Evaluation of percutaneous nephrolithotomy efficasy in the treatment of patients with kidney stone

Uvod: Perkutana nefrolitolapaksija (PCNL) predstavlja metodu izbora u lečenju kamena (kalkulusa) u bubregu većeg od 2 cm. Metoda pripada grupi endoskopskih minimalno invazivnih procedura. Uprkos manjoj invazivnosti u odnosu na otvorene hirurške tehnike, metoda ima i svoje specifičnosti, na polju bezbednosti i potencijalnih komplikacija. Pristup kamenu se obavlja širenjem kanala kroz parenhim bubrega, nakon ulaska iglom do željenog dela sabirnog sistema bubrega i kamena. Kao i ostale tehnike fragmentisanja kamena u bubregu i PCNL može da ima uticaj na bubrežnu funkciju. Cilj: Analiza (1) uspešnosti PCNL u lečenju kamena u bubregu u odnosu na veličinu, anatomske odnose i lokalizaciju, (2) učestalosti komplikacija kod bolesnika lečenih ovom metodom, u odnosu na veličinu, anatomske odnose i lokalizaciju, (3) uticaja metode na bubrežnu funkciju i eventualnog stepena oštećenja bubrega i (4) učestalosti recidiva. Materijal i metode: Kohortnom studijom su obuhvaćeni pacijenati Klinike za urologiju KCS koji su u periodu od 2010. do 2014. godine operisani PCNL metodom, od strane jednog hirurga. Selekcija pacijenata obavljena je prema preporukama za tretman kalkuloze bubrega Evropske asocijacije urologa i svi su imali kamen veći od 2 cm. Nakon sprovedenih radiografskih procedura karakteristike kalkulusa, veličina, broj i položaj, kao i anatomska građa sabirnog sistema bubrega i samog bubrega sagledavani su korišćenjem „Guy’s Stone Score“ klasifikacije (GSS) i bolesnici su svrstavani u jednu od četiri ponuđene kategorije. Klasifikacija komplikacija izvršena je prema modifikovanom Clavien-Dindo sistemu. Uspeh procedure je definisan kao izostanak rezidualnih fragmenata > 3 mm. Bubrežna funkcija je praćena određivanjem β2-mikroglobulina i mikroalbuminurije. Tri meseca nakon operacije vršena je procena učestalosti recidiva. Rezultati: Ispitivanu populaciju činilo je 111 bolesnika. Medijana starosti bolesnika je iznosila 48 godina. Medijana veličine kamena iznosila je 51 mm. Najmanji kamen bio promera 21 mm, a najveći 91 mm. Klasifikovani prema GSS klasifikaciji, 16,2% bolesnika je pripadalo grupi GSS 1, 18,9% GSS 2, 26,2% GSS 3 i 38,7% grupi GSS 4...INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is considered today as a treatment of choice for kidney stones bigger than 2 cm. PCNL is endoscopic, minimally invasive procedure. Beside its low aggressiveness it is accompanied with few specific, critical steps and possible complications. The crucial step to perform successful and safe procedure is renal access. Precise access to the planed and desired part of the kidney collecting system is followed with careful dilatation of the working tract. As all other techniques of kidney stones disintegration, PCNL can possibly impact renal function. OBJECTIVE: The aim of the present study was to investigate 1) PCNL efficacy and 2) PCNL safety, overall and dependent on stone complexity, respectively, 3) possible mechanism of impact on renal function and 4) the frequency of stone recurrence. MATERIAL AND METHODS: The study cohort evaluated all patients of Clinic of urology in Belgrade who underwent PCNL by a single surgeon, between August 2010 and December 2014. The patients were selected according to the Guideline of the European Association of Urology and all stones were bigger than 2 cm. After the appropriate radiological and laboratory investigation the complexity of the stones, but also of kidney anatomy was determined by Guy’s Stone Score classification. Stones were classified to one of the four offered groups. Complications were evaluated using modified Clavien-Dindo classification. For detection of possible impact of PCNL on renal function the micro albumin and β2-microglobulin levels in urine were evaluated. Three months following PCNL the frequency of recurrence was determined. RESULTS: Study cohort gained 111 patients. The median age of the patients was 48 years, while the median stone diameter was 51 mm. The smallest stone was 21 mm and the biggest 91 mm. According to Guy’s Stone Score (GSS) 16,2% of the patients were classified in GSS 1 group, 18,9% in GSS 2, 26,2% in GSS 3 and 38,7% in GSS 4 groups, respectively. The overall efficacy of the study was 75%, as 83 out of 111 patients were stone free after the procedure..

