The Effect of Targeted Antibiotic Prophylaxis on Lower Urinary Tract Symptoms Following Prostate Biopsy: A Prospective Randomized Trial

Objective:Targeted antibiotic prophylaxis in prostate biopsy is recommended for patients at risk due to increased complication rates seen in recent years. Lower urinary tract symptoms (LUTS) is currently one of the most prevalent complications with a rate of more than 40%. The study examined the effects of targeted antibiotic prophylaxis on biopsy-related LUTS and to compare the results with standard prophylaxis.Materials and Methods:A total of 240 patients were included in the study, 120 of whom had been administered targeted antibiotic prophylaxis and 120 of whom had received ciprofloxacin treatment between January 2021-Januray 2023. Patients’ results before the procedure, on the 7th day, and in the first month were prospectively recorded and compared.Results:While Qmax mean values were measured as 18.3±5.1 mL/s in the targeted prophylaxis group and 17.4±4.6 mL/s in the control group (p=0.157) before the procedure, these values were found to be 14.6±3.3 mL/s and 11.7±4.1 mL/s (p<0.001) on the 7th day and 16.8 16.8±4.3 mL/s and 14.9±3.5 mL/s (p=0.013) in first month, respectively. IPSS mean scores of the groups were calculated as 16.8±4.3 mL/s and 14.9±3.5 mL/s (p=0.013) before the procedure, respectively, while these scores were found to be 18.12±6.1 and 22.97±7.4 (p<0.001) on the 7th day and 17.5±5.5 and 22.8±7.5 (p<0.001) in the first month, respectively.Conclusion:In this study, we found that targeted antibiotic prophylaxis had a significant effect on preventing biopsy-related LUTS. We believe that routine application of targeted antibiotic prophylaxis can be effective in reducing the rates of biopsy-related LUTS

Comparison of Pneumatic, Ultrasonic and Combination Lithotripters in Percutaneous Nephrolithotripsy

Purpose We aimed to compare the outcomes of pneumatic (PL), ultrasonic (UL) and combined (PL/UL) lithotripsy performed in percutaneous lithotripsy (PNL) according to success rates and stone clearence. Materials and Methods The medical records of 512 patients treated with PNL between April 2010 and April 2013 were evaluated. Postoperative stone analysis revealed as calcium oxalate in 408 of these patients. The operation notes of 355 patients recorded in detail with complete parameters were reviewed. According to stone disintegration method, patients were divided into three groups: PL only in Group I, UL only in Group II, and UL/PL combination in Group III. Number of patients was 155, 110 and 90, respectively. Results Fluoroscopy screening time was significantly shorter in group II, and III compared to group I (p<0.001). The failure rates were 13.5% (21 patients) for group I, 3.6% (4 patients) for group II, and 3.3% (3 patients) for group III. There was a significant statistical difference in favor of group II and III by means of success (p=0.023). Group II and III had larger FSA, and this was statistically significant (p=0.032). Stone disintegration time (SDT) was 64.0±41.92 minutes for group I, 49.5±34.63 for group II, and 37.7±16.89 for group III. Group III has a statistically significant shorter SDT (p=0.011). Conclusions We concluded that, in cases with high stone burden, where faster and efficient lithotripsy is needed, combined ultrasonic / pneumatic lithotripter may be the ideal choice and in suitable cases ultrasonic lithotripter usage provides important advantages to the surgeon

The comparison of standard and tubeless percutaneous nephrolithotomy procedures

Purpose To compare totally tubeless and standard percutaneous nephrolitotomy procedures on many parameters. Materials and Methods Percutaneous nephrolitotomy was performed on 195 patients between June 2009 and May 2012. The data of those patients were evaluated retrospectively. Totally tubeless cases were enrolled to Group 1, and Group 2 consisted of non-tubeless cases (re-entry or Foley catheter). Results Group 1 included 85 cases and group 2 a total of 110 patients. Paper tracing values for the kidney stones were 321.25 &#177; 102.4 mm2 and 324.10 &#177; 169.5 mm2 respectively. Mean fluoroscopy time was 4.9 &#177; 1.9 min and 5.08 &#177; 2.7 min, mean operation time was 78.8 &#177; 27.9 min and 81.9 &#177; 28.77 min and mean decrease in hematocrit was 2.6 &#177; 1.6 and 3.74 &#177; 1.9 respectively. All these comparisons were statistically significant. Length of hospitalization was 1.6 &#177; 1.1 and 3.5 &#177; 1.5 days for Groups 1 and 2 respectively. Mean superficial pain score was 5.8 &#177; 1.6 and 6.7 &#177; 1.2 respectively for both groups after 1 hour. At 6 hours, the scores changed to 3.87 &#177; 1.22 and 4.84 &#177; 1.3 respectively. The analgesic dose was 1.00 &#177; 0.7 and 1.53 &#177; 0.6 for the groups respectively at 6 hours. All the statistical differences were significant for these three parameters. Conclusions We believe that, because of their post operative patient comfort and decreased length of hospital stay, totally tubeless procedures should be considered as an alternative to standard percutaneous nephrolitotomy

Serum Kreatinin Seviyelerinin Perkutan Nefrolitotripside Kanama Uzerine Etkisi

Amac: Perkutan nefrolitotripsi (PNL), urolojinin son yillarina damga vurmus, pek cok merkezde uygulanabilen, morbiditesi ve mortalitesi son derece dusuk bir tedavi yontemi olarak karsimiza cikmaktadir. Biz bu calismamizda, PNL oncesi serum kreatinin degerindeki yuksekligin post operatif kanama durumuna etkisini arastirmayi amacladik. Materyal ve Metod: Klinigimizde PNL uygulanmis olan hastalar arasinda ure ve kreatinin degerleri yuksek olan hastalar ayrildi. Bu hastalarin yaslari, tas boyutlari, cinsiyetleri, tedavi oncesi hematokrit degerleri ve ek ko-morbiditeleri kaydedilerek hastalarin bu degerlerine benzer degerleri olan hastalar ile diger grup olusturuldu. Serum kreatinin degerleri yuksek olanlar Grup 1, normal olanlar ise Grup 2 olarak adlandirildi. Hastalarin beden kitle endeksi, tas boyutlari, operasyon oncesi ve sonrasi kreatin degeri, operasyon oncesi ve sonrasi hematokrit degeri, preoperatif trombosit sayisi, koagulasyon parametreleri (aPTT, INR degerleri), trakt sayisi, operasyon suresi, preoperatif trombosit sayisi, tassizlik oranlari ve eritrosit transfuzyonu olup olmadigi kaydedilerek kiyaslandi. Bulgular: Gruplarda preoperatif kreatinin degerleri sirasi ile Grup 1 ve 2 icin 2,11 +/- 0,44 ve 0,98 +/- 0,27 idi. Tas boyutlari 1. Grup icin 29,41 +/- 3,83 mm, 2. Grup icin ise 29,49 +/- 2,99 idi (p=0,317). Hastalarin operasyon oncesi hematokrit degerleri 1 ve 2. Gruplar icin sirasiyla 44,88 +/- 5,61 ve 47,51 +/- 4,61 idi (p=0,381). Bu degerler operasyon sonrasi her iki grup icin sirasi ile 30,27 +/- 7,01 ve 37,74 +/- 7,11 idi (p=0,044). Sonuc: Calismamizda kreatinin degerlerinin PNL sonrasi kanama icin bir risk faktoru oldugu, serum kreatinin degerlerinin yuksekligi olan hastalarda, olmayanlara oranla hematokrit dususunun daha fazla oldugu gorulmektedir. [Cukurova Med J 2015; 40(2.000): 221-225