3rd Postoperative Month Research Articles

HBV Reactivation After Bariatric Surgery for HBV-Infected Obese Patients.

The association between non-alcoholic fatty liver disease and hepatitis B virus (HBV) infection is inconclusive. The aim of this study was to investigate the viral dynamic of HBV and its association with change of body mass index (BMI), aspartate transaminase (AST), and alanine transaminase (ALT) levels after bariatric surgery. Patients who underwent bariatric surgery between June 2011 and May 2014 were selected in this retrospective study. BMI, AST, ALT, and HBV DNA levels were calculated pre-operatively and at 1st, 3rd, and 6th postoperative months. Two hundred and seventy-nine patients including 34 (12.2%) HBsAg-positive and 245 (87.8%) HBsAg-negative patients were enrolled. Eighteen HBsAg-positive and HBeAg-negative patients were matched with 36 HBsAg-negative patients. A significant decrease in BMI was found since 1st postoperative month in both groups. AST and ALT increased at 1st postoperative month, but decreased at 3rd and 6th postoperative months in both groups. However, a significant increase in HBV DNA level was observed in HBeAg-negative patients since 1st postoperative month with the highest peak at 3rd postoperative month. HBV reactivation occurred in 4 out of 17 (23.5%) patients, 8 out of 16 (50.0%) patients, and 4 out of 12 (33.3%) patients at 1st, 3rd, and 6th postoperative months, respectively. The change of HBV DNA was not associated with change of BMI, AST, or ALT after bariatric surgery. Bariatric surgery can achieve significant weight loss and improvement of liver function tests. However, there existed significant risk of HBV reactivation after bariatric surgery for patients with obesity.

Transdermal fentanyl patch versus standard analgesia in postoperative oral submucous fibrosis patients: a triple blinded, randomised control trial

Severe pain experienced by patients with oral submucous fibrosis (OSMF) compromises their physiotherapy and negatively affects the surgical outcome and the patient’s compliance. The main aim of this study was to develop a protocol for pain control in the management of OSMF postoperatively. This was a prospective, parallel with active control, double-arm, triple-blinded, randomised control trial (RCT) with 48 OSMF patients, randomised into two groups - Group A (control, n = 25): received non-opioid analgesics (NSAIDs) and Group B (cases, n = 23): received transdermal fentanyl patches (TFP). Pain and interincisal opening were measured on postoperative days 1, 3, 5, 7, 9, and 15, and on the1st and 3rd postoperative months. Quality of Life (QoL) was assessed preoperatively, on the 15th day postoperatively, and 3rd month postoperatively, and compliance was documented postoperatively on the 9th day. The transdermal fentanyl patch was found to have statistically significantly more effect in controlling severe pain during active mouth opening exercises, and thus significantly increased the patients’ compliance. Although there was increased mouth opening and QoL in the fentanyl group, the differences were statistically insignificant. Our study recommends the use of TFP for better pain control and compliance in postoperative OSMF patients.

Decompression alone or decompression and fusion in degenerative lumbar spondylolisthesis.

SummaryBackgroundClinically, there are substantive practice variations in surgical management of degenerative lumbar spondylolisthesis. We aimed at evaluating whether decompression alone outcomes for patients with degenerative lumbar spondylolisthesis are comparable to those of decompression with fusion.MethodsIn this meta-analysis, the Embase, PubMed, and Cochrane Library databases were searched from inception to February 16th, 2022. Randomised controlled trials (RCTs) and cohort studies comparing decompression alone with decompression and fusion for patients with degenerative lumbar spondylolisthesis were included in this study. There were no language limitations. Odds ratio (OR), mean difference (MD) and 95% confidence interval (CI) were used to report results in the random-effects model. Main outcomes included Oswestry disability index (ODI), pain, clinical satisfaction, complication and reoperation rates. The study protocol was published in PROSPERO (CRD42022310645).FindingsThirty-three studies (6 RCTs and 27 cohort studies) involving 94 953 participants were included. Differences in post-operative ODI between decompression alone and decompression with fusion were not significant. A small difference for back (MD, 0.13; [95% CI, 0.08 to 0.18]; I2:0.00%) and leg pain (MD, 0.30; [95% CI, 0.09 to 0.51]; I2:48.35%) was observed on the 3rd post-operative month. The results did not reveal significant differences in leg pain and back pain between decompression alone and fusion groups on the 6th, 12th, and 24th post-operative months. Difference in clinical satisfaction between decompression alone and decompression with fusion were not significant from RCTs (OR, 0.26; [95% CI, 0.03 to 1.92]; I2:83.27%). Complications (OR, 1.54; [95% CI, 1.16 to 2.05]; I2:48.88%), operation time (MD, 83.39; [95% CI, 55.93 to 110.85]; I2:98.75%), intra-operative blood loss (MD, 264.58; [95% CI, 174.99 to 354.16]; I2:95.61%) and length of hospital stay (MD, 2.85; [95% CI, 1.60 to 4.10]; I2:99.49%) were higher with fusion.InterpretationClinical effectiveness of decompression alone was comparable to that of decompression with fusion for degenerative lumbar spondylolisthesis. Decompression alone is recommended for patients with degenerative lumbar spondylolisthesis.FundingThis work was supported by grants from the National Natural Science Foundation of China (No. 81871818), Tangdu Hospital Seed Talent Program (Fei-Long Wei), Natural Science Basic Research Plan in Shaanxi Province of China (No.2019JM-265) and Social Talent Fund of Tangdu Hospital (No.2021SHRC034).

