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Keskin ET, Bozkurt M, Şahin M, Özdemir H, Şevik Ç, Canat HL. Effect of preoperative single-dose methylprednisolone administration on early postoperative pain following retrograde intrarenal surgery. Int Urol Nephrol 2024; 56:1253-1258. [PMID: 37999826 DOI: 10.1007/s11255-023-03875-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE To evaluate the effect of preoperative single-dose methylprednisolone use on postoperative early pain after retrograde intrarenal surgery (RIRS). METHODS Patients who had 10-20 mm solitary kidney stones and underwent RIRS procedures were included in this prospective cohort study between February 2022 and May 2023. Patients who were administered methylprednisolone at a dose of 1 mg/kg preoperatively were included in group 1 (n: 31), and the other first 90 patients who met the inclusion criteria and did not receive methylprednisolone before surgery were included in group 2 (n: 90). Demographic data, features of stone, postoperative pain at 1, 6, 12, 18, and 24 hour, the need for analgesics, changes in serum glucose levels, and the prevalence of postoperative fever were compared. RESULTS Age, sex, stone laterality, localization, size, Hounsfield Unit, modified Satava scores, stone-free status, duration of the RIRS procedure, and duration of the ureteral access sheath were found to be similar between groups. Visual Analog Scale (VAS) scores at postoperative 1, 6, 12, 18, and 24 h were found to be statistically significantly lower in group 1 (p = .001, p = .001, p = .001, p = .001, and p = .001, respectively). Similarly, postoperative analgesic requirements were found to be significantly lower in group 1 (p = .048) with a similar postoperative fever rate and changes in serum glucose levels between groups. CONCLUSION Giving a single dose of methylprednisolone at a dose of 1 mg/kg preoperatively for the RIRS procedure is safe and effective at preventing early pain and the need for analgesics after the RIRS procedure.
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Affiliation(s)
- Emin Taha Keskin
- Department of Urology, Başaksehir Çam and Sakura City Hospital, Istanbul, Turkey.
| | - Muammer Bozkurt
- Department of Urology, Başaksehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Mehmet Şahin
- Department of Urology, Başaksehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Harun Özdemir
- Department of Urology, Başaksehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Çağrı Şevik
- Department of Urology, Başaksehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Halil Lutfi Canat
- Department of Urology, Başaksehir Çam and Sakura City Hospital, Istanbul, Turkey
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Cardoso A, Coutinho A, Neto G, Anacleto S, Tinoco CL, Morais N, Cerqueira-Alves M, Lima E, Mota P. Percutaneous nephrostomy versus ureteral stent in hydronephrosis secondary to obstructive urolithiasis: A systematic review and meta-analysis. Asian J Urol 2024; 11:261-270. [PMID: 38680594 PMCID: PMC11053331 DOI: 10.1016/j.ajur.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/13/2023] [Indexed: 05/01/2024] Open
Abstract
Objective To assess if there is a preferable intervention between retrograde ureteral stent (RUS) and percutaneous nephrostomy (PCN) tube, in cases of upper urinary tract stone obstruction with complications requiring urgent drainage, by evaluating outcomes regarding urinary symptoms, quality of life (QoL), spontaneous stone passage, and length of hospital stays, since there is no literature stating the superiority of one modality over the other. Methods We searched MEDLINE and other sources for relevant articles in June 2019 without any date restrictions or filters applied. The selection was done first by the title and abstract screening and then by full-text assessment for eligibility. Only randomized controlled trials or cohort studies in patients with hydronephrosis secondary to obstructive urolithiasis that presented comparative data between PCN and RUS placement concerning at least one of the defined outcome measures were included. Lastly, MEDLINE database and PubMed platform were screened again using the same terms, from June 2019 until November 2022. Results Of 556 initial articles, seven were included in this review. Most works were considered of moderate-to-high quality. Three studies regarding QoL showed a tendency against stenting, even though only one demonstrated statistically significant negative impact on overall health state. Two works reported significantly more post-intervention urinary symptoms in stenting patients. One article found that PCN is a significant predictor of spontaneous stone passage, when adjusted for stone size and location. Findings on length of hospital stays were not consistent among articles. Conclusion PCN appears to be the intervention better tolerated, with less impact on the patient's perceived QoL and less post-operative urinary symptoms, in comparison with RUS. Nevertheless, further studies with larger samples and a randomized controlled design are suggested.