Assessment of the occupational exposure of urologists during percutaneous nephrolithotomy surgical interventions

Percutaneous nephrolitholapaxy (PCNL) is an endoscopic procedure that represents the method of choice for the need to shred and eliminate larger stones in the kidneys. The procedure is performed under fluoroscopy guidance, with presence of medical staff in the vicinity of patient couch which presents potential radiation protection concern. Assessment of the radiation exposure of the urologist who performs the procedure is an essential part of radiation protection arrangement. The objective of this work is to assess radiation dose for urologist in order to verify compliance with regulatory dose limits and to investigate need to occupations dose monitoring arrangements. Furthermore, in the particular case, the X-tube is above the patient’s table, which brings higher dose compared with situation when it is bellow. Two consecutive 3 months long research was based on active personal dosimeters (APD) and passive, thermoluminescence dosimeters (TLD) use to assess whole body and eye lens occupational dose. During this period 77 interventions (conducted by two urologists) were performed. The average exposure measured using APD was 147 µSv, but doses varied from 24.5 µSv to 813 µSv. Using dedicated eye lens TLDs placed on left and right temple, the doses for the urologist were 3, 24 mSv and 3.43 mSv, respectively for first and 0.9 mSv and 1.03 mSv for second urologist. Whole body dosimeters worn over the apron showed a cumulative dose of 6.31 mSv and 0.54 mSv for two urologists, respectively. The presented results indicate that doses are below the regulatory dose limits; however, their magnitude requires caution and careful individual monitoring arrangements.VII International Conference on Radiation in Various Fields of Research : RAD 2019 : book of abstracts; June 10-14, 2019; Herceg Novi, Montenegr

Atypical proliferating mucinous tumors of gigantic dimensions

Background. Ovarian tumors of low malignant potential (LMP) are also known as atypically proliferating tumors. Ovarian tumors of LPM account for approximately 15% of all epithelial ovarian cancers. Mean age of occurrence is 40 years and they are 15-20 cm in diameter. Case report. A 32-year-old female patient was hospitalized as an urgent case with a large tumor mass that filled the entire abdomen. Cyst was 100 × 70 cm dimensions belonging to the right ovary and filled with 18 liters of content. Right adnexectomy, resection of the second ovary, as well as biopsy of the omentum were performed. Lymphadenectomy of the right iliac and obturator area was also performed. After receiving definitive histopathological results it was decided to perform a radical reoperation. On the 10th postoperative day relaparotomy, total hysterectomy and left adnexectomy were performed. The patient was released on the 6th postoperative day. She used to come to regular examinations up to date. Conclusion. This case is a proof that LMP tumors have low malignant potential, they grow slowly and can reach great proportions

Interplay between Comprehensive Inflammation Indices and Redox Biomarkers in Testicular Germ-Cell Tumors

