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Sharma G, Sharma A, Devana SK, Singh SK. Mini Versus Standard Percutaneous Nephrolithotomy for the Management of Renal Stone Disease: Systematic Review and Meta-analysis of Randomized Controlled Trials. Eur Urol Focus 2022; 8:1376-1385. [PMID: 34404619 DOI: 10.1016/j.euf.2021.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/26/2021] [Accepted: 07/29/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT Mini percutaneous nephrolithotomy (mPNL) involves the creation of a smaller access tract compared with standard PNL (sPNL). Smaller tract sizes could lead to decreased blood loss, pain, and need for blood transfusion. Previous studies on this topic have reported variable findings and were of poor quality. OBJECTIVE To compare the safety and efficacy of mPNL with those of sPNL for the management of patients with renal stone disease by conducting a systematic review and meta-analysis. EVIDENCE ACQUISITION Systematic literature search was performed to identify relevant randomized controlled trials (RCTs) for the review. The primary outcomes for the study were stone-free rate (SFR) and blood transfusion rate. The secondary outcomes were complication rates, fever, fall in hemoglobin, operative time, length of stay (LOS), need for auxiliary procedure, and visual analog scale (VAS) score at 24 h. We followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, and the study protocol was registered with PROSPERO in priori (CRD42021252444). EVIDENCE SYNTHESIS In this review, 16 RCTs with 3961 patients were included. SFR was comparable between the two groups (risk ratio [RR] 1.01 [0.99, 1.04], p = 0.30), whereas the need for transfusion was lower with mPNL (RR 0.54 [0.37, 0.78], p = 0.001). Fall in hemoglobin (mean difference [MD] -0.67 [-0.93, -0.41], p = 0.000) and LOS (MD -0.59 [-0.81, -0.37], p = 0.000) were shorter with mPNL. Operative time was significantly shorter with sPNL (MD 8.28 [3.96, 12.59], p = 0.000). Complications were lower with mPNL (RR 0.89 [0.79, 0.97], p = 0.01). The need for auxiliary procedures (RR 0.77 [0.58, 1.03], p = 0.08) and VAS at 24 h (MD -0.79 [-1.63, 0.05], p = 0.06) were similar in the two groups. CONCLUSIONS Mini PNL has similar efficacy to sPNL in terms of SFRs. However, mPNL has a superior safety profile with fewer overall complications and a reduced need for blood transfusion. PATIENT SUMMARY In this study, we conducted a meta-analysis comparing mini and standard percutaneous nephrolithotomy (PNL) for the management of patients with renal stone disease. We showed that mini and standard PNL are associated with similar stone-free rates. Overall complications and the need for blood transfusion were lower with mini PNL.
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Affiliation(s)
- Gopal Sharma
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Abhay Sharma
- Medical Student, University College of Medical Sciences, New Delhi, India
| | - Sudheer Kumar Devana
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
| | - Shrawan Kumar Singh
- Department of Urology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Zeng G, Cai C, Duan X, Xu X, Mao H, Li X, Nie Y, Xie J, Li J, Lu J, Zou X, Mo J, Li C, Li J, Wang W, Yu Y, Fei X, Gu X, Chen J, Kong X, Pang J, Zhu W, Zhao Z, Wu W, Sun H, Liu Y, la Rosette JD. Mini Percutaneous Nephrolithotomy Is a Noninferior Modality to Standard Percutaneous Nephrolithotomy for the Management of 20-40mm Renal Calculi: A Multicenter Randomized Controlled Trial. Eur Urol 2020; 79:114-121. [PMID: 32994063 DOI: 10.1016/j.eururo.2020.09.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/10/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND High quality of evidence comparing mini percutaneous nephrolithotomy (mPNL) with standard percutaneous nephrolithotomy (sPNL) for the treatment of larger-sized renal stones is lacking. OBJECTIVE To compare the efficacy and safety of mPNL and sPNL for the treatment of 20-40mm renal stones. DESIGN, SETTING, AND PARTICIPANTS A parallel, open-label, and noninferior randomized controlled trial was performed at 20 Chinese centers (2016-2019). The inclusion criteria were patients 18-70 yr old, with normal renal function, and 20-40mm renal stones. INTERVENTION Percutaneous nephrolithotomy PNL was performed using either 18 F or 24 F percutaneous nephrostomy tracts. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was the one-session stone-free rate (SFR). The secondary outcomes included operating time, visual analog pain scale (VAS) score, blood loss, complications as per the Clavien-Dindo grading system, and length of hospitalization. RESULTS AND LIMITATIONS The 1980 intention-to-treat patients were randomized. The mPNL group achieved a noninferior one-session SFR to the sPNL group by the one-side noninferiority test (0.5% [difference], p < 0.001). The transfusion and embolization rates were comparable; however, the sPNL group had a higher hemoglobin drop (5.2 g/l, p < 0.001). The sPNL yielded shorter operating time (-2.2 min, p = 0.008) but a higher VAS score (0.8, p < 0.001). Patients in the sPNL group also had longer hospitalization (0.6 d, p < 0.001). There was no statistically significant difference in fever or urosepsis occurrences. The study's main limitation was that only 18F or 24F tract sizes were used. CONCLUSIONS Mini mPNL achieves noninferior SFR outcomes to sPNL, but with reduced bleeding, less postoperative pain, and shorter hospitalization. PATIENT SUMMARY We evaluated the surgical outcomes of percutaneous nephrolithotomy using two different sizes of nephrostomy tracts in a large population. We found that the smaller tract might be a sensible alternative for patients with 20-40mm renal stones.