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Affiliation(s)
| | | | - Gonçalo Neto
- School of Medicine, University of Minho, Braga, Portugal
| | - Sara Anacleto
- Department of Urology, Hospital de Braga, Braga, Portugal
| | | | - Nuno Morais
- Department of Urology, Hospital de Braga, Braga, Portugal
| | | | - Estevão Lima
- School of Medicine, University of Minho, Braga, Portugal
- Association (2CA-Braga). School of Medicine, University of Minho, Braga, Portugal
| | - Paulo Mota
- Department of Urology, Hospital de Braga, Braga, Portugal
- School of Medicine, University of Minho, Braga, Portugal
- Association (2CA-Braga). School of Medicine, University of Minho, Braga, Portugal
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Savoie PH, Boissier R, Long JA. [Renal colic: How to calm and optimize the stone expulsion? Which treatment for pregnant women and children?]. Prog Urol 2021; 31:956-966. [PMID: 34814989 DOI: 10.1016/j.purol.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 07/22/2021] [Accepted: 08/02/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The aims of this narrative review was to report on the contemporary data of renal colic (RC) in terms of epidemiology and pressure on emergency structures and also to describe the latest therapeutic developments about uncomplicated RC, depending on the pediatric, adult and pregnancy population. MATERIAL AND METHODS A request to the health surveillance network for emergencies and deaths (SurSaUD®, Santé Publique France) revealed original data on the contemporary epidemiology of renal colic. A narrative synthesis of the articles (French, English) available on the Pubmed database was produced in June 2021. RESULTS Renal colic represents 1.1% of the annual total of emergency room visits. The mean age at admission was 45 years and 62% of patients were men. NSAIDs and Paracetamol are the most effective analgesic treatments and should be given priority over opioids. Non-drug analgesic treatments by tactile stimulation probably have a place in the CN management, particularly in case of contraindications. Among the validated treatments, alphablockers allow better expulsion when the stone is located in the pelvic ureter and if its size is between 5 and 10mm in diameter. In pregnant women, the predominant problem is to confirm the diagnostic. If there is a strong suspicion, MRI or a low-dose CT scan is possible. Ureteroscopy is feasible in particular in the first part of pregnancy to avoid iterative ureteral catheter changes. The care for children is now based on that of adults. CONCLUSION The renal colic care pathway in 2021 can benefit from various optimizations in the field of expulsion and analgesic treatments. Good knowledge of the specific situations in pregnant women and children allowing to improve the quality of care.
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Affiliation(s)
- P-H Savoie
- Hôpital d'instruction des Armées Sainte Anne, BP 600, 83800 Toulon cedex 09, France.
| | - R Boissier
- Aix-Marseille université, service de chirurgie urologique et de transplantation rénale. CHU Conception, AP-HM, 13005 Marseille, France
| | - J-A Long
- Centre Hospitalier universitaire de Grenoble, 38043 Grenoble cedex 9, France; TIMC-IMAG, CNRS 5525, La Tronche Cedex 9, France
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Lee MS, Assmus M, Agarwal D, Rivera ME, Large T, Krambeck AE. Opioid Free Ureteroscopy: What is the True Failure Rate? Urology 2021; 154:89-95. [PMID: 33774043 DOI: 10.1016/j.urology.2021.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/15/2021] [Accepted: 03/14/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the true failure rate of opioid free ureteroscopy (OF-URS) and rates of new-persistent opioid use utilizing a national prescription drug monitoring program. MATERIAL AND METHODS We identified 239 patients utilizing our retrospective stone database who underwent OF-URS from Februrary 2018-March 2020. In Feb 2018, we initiated a OF-URS pathway (diclofenac, tamsulosin, acetaminophen, pyridium and oxybutynin). Patients who had a contraindication to NSAIDs were excluded from primary analyses. A prescription drug monitoring program was then utilized to determine the number of patients who failed OF-URS (defined as receipt of an opioid within 31 days of surgery) as well as rates of new-persistent opioid use (defined as receipt of opioid 91-180 days after surgery). All statistical analyses were performed using SAS 9.4. Tests were 2-sided and statistical significance was set at P<0.05. RESULTS We found a OF-URS failure rate of 16.6% and 14.0% in the total and opioid naïve cohorts, respectively. Rates of new-persistent opioid use were 0.9% and 1.2%, respectively (lower than published expected rate of ~6% after URS with postoperative opioids). 91% of patients obtained opioid from alternative sources. Uni/multivariate analyses were performed for both cohorts. In the total cohort, benzodiazepine users had a lower risk of OF-URS failure on multivariate analysis. No variables were associated with OF-URS failure in the opioid naïve cohort. CONCLUSION The true failure rate of OF-URS is higher than previously thought at 16.6% and 14.0%. However, efforts to reduce opioid prescriptions with OF-URS pathways have successfully reduced new-persistent opioid use.
