 1) vs. 80.5 ± 189% (Group 2). CMS: 79.4 ± 21 vs. 81.9 ± 16, ASES: 77.2 ± 20.4 vs. 77.5 ± 23.1, OS: 39.5 ± 9.1 vs. 40.8 ± 8.2; OS: 39.5 ± 9.1 vs. 40.8 ± 8.2. In the radiological follow-up, fractures healed in all cases. Furthermore, the quality of fracture reduction in both groups is comparable without significant differences. The revision rate was 9.5% in Group 1 vs. 16.2% in Group 2. Discussion: Both age groups show comparable functional outcomes and complication rates. Thus, the locking plate osteosynthesis can be used irrespective of patient age; the treatment decision should instead be based on fracture morphology and individual patient factors.

scholarly journals The target matters – general vs. individualized exercise prescription for fertile-aged women with metabolic risk: a randomized controlled trial

2020 ◽  
Author(s):  
Maritta K Poyhonen-Alho ◽  
Vesa Hyrylä ◽  
Mika P. Tarvainen ◽  
Heikki O. Tikkanen ◽  
Saila Koivusalo ◽  
...  
Keyword(s):  
Body Composition ◽  
Gestational Diabetes ◽  
Oxygen Uptake ◽  
Exercise Intervention ◽  
Density Lipoprotein ◽  
Individualized Intervention ◽  
Randomized Controlled ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background Little is known about the associations of different depths of individualization of the exercise intervention on cardiorespiratory fitness (CRF), metabolic outcomes and cardiac autonomic regulation in at-risk subjects. This randomized trial compared the effect of general physical activity (PA) guideline -targeted and highly individualized exercise intervention on maximal oxygen uptake, heart rate variability, body composition, and glucose and lipid profiles in fertile-aged women with increased risk for gestational diabetes. Methods Forty-five women with previous gestational diabetes or BMI>30kg/m 2 were randomized into general advice without intervention (Group 1), individualized intervention planned according to PA questionnaires and general guidelines for exercise training (Group 2) and highly individualized intervention based on results from the pre-intervention cardiopulmonary exercise test (CPET) groups (Group 3). All subjects performed pre-intervention CPET on a cycle ergometer with step incremental protocol until volitional fatigue, followed by a 3-month intervention period and post-intervention CPET. Examinations included HRV assessment during CPET and body composition (bioimpedance), blood glucose and lipid profiles. Results Total dropout was 53.8% at various points of the study leaving 8 subjects in Group 1, 12 subjects in Group 2 and 10 subjects in Group 3. CRF improved only in Group 3 (+1.9 ml/kg/min, 95% CI 0.3 to 3.5). This was associated with an increase in high-density lipoprotein (0.18 mmol/L, 95% CI 0.04 to 0.32) and increased HRV. In Group 2, we found a decrease in body mass index (-0.7 kg/m 2, 95% CI -1.3 to -0.1), fasting insulin (-4.14 mU/L, 95% CI -6.58 to -1.70), insulin resistance (-1.21, 95% CI -1.88 to -0.54), and low-density lipoprotein (-0.44 mmol/L, 95% CI -0.79 to -0.09). The dropouts in Group 1 had significantly less weight, smaller waist circumference, less visceral fat, and higher maximal oxygen uptake compared to the continuers in Group 1. Conclusions To improve CRF and cardiac autonomic function the exercise intervention should be highly individualized. PA intervention focused to achieve general exercise guidelines is not enough to improve CRF over 3-month period but combined with weight loss has beneficial effects on the metabolic profile. In randomized controlled trials, dropout may be biased. Trial Registration clinicaltrials.gov (NCT01675271)

scholarly journals A randomized, controlled study to compare the effects of intravenous labetalol and esmolol on haemodynamic changes during laryngoscopy and intubation