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Affiliation(s)
- Guohua Zeng
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, and Guangdong Key Laboratory of Urology, Guangzhou, China.
| | - Chao Cai
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, and Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Xianzhong Duan
- Department of Urology, Baoshan No.2 People's Hospital, Baoshan, China
| | - Xun Xu
- Department of urology, Affiliated Nanhai Hospital, Southern Medical University (People's Hospital of Nanhai District), Foshan, China
| | - Houping Mao
- Department of Urology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xuedong Li
- Department of Urology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yong Nie
- Department of Urology, Yiling Hospital,Yichang, China
| | - Jianjun Xie
- Department of Urology, The Affiliated Suzhou Hospital of Nanjing Medical University
| | - Jiongming Li
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jun Lu
- Department of Urology, Shanghai General Hospital, Shanghai, China
| | - Xiaofeng Zou
- Department of Urology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Jianfeng Mo
- Department of Urology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, China
| | - Chengyang Li
- Department of Urology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jianzhong Li
- Department of Urology, General Hospital of Northern Theater Command
| | - Weiguo Wang
- Department of Urology, Jining No.1 People's Hospital, Jining, China
| | - Yonggang Yu
- Department of Urology, 181st Hospital of Chinese People's Liberation Army, Guilin, China
| | - Xiang Fei
- Department of Urology, ShengJing Hospital of China Medical University, Shenyang, China
| | - Xianen Gu
- Department of Urology, Chui Yang Liu Hospital Affiliated to Tsinghua University, Beijing, China
| | - Jianhui Chen
- Department of Urology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiangbo Kong
- Department of Urology, China-Japan Union Hospital, Jilin University, Changchun, China
| | - Jian Pang
- Department of Urology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yet-sen University, Jiangmen, China
| | - Wei Zhu
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, and Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Zhijian Zhao
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, and Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Wenqi Wu
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, and Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Hongling Sun
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, and Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Yongda Liu
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, and Guangdong Key Laboratory of Urology, Guangzhou, China
| | - Jean de la Rosette
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, and Guangdong Key Laboratory of Urology, Guangzhou, China; Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Department of Urology, Istanbul Medipol University, Istanbul, Turkey
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Ritchie D, Bresler A, Paskhover B. Contributions of the First Female Plastic Surgeon to Modern-Day Rhytidectomies. Aesthetic Plast Surg 2020; 44:240-245. [PMID: 31637506 DOI: 10.1007/s00266-019-01507-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 09/23/2019] [Indexed: 11/27/2022]
Abstract
Dr. Suzanne Noël was a pioneer for female surgeons and made fundamental contributions to the field of plastic surgery. Her hallmark operation, the "petit operation," defined the fundamental aspects to many modern rhytidectomies including the mini-lift and the short scar facelift. These contributions included camouflaging incisions in the hairline, limiting incision length, avoiding tension on the skin, meticulous handling of the skin edges, appropriate and precise vector placement, and staging operation when required. Through understanding the history of the fundamental principles on which rhytidectomy was constructed will help the cosmetic surgeon understand the nuances of this operation. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- David Ritchie
- Saint George's University School of Medicine, University Centre Grenada, Saint George's, West Indies, Grenada
| | - Amishav Bresler
- Department of Otolaryngology Head and Neck Surgery, Rutgers New Jersey Medical School, Suite 8100, Newark, NJ, 07101, USA.
| | - Boris Paskhover
- Department of Otolaryngology Head and Neck Surgery, Rutgers New Jersey Medical School, Suite 8100, Newark, NJ, 07101, USA.
