Supine PCNL is the Way Forward, with Reduced Anesthesia and Operative Times As Compared to Prone PCNL, Along with Comparable Blood Loss and Stone Free Rates

Objective:The aim of this study is to compare safety and efficacy of supine versus prone percutaneous nephrolithotomy (PCNL) in terms of stonefree rate, operative time, anesthesia time and blood loss in a retrospective case-control trial.Materials and Methods:Fifty patients underwent supine PCNL during the study period (group A). Equal number of patients, who underwent prone PCNL during same period with similar demographic and clinical attributes, were taken as controls (group B). Demographic details, such as gender and age, and body mass index, stone size, stone location and stone laterality were comparable between the two groups. Pre- and post-operative hemoglobin (Hb) levels in patients in both groups were tabulated. Variables analyzed to compare the groups included operative time, anesthesia time, fall in Hb, blood transfusion, stone clearance and need for auxiliary procedure.Results:The median operative time (minutes) in patients of group A [35; interquartile ratio (IQR): 25], was significantly different from group B (70; IQR: 40) (p=0.000). The median anesthesia time (minutes) in patients in group A (50; IQR: 25) was significantly different from group B (85; 45) (p=0.000). The median fall in Hb (g/dL) in patients in group A (1.700; IQR: 1.2) was significantly different from group B (1.200; IQR: 2.4) (p=0.967). Two patients in group A and 7 in group B needed blood transfusion (p=0.080). Thirty two patient in group A and 34 in group B achieved stonefree status (p=0.833). Eleven patients in group A and 6 in group B needed auxiliary procedure in the form of extracorporeal shockwave lithotripsy (p=0.287).Conclusion:Supine PCNL is as safe and effective as conventionally performed prone PCNL, with an added benefit of decreased operative and anesthesia time

Is Routine Measurement of Post-operative Hemoglobin and Electrolytes Necessary in Every Patient After Transurethral Resection of the Prostate?

Objective: To evaluate the importance of post-operative hemoglobin and electrolyte monitoring after transurethral resection of the prostate (TURP) and establish the parameters to be considered for monitoring.Materials and Methods:Data of patients who underwent TURP between 2007 and 2017 were reviewed. Data regarding prostate size, irrigation fluid volume, resection time, pre- and post-operative electrolytes, hemoglobin levels taken within 48 hours before and after surgery, and blood transfusion information were collected. In order to establish parameters for post-operative laboratory monitoring, we categorized prostate size, resection time, and irrigation fluid into groups i.e. (80 g), (60 min) and (40 L) respectively.Results:A total of 1.000 patients were included. The median age was 66 years with the minimum of 46 years and maximum of 98 years. The median prostate size was 54.26 g. Among all pre- and post-operative laboratory parameters, only hemoglobin and sodium showed a significant change, which were analyzed further. Drop in hemoglobin was significantly associated with increasing prostate size and volume of irrigation fluid. Patients with a prostate size of >80 g had 27.3 times higher chance of significant (>2 g) drop in hemoglobin while 5.1 times higher when irrigation volume exceeded 40 liters. Low levels of sodium were strongly associated with prostate size, irrigation fluid volume, and resection time. However, all these factors become insignificant (p≥0.05) for their effect on low sodium, when these variables were adjusted with each other. Blood transfusion was performed in 27 patients. All these patients belonged to a group of patients with prostate size of more than 80 g with high resection time and irrigation fluid volume. Three patients had TUR syndrome. Post-operative hemoglobin and electrolytes monitoring contributed to a change in the management of only 14% of patients.Conclusion:Routine post-operative hemoglobin and electrolyte measurement is not required in every patient undergoing TURP. Use of risk stratification approach will help us to decide which patient needs post-operative lab testing

Supracostal PCNL-Standard Nephrostomy with Day Long Pain Versus Painless Tubeless