MP36-14 THE EFFECT OF RENAL TRANSPLANTATION ON ERECTILE FUNCTIONS IN PATIENTS WITH END-STAGE RENAL DISEASE

You have accessJournal of UrologyCME1 May 2022MP36-14 THE EFFECT OF RENAL TRANSPLANTATION ON ERECTILE FUNCTIONS IN PATIENTS WITH END-STAGE RENAL DISEASE Serdar Karadag Serdar KaradagSerdar Karadag More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002590.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Erectile dysfunction (ED) is defined as the inability to achieve and maintain an erection sufficient to allow satisfactory sexual performance. In end-stage renal disease (ESRD), ED is an important problem that impairs quality of life. The incidence of ED may increase up to 84%, especially in ESRD patients receiving hemodialysis. Our aim is to determine the effect of renal transplantation on erectile functions in ESRD patients and patient-related factors affecting this change. METHODS: Data of patients with ESRD who had a renal transplant at our center from January 2015 to August 2020 were reviewed retrospectively. All male patients who had a kidney transplant for any reason and whose data were not missing were included. The patients were screened for erectile functions before kidney transplantation and at the 1st, 3rd and 12th months after transplantation. The International Index of Erectile Function (IIEF-5) evaluation questionnaire was used as a measure of erectile functions. The total scores were calculated, with normal erectile function defined as a score of 22 to 25; cases of ED were classified as mild (12–21), moderate (8–11), or severe (5–7). RESULTS: The mean age of 55 patients included in the study was 39.7±10.9 years. Mild ED was detected in 21 patients (38.2%), moderate ED in 19 patients (34.5%), and severe ED in 10 patients (18.2%). Preoperative mean IEFF-5 score was calculated as 13.8±5.5, 14.3±5.7 at 1st month, 16.9±6.8 at 3rd months, and 18.4±6.9 at 12th months. In the evaluation of erectile function, no significant improvement was observed in erectile functions at post-transplant 1st month (p>0.05), while significant improvements were noted at postoperative 3rd and 12th months (p=0.03, p=0.02, respectively). When the change in IEFF-5 score was evaluated between 3rd and 12th months, there was a statistically significant difference (p=0.04). Age, diabetes, hypertension, coronary artery disease, transplantation time and preoperative IEFF-5 score were found to be significantly associated with postoperative IEFF-5 score changes at the 3rd and 12th months. (p<0.05). CONCLUSIONS: Our data show that kidney transplantation improves erectile function in ESRD patients. Age, diabetes, hypertension, coronary artery disease, transplantation time and pre-transplant erectile function status were found to be significantly associated with postoperative erectile function changes. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e602 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Serdar Karadag More articles by this author Expand All Advertisement PDF DownloadLoading ...