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Affiliation(s)
- Matthew S Lee
- Department of Urology, Methodist Hospital, Indiana University School of Medicine, Indianapolis, IN.
| | - Mark Assmus
- Department of Urology, Methodist Hospital, Indiana University School of Medicine, Indianapolis, IN
| | - Deepak Agarwal
- Department of Urology, Methodist Hospital, Indiana University School of Medicine, Indianapolis, IN
| | - Marcelino E Rivera
- Department of Urology, Methodist Hospital, Indiana University School of Medicine, Indianapolis, IN
| | - Tim Large
- Department of Urology, Methodist Hospital, Indiana University School of Medicine, Indianapolis, IN
| | - Amy E Krambeck
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
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Pouraghaei M, Moharamzadeh P, Paknezhad SP, Rajabpour ZV, Soleimanpour H. Intranasal ketamine versus intravenous morphine for pain management in patients with renal colic: a double-blind, randomized, controlled trial. World J Urol 2020; 39:1263-1267. [PMID: 32591901 DOI: 10.1007/s00345-020-03319-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/16/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Urinary stones are a common urologic problem that can be manifested as an intense pain, known as renal colic. Pain control is an important intervention for the emergency treatment of renal colic patients. Intranasal ketamine can form a crucial part of such interventions by offering a new route for a widely-used analgesic drug. METHODS In a double-blind, randomized, clinical trial, adults with renal colic admitted to a tertiary hospital emergency department were examined. The intervention group received 1 mg/kg intranasal (IN) ketamine and 1 ml of saline as a placebo. The control group received 0.1 mg/kg intravenous (IV) morphine and four puffs of saline as the placebo. The pain score was measured on the Numerical Rating Scale (NRS) 0, 15, 30 and 60 min after the drug administration. RESULTS A total of 184 patients enrolled in this study in two parallel groups. The two groups did not differ significantly in terms of pain intensity at the time of their referral (P = 0.489), 15 min post-dose (P = 0.204), 30 min post-dose (P = 0.978) and 60 min post-dose (P = 0.648). CONCLUSION IN ketamine is as effective as IV morphine for pain control in renal colic patients. No remarkable side-effects were observed for IN ketamine use in these patients.
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Affiliation(s)
- Mahboub Pouraghaei
- Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Payman Moharamzadeh
- Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Pouya Paknezhad
- Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Hassan Soleimanpour
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
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Kidney stones and the opioid epidemic: recent developments and review of the literature. Curr Opin Urol 2019; 30:159-165. [PMID: 31834080 DOI: 10.1097/mou.0000000000000705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW A public health emergency has been declared in response to rising opioid addiction and opioid-related deaths in the United States. As kidney stones have been identified as an important source of initial and repeated opioid exposures, this review seeks to describe the scope of the problem and report relevant alternatives to opioid analgesia for stones. RECENT FINDINGS Recent literature summarizing the extent of opioid use among those with stones is reviewed. A number of opioid-minimizing strategies and analgesic regimens have been proposed and studied. A review of these modifications and alternatives is provided. SUMMARY Both symptomatic renal colic and surgical interventions to address stones may prompt need for analgesia. Reducing prescribed opioids reduces both patient use and risk of diversion. Modifications in surgical technique, administration of local anesthetics, and use of systemic nonopioid analgesics have all been successfully employed.
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Hamidi N. Author reply: Letter to editor on the effect of corticosteroid on postoperative early pain, renal colic and total analgesic consumption after uncomplicated and unstented ureteroscopy: a matched-pair analysis by Mark C. Kendall. World J Urol 2018; 37:213. [PMID: 29858699 DOI: 10.1007/s00345-018-2356-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/25/2018] [Indexed: 11/27/2022] Open
Affiliation(s)
- Nurullah Hamidi
- Department of Urology, Atatürk Training and Research Hospital, Universiteler Mah, No:1, Cankaya, 06430, Ankara, Turkey.
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Kendall MC. Comment on: "The effect of corticosteroid on postoperative early pain, renal colic and total analgesic consumption after uncomplicated and unstented ureteroscopy: a matched-pair analysis". World J Urol 2018; 36:1801. [PMID: 29766317 DOI: 10.1007/s00345-018-2324-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 01/18/2023] Open
Affiliation(s)
- Mark C Kendall
- Department of Anesthesiology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI, 02903, USA.
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