Sustained and dysregulated inflammation, concurrent tumor-induced immune suppression, and oxidative stress are profoundly involved in cancer initiation, presentation, and perpetuation. Within this prospective study, we simultaneously analyzed the preoperative indices of systemic inflammatory response and the representative byproducts of oxidative DNA, protein, and lipid damage with the aim of evaluating their clinical relevance among patients diagnosed with testicular germ-cell tumors (GCT). In the analytical cohort (n = 88, median age 34 years), neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and C-reactive protein (CRP) were significantly altered in patients with a higher tumor stage (p < 0.05). Highly suggestive correlations were found between NLR, dNLR, and SII and modified nucleoside 8-OHdG. CRP and albumin-to-globulin ratio (AGR) significantly correlated with thiols group level and maximal tumor dimension (p < 0.05). Based on receiver operating characteristic (ROC) curve analyses, all the evaluated pre-orchiectomy inflammation markers demonstrated strong performance in predicting metastatic disease; optimal cut-off points were determined for each indicator. Although further large-scale studies are warranted, inflammatory and redox indices may both complement the established tumor markers and standard clinicopathological prognostic variables and contribute to enhanced personalized risk-assessment among testicular GCT patients

Evaluation of percutaneous nephrolithotomy efficasy in the treatment of patients with kidney stone

Uvod: Perkutana nefrolitolapaksija (PCNL) predstavlja metodu izbora u lečenju kamena (kalkulusa) u bubregu većeg od 2 cm. Metoda pripada grupi endoskopskih minimalno invazivnih procedura. Uprkos manjoj invazivnosti u odnosu na otvorene hirurške tehnike, metoda ima i svoje specifičnosti, na polju bezbednosti i potencijalnih komplikacija. Pristup kamenu se obavlja širenjem kanala kroz parenhim bubrega, nakon ulaska iglom do željenog dela sabirnog sistema bubrega i kamena. Kao i ostale tehnike fragmentisanja kamena u bubregu i PCNL može da ima uticaj na bubrežnu funkciju. Cilj: Analiza (1) uspešnosti PCNL u lečenju kamena u bubregu u odnosu na veličinu, anatomske odnose i lokalizaciju, (2) učestalosti komplikacija kod bolesnika lečenih ovom metodom, u odnosu na veličinu, anatomske odnose i lokalizaciju, (3) uticaja metode na bubrežnu funkciju i eventualnog stepena oštećenja bubrega i (4) učestalosti recidiva. Materijal i metode: Kohortnom studijom su obuhvaćeni pacijenati Klinike za urologiju KCS koji su u periodu od 2010. do 2014. godine operisani PCNL metodom, od strane jednog hirurga. Selekcija pacijenata obavljena je prema preporukama za tretman kalkuloze bubrega Evropske asocijacije urologa i svi su imali kamen veći od 2 cm. Nakon sprovedenih radiografskih procedura karakteristike kalkulusa, veličina, broj i položaj, kao i anatomska građa sabirnog sistema bubrega i samog bubrega sagledavani su korišćenjem „Guy’s Stone Score“ klasifikacije (GSS) i bolesnici su svrstavani u jednu od četiri ponuđene kategorije. Klasifikacija komplikacija izvršena je prema modifikovanom Clavien-Dindo sistemu. Uspeh procedure je definisan kao izostanak rezidualnih fragmenata > 3 mm. Bubrežna funkcija je praćena određivanjem β2-mikroglobulina i mikroalbuminurije. Tri meseca nakon operacije vršena je procena učestalosti recidiva. Rezultati: Ispitivanu populaciju činilo je 111 bolesnika. Medijana starosti bolesnika je iznosila 48 godina. Medijana veličine kamena iznosila je 51 mm. Najmanji kamen bio promera 21 mm, a najveći 91 mm. Klasifikovani prema GSS klasifikaciji, 16,2% bolesnika je pripadalo grupi GSS 1, 18,9% GSS 2, 26,2% GSS 3 i 38,7% grupi GSS 4...INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is considered today as a treatment of choice for kidney stones bigger than 2 cm. PCNL is endoscopic, minimally invasive procedure. Beside its low aggressiveness it is accompanied with few specific, critical steps and possible complications. The crucial step to perform successful and safe procedure is renal access. Precise access to the planed and desired part of the kidney collecting system is followed with careful dilatation of the working tract. As all other techniques of kidney stones disintegration, PCNL can possibly impact renal function. OBJECTIVE: The aim of the present study was to investigate 1) PCNL efficacy and 2) PCNL safety, overall and dependent on stone complexity, respectively, 3) possible mechanism of impact on renal function and 4) the frequency of stone recurrence. MATERIAL AND METHODS: The study cohort evaluated all patients of Clinic of urology in Belgrade who underwent PCNL by a single surgeon, between August 2010 and December 2014. The patients were selected according to the Guideline of the European Association of Urology and all stones were bigger than 2 cm. After the appropriate radiological and laboratory investigation the complexity of the stones, but also of kidney anatomy was determined by Guy’s Stone Score classification. Stones were classified to one of the four offered groups. Complications were evaluated using modified Clavien-Dindo classification. For detection of possible impact of PCNL on renal function the micro albumin and β2-microglobulin levels in urine were evaluated. Three months following PCNL the frequency of recurrence was determined. RESULTS: Study cohort gained 111 patients. The median age of the patients was 48 years, while the median stone diameter was 51 mm. The smallest stone was 21 mm and the biggest 91 mm. According to Guy’s Stone Score (GSS) 16,2% of the patients were classified in GSS 1 group, 18,9% in GSS 2, 26,2% in GSS 3 and 38,7% in GSS 4 groups, respectively. The overall efficacy of the study was 75%, as 83 out of 111 patients were stone free after the procedure..