Electrophysiological evaluation of alterations in penile sensation due to penile prosthesis implantation in patients with erectile dysfunction

ObjectiveThe present study was aimed to determine the effect of penile prosthesis implantation (PPI) surgery on penile sensation by evaluating the penile electromyography (EMG) variables. MethodsThe research was designed as a prospective study. Thirty patients who were diagnosed with organic erectile dysfunction and had underwent PPI surgery between January 2017 and January 2018 in the Urology Clinic of Antalya Training and Research Hospital were included in this study. Penile sensory EMG was performed on each patient 1 day prior to the surgery by the Physical Therapy and Rehabilitation clinic. Additionally, the control EMG study was also performed in the 3rd and 6th postoperative months. ResultsWe included 27 patients in this study who attended regular follow-ups and had complete EMG results. Out of the 27 patients, 23 (85.2%) patients had received malleable (ProMedon) penile prosthesis, one (3.7%) patient had received a two-piece inflatable (Ambicor) penile prosthesis, and three (11.1%) patients had received a three-piece inflatable (AMS 700 CXR) penile prosthesis. The mean nerve conduction value (NCV) of the patients was 29.85 (standard derivation: 22.54; range: 0–78.4) m/s during the preoperative period, whereas it was 27.64 (standard derivation: 24.72; range: 0–83.3) m/s in the 3rd postoperative month and 24.80 (standard derivation: 22.31; range: 0–88.4) m/s in the 6th postoperative month. There was no significant difference between preoperative NCV and 3rd postoperative month NCV (p=0.607). Similarly, no significant difference was observed between preoperative NCV and 6th postoperative month NCV (p=0.276). Additionally, the change between NCV values at postoperative 3rd and 6th months was not statistically significant (p=0.553). ConclusionSignificant loss of penile sensation does not occur in patients who undergo PPI surgery.

An Unusual Case of Large Vulvar Soft Fibroma In An Adult Patient: A Case Report

A 25-year-old female patient applied to our clinic with a complaint of a growing mass in external genitalia. Patient’s complaint began 10 years ago as a small papillomatous lesion in the right labia majora, which increased in size progressively reaching to present size of 20-30 cm in 2-3 years after the first symptom. The mass was prediagnosed as vulvar soft fibroma, and surgical excision was decided. The histopathological findings were compatible with fibroepithelial polyp .The patient had no postoperative complication, and there was no residue or recurrence at the last assessment on postoperative 3rd month.

Early and Late Effects of Percutaneous Nephrolithotomy on Renal Functions According to Basal Renal Function Reserv

Objective: In this study, we aimed to investigate the early and late effect of percutaneous nephrolithotomy on renal function based on preoperative glomerular filtration rate levels. Material and Method: Between January 2012 and November 2016, 351 patients who underwent percutaneous nephrolithotomy were included. According to the preoperative glomerular filtration rate, patients were divided into three groups: group 1 was consists of glomerular filtration rate &amp;gt;90 levels; group 2 was consists of glomerular filtration rate levels between 60-90; group 3 was consists of glomerular filtration rate &amp;lt;60 levels. Glomerular filtration rate measure¬ments were performed preoperatively, at post-operative 1st day and 3rd month. Results: On postoperative 1st day, mean glomerular filtration rate was significantly decreased in group 1 and group 2, non-significantly decreased in group 3. At 3rd month, the mean glomerular filtration rate was again decreased compared to preoperative levels in group 1 and group 2 but this time it was statistically non-significant. However, mean glomerular filtration rate of group 3 was statistically significantly increased compared to preoperative levels. Conclusions: Estimated glomerular filtration rate, as a better indicator of renal function, is significantly affected by the percutaneous nephrolithotomy procedure. Although, firstly renal function decreased after percutaneous nephrolithotomy because of the renal trauma procedure, kidney function is better at postoperative 3rd month because of the disappearance of kidney stone . So percutaneous nephrolithotomy was significantly improved the renal functions in patients with preoperative glomerular filtration rate &amp;lt; 60 due to renal stone.

Evaluation of the anterior chamber angle by anterior segment optical coherence tomography after implantable phakic contact lens implantation in myopic eyes

PurposeTo evaluate the changes in the angle of the AC and lens vault after IPCL implantation by AS-OCT in myopic patients.MethodsThis was a prospective observational study involving 30 myopic eyes implanted with IPCL. AS-OCT was used to evaluate lens vault and AC angle parameters including anterior chamber angle, angle opening distance and trabecular-iris space area (TISA) at 1, 3 and 6 months postoperatively.ResultsAll 3 AC angle parameters were significantly reduced at the 1st postoperative month compared to preoperative values, but remained stable thereafter with no significant change at the 3rd or 6th postoperative months. The lens vault showed no significant change over the entire follow-up period.ConclusionIPCL implantation is a safe method for correction of myopia with stable AC angle narrowing over the course of 6 months postoperatively as monitored using AS-OCT.