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Cassum LA, Cash K, Qidwai W, Vertejee S. Exploring the experiences of the older adults who are brought to live in shelter homes in Karachi, Pakistan: a qualitative study. BMC Geriatr 2020; 20:8. [PMID: 31906863 PMCID: PMC6945572 DOI: 10.1186/s12877-019-1376-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/08/2019] [Indexed: 12/01/2022] Open
Abstract
Background The traditional joint family system in a culturally diverse Pakistani society shows great respect and care for older population by the families and their generations. However, in the recent years the phenomenon of population ageing in Pakistan is rapidly increasing due to demographic shift influencing life expectancy, along with changes in socio-cultural values. This transition has resulted in institutionalization of the elderly as an emerging shelter alternative. The aim of this study was to explore the experiences of the elderly people and to identify the reason which compelled them to reside in these shelter homes. Method A qualitative methodology, with a descriptive exploratory design, was adopted for the study. A purposive sample of 14 elderly males and females were selected, from two different shelter homes in Karachi, Pakistan. Semi-structured interviews were audio recorded and transcribed. Content analysis was done to extract the themes and comprehend the data. Results Content analysis revealed five major themes: the circumstances of leaving home, experiences, and challenges to wellbeing before entering the care facility, coping with challenges, and decision to live in a shelter home. The analysis discovered that the elderly were experiencing lack of physical, psychological, emotional, and financial support from their family and children. It also indicated that migration of children for better career and employment opportunities, entrance of women into the workforce, and insensitive behaviour of children, left the senior citizens neglected and helpless. The findings also uncovered the challenges of unemployment and family disputes that the elderly had to face made them dependent, distressed, helpless, and lonely resulting in both their apparently willing and forceful decision to reside in shelter homes. Conclusion The findings point to need for further investigation of the identified areas in this study through qualitative and quantitative researches. There is a dire need for increasing public awareness through the social, electronic, and print media, and providing capacity building training to HCPs for the care of the elderly. The lobbying group can act as a catalyst in persuading the government officials for the execution of a policy on retirement, day care and subsidized provision of health services for the betterment of the elderly.
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Affiliation(s)
- Laila Akber Cassum
- Aga Khan University School of Nursing and Midwifery, P.O.Box 3500, Stadium Road Karachi, Karachi City, Pakistan.
| | - Keith Cash
- Faculty of Public Health, Kuwait University, Hawally, Kuwait
| | - Waris Qidwai
- Department of Family Medicine, Karachi City, Pakistan
| | - Samina Vertejee
- Aga Khan University School of Nursing and Midwifery, P.O.Box 3500, Stadium Road Karachi, Karachi City, Pakistan
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Affiliation(s)
- L Genser
- Service de chirurgie digestive hépato-bilio-pancréatique et transplantation hépatique, Sorbonne Université, institut hospitalo-universitaire ICAN, groupe hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - J C Vaillant
- Service de chirurgie digestive hépato-bilio-pancréatique et transplantation hépatique, Sorbonne Université, institut hospitalo-universitaire ICAN, groupe hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J M Siksik
- Service de chirurgie digestive hépato-bilio-pancréatique et transplantation hépatique, Sorbonne Université, institut hospitalo-universitaire ICAN, groupe hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France
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Abstract
OBJECTIVE The objective was to report our initial experience of mini percutaneous nephrolithotomy (mPCNL) performed on patients in the pediatric age group (<18 years) using a miniature nephroscope (12F). SUBJECTS AND METHODS A total of 20 children underwent mPCNL for renal stone extraction in the Department of Urology, Yenepoya Medical College, Mangalore, India, from February 2013 to January 2014. The patients were evaluated on the basis of parameters viz. age at the time of surgery, size and number of stones, duration of surgery, stone clearance, and postoperative complications. RESULTS A total of 20 mPCNLs were performed on children, with age ranging from 8 to 16 years. Three children had three stones each, six children had two stones each, eight children had one stone each, and three had multiple. The median stone burden was 1.36 cm. The procedure was via single puncture in 15 cases, and two punctures in five cases. Punctures were upper calyceal in seven cases, lower calyceal in seven cases, and combined upper and lower calyceal in six cases. The calculi were accessed by a 12F mini nephroscope, laser lithotripsy was used in 12 cases and pneumatic lithotripsy used for the rest. Total clearance was achieved in 18 out of 20 cases (90%). Postoperative complications developed in one child, in the form of sepsis. CONCLUSION Our initial experience concludes that mPCNL is a safe and efficacious tool for the management of renal calculi in the pediatric population.
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Affiliation(s)
- Nischith D'Souza
- Department of Urology, Yenepoya Medical College and Hospital, Mangalore, Karnataka, India
| | - Saptarshi Paul
- Department of Urology, Yenepoya Medical College and Hospital, Mangalore, Karnataka, India
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