Evaluation of percutaneous nephrolithotomy efficasy in the treatment of patients with kidney stone

Uvod: Perkutana nefrolitolapaksija (PCNL) predstavlja metodu izbora u lečenju kamena (kalkulusa) u bubregu većeg od 2 cm. Metoda pripada grupi endoskopskih minimalno invazivnih procedura. Uprkos manjoj invazivnosti u odnosu na otvorene hirurške tehnike, metoda ima i svoje specifičnosti, na polju bezbednosti i potencijalnih komplikacija. Pristup kamenu se obavlja širenjem kanala kroz parenhim bubrega, nakon ulaska iglom do željenog dela sabirnog sistema bubrega i kamena. Kao i ostale tehnike fragmentisanja kamena u bubregu i PCNL može da ima uticaj na bubrežnu funkciju. Cilj: Analiza (1) uspešnosti PCNL u lečenju kamena u bubregu u odnosu na veličinu, anatomske odnose i lokalizaciju, (2) učestalosti komplikacija kod bolesnika lečenih ovom metodom, u odnosu na veličinu, anatomske odnose i lokalizaciju, (3) uticaja metode na bubrežnu funkciju i eventualnog stepena oštećenja bubrega i (4) učestalosti recidiva. Materijal i metode: Kohortnom studijom su obuhvaćeni pacijenati Klinike za urologiju KCS koji su u periodu od 2010. do 2014. godine operisani PCNL metodom, od strane jednog hirurga. Selekcija pacijenata obavljena je prema preporukama za tretman kalkuloze bubrega Evropske asocijacije urologa i svi su imali kamen veći od 2 cm. Nakon sprovedenih radiografskih procedura karakteristike kalkulusa, veličina, broj i položaj, kao i anatomska građa sabirnog sistema bubrega i samog bubrega sagledavani su korišćenjem „Guy’s Stone Score“ klasifikacije (GSS) i bolesnici su svrstavani u jednu od četiri ponuđene kategorije. Klasifikacija komplikacija izvršena je prema modifikovanom Clavien-Dindo sistemu. Uspeh procedure je definisan kao izostanak rezidualnih fragmenata > 3 mm. Bubrežna funkcija je praćena određivanjem β2-mikroglobulina i mikroalbuminurije. Tri meseca nakon operacije vršena je procena učestalosti recidiva. Rezultati: Ispitivanu populaciju činilo je 111 bolesnika. Medijana starosti bolesnika je iznosila 48 godina. Medijana veličine kamena iznosila je 51 mm. Najmanji kamen bio promera 21 mm, a najveći 91 mm. Klasifikovani prema GSS klasifikaciji, 16,2% bolesnika je pripadalo grupi GSS 1, 18,9% GSS 2, 26,2% GSS 3 i 38,7% grupi GSS 4...INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is considered today as a treatment of choice for kidney stones bigger than 2 cm. PCNL is endoscopic, minimally invasive procedure. Beside its low aggressiveness it is accompanied with few specific, critical steps and possible complications. The crucial step to perform successful and safe procedure is renal access. Precise access to the planed and desired part of the kidney collecting system is followed with careful dilatation of the working tract. As all other techniques of kidney stones disintegration, PCNL can possibly impact renal function. OBJECTIVE: The aim of the present study was to investigate 1) PCNL efficacy and 2) PCNL safety, overall and dependent on stone complexity, respectively, 3) possible mechanism of impact on renal function and 4) the frequency of stone recurrence. MATERIAL AND METHODS: The study cohort evaluated all patients of Clinic of urology in Belgrade who underwent PCNL by a single surgeon, between August 2010 and December 2014. The patients were selected according to the Guideline of the European Association of Urology and all stones were bigger than 2 cm. After the appropriate radiological and laboratory investigation the complexity of the stones, but also of kidney anatomy was determined by Guy’s Stone Score classification. Stones were classified to one of the four offered groups. Complications were evaluated using modified Clavien-Dindo classification. For detection of possible impact of PCNL on renal function the micro albumin and β2-microglobulin levels in urine were evaluated. Three months following PCNL the frequency of recurrence was determined. RESULTS: Study cohort gained 111 patients. The median age of the patients was 48 years, while the median stone diameter was 51 mm. The smallest stone was 21 mm and the biggest 91 mm. According to Guy’s Stone Score (GSS) 16,2% of the patients were classified in GSS 1 group, 18,9% in GSS 2, 26,2% in GSS 3 and 38,7% in GSS 4 groups, respectively. The overall efficacy of the study was 75%, as 83 out of 111 patients were stone free after the procedure..