Changes in Intraocular Pressure and Ocular Biometry After Blepharoplasty.

To investigate the effects of blepharoplasty on intraocular pressure (IOP) and ocular biometric parameters. A total of 112 eyelids of 56 patients undergoing bilateral blepharoplasty due to upper eyelid dermatochalasis was included. The patients were classified into three groups according to margin reflex distance (MRD) (Group 1 >4 mm MRD, Group 2 2-4 mm MRD, and Group 3 <2 mm MRD). The IOP and ocular biometric parameters obtained baseline and postoperative 3rd month were compared. The demographic characteristics of the groups were similar (p > 0.05, for all). IOP (p = 0.002) and central corneal thickness (p = 0.038) increased in Group 3. The mean amount of the increase in IOP was 0.95mmHg. The keratometric values increased in all groups and corneal astigmatism was also increased in Group 2 and Group 3 (p < 0.001, for all). The mean amount of the increase in corneal astigmatism was 0.54D in Group 3. Anterior chamber depth and axial length did not change (p > 0.05, for all). The intraocular lens powers calculated by six different formulas decreased in Group 3 (p < 0.001, for all), and the mean amount of the decrease was 0.40D. Clinicians should be aware of the potential change in IOP and ocular biometric parameters in patients who underwent blepharoplasty. If a patient has glaucoma risk factors, close follow-up is needed after blepharoplasty. Change in strategy or timing may also be needed for dermatochalasis patients when planning corneal refractive surgery or cataract surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effect of patellar denervation by circumpatellar electrocautery on clinical outcomes of patients with total knee arthroplasty running title: Patellar denervation in knee arthroplasty

Objective: Anterior knee pain may lead to worse outcomes after total knee arthroplasty. The effect of patellar denervation (PD) by electrocautery on postoperative pain and function in patellar nonresurfacing TKA were assessed in this study. Materials and Methods: This retrospective study included patients with a minimum of 24 months follow-up who were operated for TKA between January 2014 and January 2018. Patellar Denervation (PD) group; patients who underwent circumpatellar electrocautery around the patella, and Control (C) group; who did not underwent. Patient demographics, preoperative patellofemoral osteoarthritis grades, Knee Society System (KSS) scores, Feller patella score (PS), Short Form-36 (SF-36) and visual analog scale (VAS) scores at preoperative, postoperative 3. Month and last follow-up examination were noted. Results: There was no difference between groups in terms of gender distribution and age (P &gt; 0.05). At 3rd postoperative month, KSS-Knee was significantly higher and VAS score was significantly lower in the PD patients compared to C group (p=0.026, p=0.023 respectively). At the final follow-up, KSS-Function and PS scores were significantly higher (p=0.031, 0.012 respectively). Some of the QoL scores were better at late follow-up in PD group. However, there was no statistical difference between these two groups in other follow-up examinations (p &gt; 0.05). Conclusion: Circumpatellar electrocautery denervation can be advantageous in reducing early postoperative knee pain. Clinical, functional and some of the QoL scores were better in the midterm postoperative period of patients with gonarthrosis treated by TKA with PD.

Transvers ve Torsiyonel Fakoemülsifikasyon ile Biaksiyel Mikroinsizyon Katarakt Cerrahisinde Saydam Korneal Kesi Değişikliklerinin Karşılaştırılması: Kohort Çalışması

Objective: To compare the effects of transverse versus torsional phacoemulsification by using the biaxial microincision cataract surgery technique on corneal structures and clear corneal incision (CCI) morphology. Material and Methods: We evaluated comparative case series of patients with moderate density nuclear cataracts who underwent biaxial microincision transverse or torsional phacoemulsification. Seventy patients have included in the study and they were divided into 2 groups: transverse and torsional. The main outcome measures included, corrected distance visual acuity, central corneal thickness, central corneal endothelial cell density, endothelial cell loss (ECL), and changes in the CCI morphology. Results: Each group comprised 35 (35 eyes) patients. Epithelial misalignment on the CCI morphology was highly significantly meaningful with the transverse group on the postoperative first day (p<0.001). Descemet membrane detachment on the first day postoperatively was high in both groups, especially in the transverse group, but the difference was not statistically significant (p=0.073). In the postoperative 3rd month, the mean ECL was 23.6% in the transverse group, and 19.0% in the torsional group, and there was no statistically significant difference between groups (p=0.187). Conclusion: In biaxial microincision cataract surgery, the corneal damage caused by transverse phacoemulsification seems to be higher compared to the torsional mode.

