Chapter 12: Tips and Tricks in the Treatment of Ureteral Stones

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Solvent, substituents and pH effects towards the spectral shifts of some highly colored indicators

The solvatochromic responses of six indicators namely Sudan orange, Alizarin yellow R, Aurin tricarboxylic acid, Alizarin yellow GG, Titan yellow and Eriochrome black-T, dissolved in seven solvents of different polarities, have been measured at room temperature. The UV/Vis absorption spectral shifts were analyzed by the multiple linear regression analysis and Kamlet–Taft equation. The observed solvatochromism was found to depend on the presence of the donor and acceptor substituents in the conjugated systems of the indicator and the physical properties of the solvent molecules. The pH effects on the wavenumbers of the absorption band maxima of some indicators with different constituents at room temperature were discussed and the mechanism of ionization was explained. The dissociation constants (pKa) of the investigated compounds were precisely assessed and the existence of the individual predominant ionic species was assigned by constructing distribution diagrams at different pH ranges

Differences in 24-hour urine composition between apatite and brushite stone formers

OBJECTIVE To determine the differences in 24-hour urine composition between apatite and brushite stone formers. METHODS We conducted a retrospective review of 110 calcium phosphate (CaP) stone formers with both stone composition analysis and 24-hour urinalysis available. Analysis of 24-hour urine constituents between apatite and brushite stone formers was performed using univariable t test and multivariable linear regression models, adjusting for clinical and demographic factors. RESULTS A total of 97 patients (88%) had predominantly apatite stones and 13 patients (12%) had predominantly brushite stones. In univariable analysis, brushite stone formers had significantly higher mean 24-hour urinary calcium excretion (apatite = 204.8 +/- 103.5 mg vs brushite = 329.7 +/- 136.6 mg, P = .007), higher mean super saturation (SS) CaP (apatite = 1.423 +/- 0.867 vs brushite = 2.576 +/- 0.171, P = .004) and lower mean SS uric acid (apatite = 0.688 +/- 0.796 vs brushite = 0.345 +/- 0.190,

Symptoms after removal of ureteral stents

BACKGROUND AND PURPOSE: Urology practices frequently encounter individuals who experience various degrees of pain/discomfort after ureteral stent removal. These symptoms have been previously proved to greatly affect functionality, convalescence time, quality of life, and healthcare costs. The etiology is unclear, but the condition is often self-limiting. We counsel individuals on their risk of having post-ureteral stent removal pain based on anecdotal data. We sought to evaluate the incidence of post-ureteral stent removal pain and attempt to find the probable cause. PATIENTS AND METHODS: All individuals who had a ureteral stent placed and subsequently removed for various etiologies (between January 2012 and May 2013) were evaluated by filling a survey conducted by a member of the healthcare team 1 to 3 weeks after ureteral stent removal. Univariate and multivariate analysis were used to assess correlation between demographics, operative procedures, convalescent time, and post-ureteral stent removal symptoms. All statistical analyses were performed using SAS((R)) software, and a P value of less than 0.05 was considered to indicate statistical significance. RESULTS: Of the 104 individuals in the final cohort, 64% had symptoms after stent removal (pain, hematuria, frequency, urgency, or fever), and among those with symptoms, 60% experienced pain/discomfort. On univariate analysis, stone basketing and indwelling stent discomfort correlated positively with pain after stent removal. On the other hand, the use of anticholinergics and a longer indwelling stent duration were associated with less pain after stent removal. On multivariate analysis, correlation with procedures involving basket extraction and indwelling stent discomfort maintained significance. CONCLUSION: Our series suggests that two of three individuals who undergo ureteral stent removal experience symptoms thereafter. Individuals undergoing stone basket extraction and those who experienced stent discomfort were more likely to have pain after stent removal. Anticholinergic use and stents indwelling for a longer time were associated with less pain after stent removal

Dedicated robotics team reduces pre-surgical preparation time

Context: Robot-Assisted Laparoscopic Radical Prostatectomy (RALRP) requires significant preoperative setup time for the room, staff, and surgical platform. The utilization of a dedicated robotics operating room (OR) staff may facilitate efficiency and decrease costs. Aims: We sought to determine the degree to which preoperative time decreased as experience was gained. Materials and Methods: A total of 476 patients with a mean age of 60.2 years were evaluated (11/2006 to 1/2010). Data was assimilated through an institutional review board approved blinded, prospective database. Utilizing time from patient arrival in the OR to robot docking as preoperative preparation, our experience was evaluated. Age, body mass index (BMI), and American Society of Anesthesiologists risk scores (ASA) were compared. Statistical Analysis Used: Analysis of variance; Two-sample t-test for unequal variances. Results: The first and last 100 cases were found to have similar age (P=0.27), BMI (P=0.11), and ASA (P=0.09). The average preoperative times were 66. 4 and 53.4 min, respectively (P<0.05). The second 100 patients treated were found to have a significantly shorter preoperative time when compared to the first 100 patients (P<0.05). When the first 100 cases were divided into cohorts of 10 cases the mean preoperative time for the first through fourth cohorts were 80.5, 69.3, 78.8, and 64.7 min, respectively. After treatment of our first 30 patients we found a significant drop in preoperative time. This persisted throughout the remainder of our experience. Conclusions: From the time of patient arrival a number of tasks are accomplished by the non-physician operating room staff during RALRP. The use of a consistent staff can decrease preoperative setup times and, therefore, the overall length of surgery