Objective: To determine the scope of tubeless (TL) supracostal percutaneous nephrolithotomy (PCNL) in terms of safety through a randomized controlled trial. Materials and Methods: Adult patients (>14 years) undergoing supracostal PCNL were randomized into two groups (25 patients each), by randomizing odd number for supracostal PCNL with tube (WT) as group A and for TL supracostal PCNL as group B. Both groups received injectable analgesia on operative day and oral analgesia from the first post-operative day. Pain severity was objectively assessed by a visual analogue scale (VAS). Chest X-ray and kidney ultrasonography were done to detect any pleural effusion and perinephric collection. These complications along with thoracostomy and endotracheal intubation were compared between the groups. Results: The mean (VAS) score in group A and B was 7.88±0.83 and 4.12±0.83, respectively (p=0.01). Four of 25 (16%) patients in group A and 1 of 25 (4%) patients in group B developed pleural effusion. Two patients (8%) in group A and 1 patient (4%) in group B required tube thoracostomy (p=0.56). One patient (4%) in group A and 2 patients (8%) in group B developed perinephric collection (p=0.56). A single patient in each group (2%) developed respiratory distress needing elective intubation and ventilation (p=1.00). The mean hospital stay in group B (4.12±0.52 days) was shorter than in group A (4.68±0.85 days) (p=0.01). Conclusion: Tubeless supracostal PCNL is less painful than supracostal PCNL WT, without difference in complication rates. Supracostal PCNL (TL) has a shorter hospital stay

Outcome of 980 nm diode laser vaporization for benign prostatic hyperplasia: A prospective study

Purpose: To evaluate the initial experience and outcome of photo-selective vaporization of the prostate (PVP) for benign prostatic hyperplasia (BPH) in Pakistan with the use of a 980 nm diode laser. Materials and Methods: A prospective study was performed from November 2016 to December 2017. A total of 100 patients diagnosed with bladder outlet obstruction secondary to BPH who planned for PVP were enrolled in the study. PVP was carried out with a diode laser at 980 nm (Biolitec Diode 180W laser) in a continuous wave with a 600 nm (twister) fiber. Baseline characteristics and perioperative data were compared. Postoperative outcomes were evaluated by International Prostate Symptom Score (IPSS), post void residual (PVR) and maximum urinary flow rate (Qmax) at 3 and 6 months after surgery. Results: The mean age was 65.82±10.42, mean prostate size was 67.35±16.42, operative time was 55.85±18.01 and total energy was 198.68±49.12 kJ. At 3 months and 6 months, significant improvements were noted (p<0.001) in IPSS 7.04±1.69 (−18.92), Qmax 19.22±4.75 mL/s (+13.09) and and PVR 18.89±5.39 mL (−112.80). Most frequent problems were burning micturition (35%) and terminal dysuria (29%). No significant difference in postoperative hemoglobin was seen in patients who were on anti-platelet drugs. Conclusions: PVP with a diode laser is a safe and effective procedure for the treatment of BPH and is also safe in patients who are on anti-platelet agents

Impact of Ar:O

In this study, a radio frequency magnetron sputtering technique was applied to deposit eminently oriented ZnO thin films on stainless steel (SS316L). The effect of different ratios (Ar:O2) of gas flow ((20:0), (15:5), (10:10), (5:15), (0:20)) on optical and structural properties of CeO2-doped ZnO thin films has been examined. The increase in grain size of thin films was observed with a partial increase in the Ar:O2 sputtering gas at substrate temperature of 673 K. The average surface roughness of the thin films has increased with sputtering gas. The photoluminescence peak exhibited a broad green-yellow band spiked at 467 nm for all the samples of CeO2-doped ZnO thin films and a wide band of visible light focused in the 500–600 nm range. Intensity reduction of deep level emission peaks of ZnO films was observed. The refractive index of undoped and CeO2-doped ZnO thin films with various sputtering gas ratios (Ar:O2) were also investigated. The optimized argon gas flow rate findings allow us to choose the deposition conditions for CeO2-doped ZnO thin films for solar thermal applications