A clinical trial comparing BiVap (Richard Wolf®) saline vaporization of the prostate vs. TwisterTM Diode Laser System in the treatment of benign prostatic obstruction between prostate volume 90 to 150 ml.

To evaluate the efficacy, safety and postoperative outcomes of the BiVap and Twister systems with benign prostatic obstruction (BPO) in prostate volüm between 90-150 ml. In total, we included 131 patients treated with BiVap system (n = 68) and Twister system (n = 63). Postoperative complications including urinary tract infection, transient hematuria, severe dysuria and fever >38° C, urinary incontinence and urethral stricture were also noted. All patients were evaluated at the postoperative 1st, 3rd, 6th and 12th month and preoperative and postoperative values of IPSS score, QoL score, total PSA, IIEF 15, PVR, Qmax and Qave were compared. Preoperative demographic characteristics were similar in the 2 groups. There was observed significant improvement for IPSS, Qmax, Qave, PVR, and QoL score by the postoperative first month compared to the preoperative values in both groups. Maximum improvement in the IPSS, Qmax, Qave, QoL score and PVR were achieved at postoperative 6, 3, 12, 3 and 12th months respectively in group 1. In group 2 maximum improvement in the same parameters were achieved at postoperative 6, 3, 6, 6 and 12th months, respectively. BiVap and Twister systems are safe, effective, and useful technique, which can be used in the surgical treatment of BPO between 90-150 ml.

The effectiveness of peripheral compartment first access and periportal capsulotomy technique for arthroscopic management of femoroacetabular impingement: A prospective case series.

The aim of this study was to evaluate the functional results of hip arthroscopy for femoroacetabular impingement (FAI) performed via the periportal capsulotomy technique combined with capsular thinning and peripheral compartment first access. This prospective study included 34 patients (20 female, 14 male; mean age = 32.3 ± 12.5 years) treated for combined type FAI and labral tears between January 2016 and January 2018. In radiographic evaluation, center-edge angle (CEA) and alpha angle were measured preoperatively and postoperatively. Patients' functional status was assessed at 3, 6, 12, and 24 months using the modified Harris Hip Score (mHHS), Hip Disability and Osteoarthritis Outcome Score - Activities of Daily Living (HOOS-ADL), and Hip Disability and Osteoarthritis Outcome Score - Sports-Specific Subscale (HOOS-SSS), and visual analog scale (VAS). The mean alpha angle decreased from 55.5°±2.9° preoperatively to 48.3° ± 2.6° postoperatively. The mean CEA decreased from 39.2° ± 3.0° preoperatively to 32.9° ± 2.6° postoperatively. The mean duration of surgery was 96.7 ± 21.1 minutes; the mean traction time was 45.5 ± 14.6 minutes. The mean mHHS at the 3rd , 6th, 12th, and 24th months showed a statistically significant increase compared to the preoperative value (P < 0.05). The mean HOOS-ADL and HOOS-SSS at the postoperative 3rd, 6th, and 12th months demonstrated a statistically significant increase compared to the preoperative values (P < 0.05). The same scores measured at the 24th month, however, did not demonstrate a significant increase. The mean VAS scores at the 3rd and 6th months postoperative illustrated a significant decrease compared to the preoperative values (P < 0.05) whereas this significant decrease was not observed at the 12th and 24th months. The combined technique of periportal capsulotomy and capsular thinning used in this study seems to be a reliable surgical method with favorable functional results, a low complication rate, and a low risk of hip instability. Level IV, Therapeutic Study.

Effect of Myopic Femtosecond Laser-Assisted LASIK on Anterior Chamber Inflammation (Flare Values) and Corneal Endothelium: A Prospective before and after Study.

