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Journal of Endourology Mar 2024Assessing whether Mayo adhesive probability (MAP) levels affect perioperative outcomes after partial nephrectomy (PN). This systematic review and meta-analysis were... (Meta-Analysis)
Meta-Analysis
Assessing whether Mayo adhesive probability (MAP) levels affect perioperative outcomes after partial nephrectomy (PN). This systematic review and meta-analysis were conducted in accordance with the PRISMA statement. A systematic search of the literature published before February 1, 2023 was conducted using Pubmed, Embase, Cochran, and Web of Science libraries. We included all articles evaluating adherent perirenal fat by MAP during PN. A total of 1807 patients from 7 studies meeting the criteria were included. In the high MAP group, the operation time was longer, and the estimated blood loss and postoperative complications were increased. There was no significant difference in positive surgical margin, warm ischemia time, and hospitalization time. As a simple and easy scoring method, MAP can predict the perioperative outcome of PN patients, especially when ≥3 is the boundary. However, more cohort studies are still needed to determine the optimal cutoff point of MAP.
Topics: Humans; Kidney Neoplasms; Nephrectomy; Kidney; Warm Ischemia; Probability; Treatment Outcome; Retrospective Studies
PubMed: 38185844
DOI: 10.1089/end.2023.0419 -
Urolithiasis Oct 2022We aimed to perform a systematic review of randomized trials to summarize the evidence on the safety and stone-free rate after Tubeless percutaneous nephrolithotomy... (Meta-Analysis)
Meta-Analysis Review
We aimed to perform a systematic review of randomized trials to summarize the evidence on the safety and stone-free rate after Tubeless percutaneous nephrolithotomy (PCNL) (ureteral stent/catheter, no nephrostomy) compared to Standard PCNL (nephrostomy, with/without ureteral stent/catheter) to evaluate if the tubeless approach is better. The inverse variance of the mean difference with a random effect, 95% Confidence Interval (CI), and p values was used for continuous variables. Categorical variables were assessed using Cochran-Mantel-Haenszel method with the random effect model, and reported as Risk Ratio (RR), 95% CI, and p values. Statistical significance was set at p < 0.05 and a 95% CI. 26 studies were included. Mean operative time was significantly shorter in the Tubeless group (MD-5.18 min, 95% CI - 6.56, - 3.80, p < 0.00001). Mean postoperative length of stay was also significantly shorter in the Tubeless group (MD-1.10 day, 95% CI - 1.48, - 0.71, p < 0.00001). Incidence of blood transfusion, angioembolization for bleeding control, pain score at the first postoperative day, the number of patients requiring postoperative pain medication, fever, urinary infections, sepsis, perirenal fluid collection, pleural breach, hospital readmission, and SFR did not differ between the two groups. Incidence of postoperative urinary fistula was significantly lower in the Tubeless group (RR 0.18, 95% CI 0.07, 0.47, p = 0.0005). This systematic review shows that tubeless PCNL can be safely performed and the standout benefits are shorter operative time and hospital stay, and a lower rate of postoperative urinary fistula.
Topics: Humans; Kidney Calculi; Length of Stay; Nephrolithotomy, Percutaneous; Nephrostomy, Percutaneous; Postoperative Complications; Randomized Controlled Trials as Topic; Treatment Outcome; Urinary Fistula
PubMed: 35674819
DOI: 10.1007/s00240-022-01337-y -
Urologia Aug 2022We review the safety and early oncological outcomes of irreversible electroporation (IRE), a novel non-thermal ablation technique, in small renal masses (SRMs)....
We review the safety and early oncological outcomes of irreversible electroporation (IRE), a novel non-thermal ablation technique, in small renal masses (SRMs). Following PROSPERO registration (CRD42020197943), a systematic search of MEDLINE, EMBASE and SCOPUS databases according to PRISMA guidelines was performed. Critical appraisal of the included studies was performed using the Newcastle-Ottawa Scale. Of 224 articles screened, 10 met the inclusion criteria. In total, 83 patients were identified. Except for one cohort study ( = 41), the remaining studies were case series of < 10. Follow up was <12 months in 7/10 articles (range 3-34 months). About 10/10 articles reported safety outcomes. There were no 30-day mortalities. The most frequently reported adverse events were transient haematuria (11/83) and asymptomatic perirenal haematomas (7/83). About 62/63 patients with reported length of stay were discharged within 24 h. No significant long-term changes in renal function were reported. About 7/10 articles reported oncological outcomes. Only one article assessed histopathological outcomes, whilst the remaining studies used cross-sectional imaging modalities to assess efficacy, recurrence or disease progression. About 4/7 patients with histopathology outcomes, showed complete response (CR). About 43/55 patients with radiological outcomes showed CR. No mortalities were reported due to SRMs. These initial findings support IRE as safe and feasible in managing SRMs. However, results from larger studies with longer follow-up are needed to evaluate oncological outcomes and compare these with other ablation methods.
