Objective To explore the effectiveness and safety of the extreme flexion and abduction hip combined with a stirrup-shaped multifunctional leg frame position in preventing obturator nerve reflex during plasma resection of bladder tumors (TUR-BT). Methods A total of 112 patients with bladder tumors were included in the study. The control group was placed in a lithotomy position, while the experimental group was placed in an extreme flexion and abduction hip combined with a stirrup-shaped multifunctional leg frame position. The grade of leg jerking, operation time, and some operative complications were compared between groups. Results The operation time, bleeding volume, the grade of leg jerking, second TUR-BT, and acquisition of detrusor muscle were significantly better in the experimental group compared to the control group ( P = 0.018, P = 0.013, P < 0.001, P = 0.041, and P < 0.001, respectively). The grade of leg jerking in the experimental group was extremely low (distributed in grade 1 and 2), and there were no severe reactions in grade 3 and 4. Conclusion The extreme flexion and abduction hip combined with a stirrup-shaped multifunctional leg frame position for TUR-BT is a safe and effective treatment method that can effectively prevent obturator nerve reflex, reduce complications, improve surgical efficacy, and reduce anesthesia dependence and risk.
Different international associations have proposed their own guidelines on urolithiasis. However, the focus is primarily on an overview of the principles of urolithiasis management rather than step-by-step technical details for the procedure. The International Alliance of Urolithiasis (IAU) is releasing a series of guidelines on the management of urolithiasis. The current guideline on shockwave lithotripsy (SWL) is the third in the IAU guidelines series and provides a clinical framework for urologists and technicians performing SWL. A total of 49 recommendations are summarized and graded, covering the following aspects: indications and contraindications; preoperative patient evaluation; preoperative medication; prestenting; intraoperative analgesia or anesthesia; intraoperative position; stone localization and monitoring; machine and energy settings; intraoperative lithotripsy strategies; auxiliary therapy following SWL; evaluation of stone clearance; complications; and quality of life. The recommendations, tips, and tricks regarding SWL procedures summarized here provide important and necessary guidance for urologists along with technicians performing SWL. PATIENT SUMMARY: For kidney and urinary stones of less than 20 mm in size, shockwave lithotripsy (SWL) is an approach in which the stone is treated with shockwaves applied to the skin, without the need for surgery. Our recommendations on technical aspects of the procedure provide guidance for urologists and technicians performing SWL.
Introduction. The emergence of new scientific and clinical evidence on the use of retrograde intrarenal surgery (RIRS) for the management of kidney stones has prompted periodic systematisation, analysis, and evaluation of outcomes to standardise its application and determine future directions for research and development.Objective. To present the Russian adaptation of a guideline on retrograde intrarenal surgery from the International Urolithiasis Alliance guideline series to provide a theoretical basis for urologists performing RIRS.Materials & Methods. A systematic review was conducted on the RIRS-associated publications available in the PubMed database to prepare a set of recommendations during the period from 1 January 1964 until 1 October 2021. The recommendations were evaluated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system, which classifies, evaluates, develops, and examines recommendations. The modified Oxford Centre for Evidence-Based Medicine's (OCEBM) system for categorising the level of evidence and relevant comments have been applied to assess the strength of the conclusions.Results. The research team conducted a comprehensive analysis of 36 published clinical guidelines on the following topics: 1. Indications and Contraindications 2. Preoperative Imaging 3. Preoperative Ureteral Stenting 4. Preoperative Medications 5. Perioperative Use of Antibiotics 6. Use of Antithrombotic Therapy 7. Anesthesia Issues 8. Intraoperative Positioning 9. Equipment 10. Complications.Conclusion. A series of recommendations for RIRS, offered here should help provide safe and effective performance of RIRS.
Abstract Purpose: The purpose of this study was to ascertain whether UTUC patients with pathologic ≥T2 and without distant metastasis (M0) benefit from adjuvant chemotherapy following radical nephroureterectomy (RNU) and look for the factors of postoperative bladder recurrence. Materials and Methods: We revised the clinical data of 398 pT2-4NxM0 patients treated with RNU between 2011 and 2021. Patients were treated with gemcitabine plus platinum adjuvant chemotherapy strategy within 90 days after RNU. All patients received at least 4 cycles of adjuvant chemotherapy. The Cox regression risk model was used to evaluate prognostic factors and risk factors for intravesical recurrence. Overall survival (OS) and Cancer-specific survival (CSS) were assessed using the Kaplan- Meier method. Possible side effects of chemotherapy were also actively monitored. Results: 105(26.4%) received adjuvant chemotherapy and 293(73.6%) did not. The median age was 61.5 years (mean66, range 33.0 to 90). The Median follow-up for the whole cohort after surgery was 64 months (mean34.7, range 1 to 129). The COX analysis revealed that gender (p= 0.023; HR 0.721), adjuvant chemotherapy(p＜0.001; HR 0.381), grade(p= 0.021; HR 1.693), and N stage (p＜0.001; HR 2.650) were independent clinicopathologically risk factors for predicting OS as well as CSS. The Kaplan–Meier curves showed that adjuvant chemotherapy significantly improved the OS and CSS in UTUC patients. In addition, adjuvant chemotherapy improved the OS and CSS curves of lymph node-positive patients compared with the non-chemotherapy group. There were no serious or fatal adverse effects that occurred during chemotherapy. Meanwhile, the COX analysis presented that UTUC patients with concomitant bladder tumor are independent risk factors for intravesical recurrence after RNU. Conclusions: Gemcitabine combined with platinum chemotherapy after RNU significantly improved OS and CSS in UTUC patients with stage ≥ pT2 without severe side effects. UTUC patients with bladder tumors may be one of the high-risk groups for bladder tumor recurrence after RNU.
目的:探讨经皮等离子电切镜囊肿去顶术治疗肾囊肿的安全性及有效性.方法:回顾性分析2020年1月-2021年5月深圳市人民医院收治的11例经CT检查确诊为单纯性肾囊肿且满足手术指征的患者,男4例,女7例.中位年龄46(35,62)岁.所有患者均因体检发现,经增强CT确诊为单纯性肾囊肿,非腹侧.囊肿最大径中位数7.52(6.26,8.21)cm.术中在超声定位下行经皮肾穿刺后,用等离子电切镜分离切除囊肿壁,术后留置引流管.同时,将其与15例同期采取传统腹腔镜下肾囊肿去顶减压术的患者临床资料进行比较.结果:26例手术均顺利完成,无严重出血、尿漏、肾实质或邻近器官血管损伤等并发症.等离子电切镜组和腹腔镜组手术时间[47(42,55)min vs 68(35,102)min]、引流管拔除时间[1(1,2)d vs 2(2,4)d]、术后住院时间[1(1,2)d vs 2(2,4)d]、住院费用[0.92(0.82,1.26)万元 vs 1.34(1.18,1.56)万元]、疼痛评分[2(2,3)分 vs 3(2,4)分],差异均有统计学意义(P＜0.05).等离子电切镜组和腹腔镜组术后中位随访时间分别为12(10,18)个月和15(9,20)个月,均无囊肿复发.结论:经皮等离子电切镜治疗单纯性肾囊肿安全、有效,具有手术时间短、创伤小、患者恢复快、住院时间短且费用低等优势.