Purpose This study aimed to investigate whether femtosecond laser-assisted LASIK (FS-LASIK) surgery causes inflammation in the anterior chamber and to analyze its effect on endothelial cells. Methods This prospective, longitudinal study included left eyes of 30 patients (19 females) who had undergone FS-LASIK surgery due to myopia and myopic astigmatism. Endothelial cell density (ECD) and morphological measurements were performed using a specular microscopy, and laser flare photometry was used to measure the anterior chamber flare values on the day of surgery. iFS™ Advanced FS and VISX STAR S4-IR Wavescan Excimer Laser platforms were used. Flare measurements were repeated on the postoperative 1st day and 7th day and the 1st and 3rd months. The endothelial measurements were repeated in the 3rd month. Results Preoperatively, the mean flare was 5.59 ± 1.24 photons/ms; it was 6.49 ± 2.42 on the postoperative 1st day, 5.87 ± 2.27 on the 7th day, 5.68 ± 1.66 on the 1st month, and 5.35 ± 1.24 on the 3rd month. A significant difference was observed only between the preoperative and postoperative 1st day flare values (p=0.047). The decrease in the ECD was clinically insignificant but statistically significant, with an average of 97.0 ± 209.9 cell count/mm2 (3.3%, p=0.017). However, there was no significant change in the coefficient of variation (p=0.448) and hexagonality (p=0.096). No significant correlation was found between the increase in the flare value on the postoperative 1st day and variables. A significant correlation was found between the decrease in ECD and the preoperative ECD (r = 0.356, p=0.027). Conclusion FS-LASIK caused minimal inflammation in the anterior chamber on only the 1st postoperative day; additionally, a minimal decrease of cell count with no morphological changes were noted in the endothelial cells on postoperative 3rd month. This trial is registered with NCT04899258.

The right ventricle of transplanted hearts at 2,640 meters above sea level. A latin-american experience.

Background:High-altitude cardiovascular adaptations increase lung pressure. This effect on the right ventricle (RV) of transplanted hearts at altitudes above 2,500 meters above sea level (masl) has not been described.Objective:The objective of the study was to describe echocardiography RV behavior in the immediate post-operative period (Days 1-7 post-Heart transplant [HTx]), 3, 6, 12, and 24 months after HTx in patients at 2,640 masl.Methods:Historical cohort of HTx patients in the period between 2005 and 2019, in a hospital located in Bogotá, Colombia. Socio-demographic, clinical, and echocardiographic evaluation data of the RV at 5 follow-up moments were analyzed.Results:91 patients underwent HTx, 64% remained at a height > 2,500 masl in the post-operative period. Transthoracic echo was available in 37 patients (40.6%). Right ventricular dysfunction was found in 95% of patients, which was predominantly moderate (43%), with improvement 3 months after transplant. The immediate post-operative Tricuspid annular plane systolic excursion was 8.9 ± 4.9 mm, with recovery from the 3rd post-operative month (15.1 ± 3.6 mm) and without significant changes in month 24 (15.8 ± 4.9 mm). Immediate post-operative systolic pulmonary artery pressure (sPAP) was 39.2 ± 8.2 mmHg, showing a decrease at 24 post-operative months (31.0 ± 5.0 mmHg). The 5-year survival was 78% Confidence Interval 95% 60-85.Conclusion:After HTx, most patients present right ventricular dysfunction, improving at the 3rd month of transplant. There were no significant differences between patients living at more than 2,500 masl and < 2,500 masl.

Percutaneous nephrolithotomy in patients with chronic kidney disease

Introduction and objective: Urolithiasis can impair renal function by obstruction, infection, its association with comorbidities, high recurrence rate and need for multiple surgical interventions. Treatment of patients with chronic kidney disease (CKD) may be challenging due to the increased risk for intra- and postoperative complications, higher ASA score and association with comorbidities. The objective of this study is to compare the preoperative characteristics, efficacy and safety of PCNL in patients with normal or mildly impaired renal function and patients with chronic kidney disease. Material and methods: Prospectively collected data on 1656 PCNL procedures, performed in the Department of Urology and Nephrology at Military Medical Academy, Sofia, Bulgaria between 2011 and 2021 was analyzed. Patients were divided in 2 groups: Group 1 (1244 patients with normal or mildly impaired renal function, eGFR &gt; 60 mL/min/1.73 m2 ) and Group 2 (412 patients with moderately impaired renal function and end stage renal disease, eGFR &lt; 60 mL/min/1.73 m2 ) Results: Patients with CKD were more likely to be older, be female, with higher incidence of comorbidities and higher preoperative ASA score, higher rate of recurrent stones, solitary kidney and staghorn stones. PCNL efficacy after single procedure and at 3rd postoperative month was lower for CKD patients (respectively 79,6% vs 83,4%, р=0.086, and 85,9% vs 90,1%, р=0.018). There were no statistically significant differences in postoperative hemoglobin drop (14,0±10,2 vs 14,2±10,4, р=0.772) and overall complications rate (14,6% vs 12,1%, р=0.793) between the two groups. Conclusions: The results of this study suggest that PCNL is an effective and safe procedure in patients with chronic kidney disease. Although, CKD patients had larger and more complex stones, higher comorbidity rate, and higher incidence of recurrent stones and infection, these factors had no negative impact on PCNL outcomes compared to patients with normal or mildly impaired renal function.