Topics: Ablation Techniques; Cohort Studies; Electroporation; Humans; Kidney Neoplasms; Treatment Outcome
PubMed: 35139717
DOI: 10.1177/03915603221077590 -
Current Opinion in Urology Mar 2022PCNL (percutaneous nephrolithotomy) and its miniaturized variants are being widely employed in stone surgery, owing to their high-stone-free rates (SFRs) and efficacy...
PURPOSE OF REVIEW
PCNL (percutaneous nephrolithotomy) and its miniaturized variants are being widely employed in stone surgery, owing to their high-stone-free rates (SFRs) and efficacy for large (>20 mm) stones. With advances in laser technology, it has been readily utilized in PCNL, with the potential for lower complication rates at similar SFR. We aimed to perform a systematic literature review with a focus on recent prospective clinical data that compares laser PCNL to either nonlaser PCNL, different PCNL sizes or other current standards of care such as shockwave lithotripsy (ESWL) or flexible ureteroscopy (FURS).
RECENT FINDINGS
Of the 294 studies initially identified through database searching, nine papers published between 2019 and 2021 were included which compared laser PCNL (Standard PCNL in three, mini-PCNL in four, ultra-mini PCNL in one, micro-PCNL in one study) to other nonlaser lithotripsy, ESWL, FURS, and different PCNL sizes. Complications for laser PCNL ranged from bleeding (4.4%), perirenal haematoma (1.1%), fever (4.6%), ureteric/renal pelvic injury (2.3%), haematuria (2.7%), and infection (2.6%). The mean SFR for laser PCNL was 91.5% at 3 months.
SUMMARY
Percutaneous laser nephrolithotripsy is well tolerated and effective, with high-SFRs at 3 months and relatively low intraoperative and postoperative complication rates. Further research is required to assess the role of intraoperative techniques and suction to improve outcomes further.
Topics: Female; Humans; Kidney Calculi; Lasers; Lithotripsy; Male; Treatment Outcome; Ureteroscopy
PubMed: 34930884
DOI: 10.1097/MOU.0000000000000959 -
Polski Przeglad Chirurgiczny Jun 2021An ongoing debate concerns the need for routine placement of prophylactic intra-abdominal drains following kidney transplantation. <br/><br/>Aim: We... (Meta-Analysis)
Meta-Analysis
An ongoing debate concerns the need for routine placement of prophylactic intra-abdominal drains following kidney transplantation. <br/><br/>Aim: We conducted a systematic review and meta-analysis to determine whether such an approach brings any advantages in the prevention of perirenal transplant fluid collection, surgical site infection, lymphocele, hematoma, urinoma, wound dehiscence, graft loss, and need for reoperation. <br/><br/>Methods: We conducted a random-effects meta-analysis of non-randomized studies of intervention comparing drained and drain-free adult renal graft recipients regarding perirenal transplant fluid collection and other wound complications. ROBINS-I tool and funnel plot asymmetry analysis were used to assess the risk of bias. <br/><br/>Results: Five studies at moderate to critical risk of bias were included. A total of 2094 renal graft recipients were evaluated. Our analysis revealed no significant differences between drained and drain-free patients regarding perirenal transplant fluid collection (pooled odds ratio [OR], 0.77; 95% confidence interval [CI], 0.28-2.17; I 2 = 72%), surgical site infection (OR, 1.64; 95% CI, 0.11-24.88; I 2 = 80%), lymphocele (OR, 0.61; 95% CI, 0.02-15.27; I 2 = 0%), hematoma (OR, 0.71; 95% CI, 0.12-3.99; I 2 = 71%), and wound dehiscence (OR, 0.75; 95% CI, 0.21-2.70; I 2 = 0%). There was insufficient data concerning urinoma, graft loss, and need for reoperation. <br/><br/>Conclusions: The available evidence is weak. Our findings show that the use of intra-abdominal drains after kidney transplantation seems to have neither beneficial nor harmful effects on perirenal transplant fluid collection and other wound complications. The present study does not support the routine placement of surgical drains after kidney transplantation. <i>In this systematic review and meta-analysis we summarize the most up-to-date evidence for and against the routine use of intra-abdominal drain following renal transplantation.</i>.
Topics: Adult; Drainage; Hematoma; Humans; Kidney Transplantation; Reoperation; Surgical Wound Infection
PubMed: 34515654
DOI: 10.5604/01.3001.0014.9166