Journal of endourology
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Journal of endourology · Mar 2021
Meta Analysis Comparative StudySafety and Efficacy of Transurethral Resection of Bladder Tumor Comparing Spinal Anesthesia with Spinal Anesthesia with an Obturator Nerve Block: A Systematic Review and Meta-analysis.
Aims: To investigate whether spinal anesthesia with an obturator nerve block (SA+ONB) can be effectively used for transurethral resection of bladder tumor (TURBT) during the coronavirus disease 2019 (COVID-19) pandemic to improve patient outcomes while also avoiding aerosol-generating procedures (AGPs). We aimed to compare outcomes of TURBTs using spinal anesthesia (SA) alone vs SA+ONB in terms of rates of obturator reflex, bladder perforation, incomplete tumor resection, tumor recurrence, and local anesthetic toxicity. Methods: We conducted a comprehensive search of electronic databases (MEDLINE, PUBMED, EMBASE, CINAHL, CENTRAL, SCOPUS, Google Scholar, and Web of Science), identifying studies comparing the outcomes of TURBT using SA vs spinal with an ONB. The Cochrane risk-of-bias tool for randomized-controlled trials (RCTs) and the Newcastle-Ottawa scale for observational studies were used to assess the included studies. ⋯ ONB was not associated with an increased risk of local anesthetic toxicity (0/159). Conclusion: Our meta-analysis suggests that TURBT using SA+ONB is superior to the use of SA alone. During the COVID-19 pandemic, where avoidance of AGPs such as a general anesthesia is paramount, the use of an ONB with SA is essential for the safety of both patients and staff without compromising care. Further high-quality RCTs with adequate sample sizes are required to compare the different techniques of ONB as well as comparing this method with general anesthesia with complete neuromuscular blockade.
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Journal of endourology · Jul 2016
Meta Analysis Comparative StudySupine Versus Prone Position in Percutaneous Nephrolithotomy for Kidney Calculi: A Meta-Analysis.
There are several positions in the operation of percutaneous nephrolithotomy (PCNL), such as prone position, supine position, flank position, and modified supine position for PCNL, but the supine and prone positions are the main two choices for several years. However, there is still discrepancy on the optimal position for PCNL. Therefore, we performed this meta-analysis to evaluate safety and efficacy of the supine versus the prone position in PCNL for renal calculi. ⋯ Compared with the prone position, the PCNL in the supine position has a slightly lower rate of stone clearance, albeit shorter mean operative time, and lower incidence of blood transfusions. The meta-analysis suggests that the PCNL in the supine position is a promising alternative.
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Journal of endourology · Nov 2015
Review Meta AnalysisThe Prognostic Role of Ki-67/MIB-1 in Upper Urinary-Tract Urothelial Carcinomas: A Systematic Review and Meta-Analysis.
Upper urinary-tract urothelial carcinomas (UTUC) constitute 5% of urothelial malignancies. Prognostic biomarkers would allow lower risk surgical approaches for less aggressive UTUCs. One biomarker-Ki-67/mindbomb E3 ubiquitin protein ligase 1 (Ki-67/MIB-1)-shows promise in UTUC, but there have been conflicting findings regarding its prognostic role. The systematic review and meta-analysis aim to determine the prognostic value of Ki-67/MIB-1 in UTUC in terms of UTUC-specific mortality rate, 5-year disease-free survival, and 5-year overall survival (including disease-specific survival). ⋯ Ki-67/MIB-1 overexpression shows promise as a prognostic biomarker for UTUC patients and requires further investigation.
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Journal of endourology · Jul 2015
Review Meta AnalysisRetrograde Intrarenal Surgery Versus Percutaneous Nephrolithotomy Versus Extracorporeal Shockwave Lithotripsy for Treatment of Lower Pole Renal Stones: A Meta-Analysis and Systematic Review.
The optimal treatment of patients with lower pole renal stones continues to be a dilemma for urologists. Retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and extracorporeal shockwave lithotripsy (SWL) all constitute viable therapeutic options in selected patients. The aim of this study was to assess the efficacy and safety of RIRS, PCNL, and SWL in management of lower pole renal stones. ⋯ RIRS offers a relative higher SFR while it has a longer operative time. PCNL is associated with the highest SFR at the expense of the longest hospital stay. SWL is performed as an outpatient procedure with a relative shorter operative time; however, it has lower a SFR and higher re-treatment rate. The categories of complications vary while the overall complication rates are comparable among the three treatment techniques.
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Journal of endourology · Apr 2013
Meta Analysis Comparative StudyTotal tubeless versus standard percutaneous nephrolithotomy: a meta-analysis.
The aim of this meta-analysis was to evaluate the efficacy and safety of total tubeless percutaneous nephrolithotomy (PCNL) versus standard PCNL. ⋯ Total tubeless PCNL is a safe and effective procedure. It significantly reduced the hospital stay, analgesic requirement, and the time to return to normal activity without increasing complications. However, further randomized trials are needed to confirm these findings.