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 · May 2020
ReviewUrologic surgery and COVID-19: How the pandemic is changing the way we operate.
The coronavirus disease 2019 (COVID-19) pandemic has had a global impact on all aspects of health care, including surgical procedures. For urologists, it has affected and will continue to influence how we approach the care of patients preoperatively, intraoperatively, and postoperatively. A risk-benefit assessment of each patient undergoing surgery should be performed during the COVID-19 pandemic based on the urgency of the surgery and the risk of viral illness and transmission. ⋯ COVID-19 patients should be separated from noninfected patients at all levels of care, including recovery, to decrease the risk of infection. Future directions will be guided by outcomes and infection rates as social distancing guidelines are relaxed and more surgical procedures are reintroduced. Recommendations should be adapted to the local environment and will continue to evolve as more data become available, the shortage of testing and PPE is resolved, and a vaccine and therapeutics for COVID-19 are developed.
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Journal of endourology · Jun 2017
ReviewContinuation of Renin-Angiotensin-Aldosterone Inhibitors Does Not Impact Renal Function Among Patients Undergoing Percutaneous Nephrolithotomy.
In the perioperative period, renin-angiotensin-aldosterone system (RAAS) inhibitors may result in cardiovascular and renal functional changes. We sought to determine the acute and chronic renal functional and blood pressure effects of continuing or withdrawing angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) after percutaneous nephrolithotomy (PCNL). ⋯ It is safe to continue RAAS inhibitors in patients undergoing PCNL during their operative hospitalization.
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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 · 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.