Extremely rapid development of transurethral resection of the prostate syndrome

Background. The transurethral resection of the prostate (TURP) syndrome is reported after ureteroscopic procedures with irrigating solutions. TURP syndrome may occur quickly or up to 24 hours postoperatively. TURP syndrome affects many systems and manifests itself mainly through acute changes in intravascular volume and plasma solute concentrations. Case report. We reported a 72- year-old patient with benign prostatic hyperplasia, diabetes mellitus and angina pectoris who underwent TURP under spinal anesthesia. Unusual marked somnolence, bradycardia (38 beats/min), disorientation and face edema indicated a diagnosis of TURP syndrome only 15 minutes after the operation had started. The diagnosis confirmed by arterial gas analyses (metabolic acidosis, pH was 7.29) and hyponatremia (96 mmol/l). Aggressive and adequate therapy with diuretic and bicarbonates decreased symptoms and saved patient's life. Conclusion. Very fast development of TURP syndrome is possible. Continuous patient monitoring is necessary to provide fast recognition of TURP syndrome. Adequate therapy can prevent considerable complications

Immediate preoperative enteral nutrition (preoperative enteral nutrition)

Nutritional support of surgical patients is a necessary part of the treatment. It alone cannot cure the disease but it significantly affects the recovery of patients and supports surgical interventions. Patients in malnutrition have shown to have significantly more postoperative infectious and non-infectious complications. This significantly prolongs treatment time and increases costs. However, there is one fact that cannot be expressed in money, which is the patient's impression of the surgical intervention. Adequate preoperative patient support, based on the intake of liquid nutritive solutions, reduces preoperative stress and deflects the metabolic response. Now, it is recommended for adults and children older than one year to drink clear liquid up to 2 hours before induction in anesthesia. Appropriate enteral nutrition has a significant place in the postoperative recovery of patients. Enteral nutrition is reducing complications, mainly infectious complications because the function of the digestive system as one large immune system is preserved. Perioperative enteral nutrition is a necessary part of the modern treatment of surgical patients. In addition to the significant effect on the occurrence of postoperative complications, it is also important that this type of diet improves the psychological status of patients