2017 ◽  
Vol 5 (9) ◽  
pp. 4003
Author(s):  
Atit Kumar ◽  
Prashant Kumar Mishra ◽  
Saurabh Shukla
Keyword(s):  
Randomized Controlled Study ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Cardiovascular Stress ◽  
Significant Difference ◽  
Haemodynamic Changes ◽  
Β Blocker ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Direct laryngoscopy and endotracheal intubation frequently induce cardiovascular stress response characterised by hypertension and tachycardia due to reflex sympathetic stimulation. Considering the clinical significance of these changes stress attenuation is needed to blunt these responses. β- blockers are used to reduce the unwanted hemodynamic responses. Esmolol is ultra-short acting cardio selective β blocker. Labetalol is useful in not only attenuating the response to laryngoscopy and intubation but also in preventing perioperative cardiovascular events. Present study compared the efficacy of esmolol and labetalol for attenuation of sympathomimetic response to laryngoscopy and intubation.Methods: It was a prospective, randomized, controlled study carried out in 75 adult patients with ASA 1 and ASA 2 posted for elective surgeries. Patients were allocated randomly into Group-1 (esmolol) and Group-2 (labetalol) and Group-3 (placebo) of 25 patients each. Inj. esmolol (1mg/kg) or Inj. labetalol (0.4 mg/kg) or placebo (0.9NS) dissolved up to 5 ml in distilled water was injected intravenously 5 minutes prior to intubation. All patients premeditated with Inj. glycopyrrolate (4µg/kg). Patient were then induced with Inj. propofol (2mg/kg), Inj. scoline (2mg/kg) given followed by laryngoscopy and intubation. Haemodynamic readings were noted at T0 (baseline before injecting the drug), T1 (1 minute after injecting the drug), T2 (after intubation), T3 (2 minutes after intubation), T4 (4 minutes after intubation), T5 (6 minutes after intubation), T6 (8 minutes after injection), T7 (10 minutes after injection).Results: Gr-1, Gr-2 and Gr-3, when compared with each other for systolic BP, diastolic BP, mean BP, and HR, showed a statistically significant difference at different intervals.Conclusions: Both the drugs are found to be effective in attenuation of hemodynamic reflex without any side effects. Further studies are recommended to substantiate the findings in present study.

scholarly journals Pre-teens, Audio Analgesia and Dental Care: A Cross-Sectional Study

2020 ◽  
Vol 4 (4) ◽  
pp. 98-101
Author(s):  
Akshaye Kumar ◽  
Priyanka Sharma ◽  
Arjun Malhotra
Keyword(s):  
Cross Sectional Study ◽  
Pain Tolerance ◽  
Control Group ◽  
Cross Sectional ◽  
Pearson’S Correlation ◽  
Promising Alternative ◽  
Pearson's Correlation ◽  
Group 2 ◽  
Fear And Anxiety ◽  
Group 1

INTRODUCTION: Research has proven that music plays an important role in alleviating fear and anxiety among patients.AIM: To assess the effect of audio analgesia in pre-teen children aged 8-12 years undergoing dental restorations. MATERIALS AND METHOD: Data was collected using a pre-tested and pre-validated proforma filled by the child prior to start of the treatment by circling the number corresponding to the expected pain during the procedure [Ranged 0 (No pain) -10 (Maximum pain)]. Children who reported their expected pain above 5, were enrolled in group 1 (The ones receiving audio analgesia) while the remaining were assigned group 2 (controls). Children in group 1 were asked to put on their favourite song using noise cancellation headphones and the procedure was commenced. After completion of the treatment, the VAS scale was re-introduced and the children were asked to re-circle the actual pain experienced during the procedure. Data was analyzed using SPSS version 20.0 using the chi-squared test and Pearson’s correlation coefficient. A significant value was obtained when p was≤ 0.05. RESULTS: Of the total 80 children enrolled in the present study, there were an equal number of males and females (40 each). It was observed that 70.3% of children in group 1 had an increased pain tolerance as compared to only 37.2% of children in the control group(p=0.01). Pearson’s Correlation revealed a positive and linear association (r: +0.721) and a significant relationship (p = 0.03) between both groups. CONCLUSION: Audio analgesia has been proven to a promising alternative to distract the patient from the anxiety faced in the dental setting and is recommended for nervous and anxious patients.

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