Management of sleeve gastrectomy leakage: case report

Treatment of postoperative gastric fistula complicated by local and systemic infection is difficult and controversial, particularly when treating obese patients with multiple prior surgical procedures. A 41-year-old male patient was transferred to our hospital to be admitted in the Intensive Care Unit with respiratory failure and postoperative sepsis, after being submitted to bariatric surgery. He had been through four subsequent surgical procedures: 1- a laparoscopic sleeve gastrectomy; 2- an exploratory laparotomy for unproven suspected subphrenic abscess; 3- a laparotomy with splenectomy and peritoneal drainage for splenic and peri-splenic abscess; 4-celiotomy and lavage for purulent peritonitis. Due to persistent clinical and analytical deterioration, and suspicion of left subphrenic abscess and digestive fistula, we proceeded to: identification and drainage of the abscess, adhesiolysis, identification of fistula orifice at the cardiac incisure (methylene blue and perioperative endoscopy), placement of a Pezzer tube for directed and controlled fistulization, Shirley’s drain in the subphrenic space for continuous lavage, jejunostomy for enteral nutrition. Under clinical and imaging control (esophageal transit, fistulography and computed tomography with water-soluble contrasts) he was started on a water diet 2 months after and the Shirley’s drain was later removed. Patient was discharged two and a half months after the intervention, maintaing the Pezzer tube and under enteral nutrition by jejunostomy. Oral feeding started in the 3rd postoperative month and jejunostomy and Pezzer probes were removed. Patient was asymptomatic at seven-month postoperative outpatient appointment.

Robot-Assisted Exploration of Somatic Nerves in the Pelvis and Transection of the Sacrospinous Ligament for Alcock Canal Syndrome

<h3>Study Objective</h3> To describe the anatomical and technical highlights of robotic exploration of the somatic nerves in the pelvis and transection of sacrospinous ligament (nerve decompression) for the patient with Alcock canal syndrome. <h3>Design</h3> Stepwise demonstration of a technique. <h3>Setting</h3> An urban general hospital. <h3>Patients or Participants</h3> A 48-year-old woman was referred for severe sitting pain, cyclic pelvic pain, gluteal and perineal pain, all of which were resistant to medication therapy. MRI revealed adenomyosis with neither deep endometriosis nor vascular entrapment. Based on neuropelveological evaluation, the patient was suspected to be suffering from Alcock canal syndrome due to compression of the pudendal nerve (and posterior cutaneous nerve of the thigh) by the sacrospinous ligament. <h3>Interventions</h3> Excluding the step for hysterectomy, the procedure was performed using the following 9 steps with the da Vinci Xi: Step 1, opening the peritoneum along external iliac artery; Step 2, exposure of the external iliac artery; Step 3, development of the lumbosacral space; Step 4, identification of the lumbosacral trunk; Step 5, identification of the superior gluteal nerve; Step 6, identification of the sciatic nerve; Step 7, identification of the inferior gluteal nerve; Step 8, identification of the pudendal nerve; and Step 9, transection of the sacrospinous ligament. <h3>Measurements and Main Results</h3> The surgery was successfully completed without any complications and the postoperative course was uneventful. On follow-up visits, the patient reported a gradual decreased in pain in postoperative 1st and 3rd months, and the neuralgia was finally completely resolved in the 6th month. Neuropelveologic evaluation still continues every 6 months. <h3>Conclusion</h3> When needed, minimally invasive techniques are applied for exploration and treatment with neuropelveological assessment. Robot-assisted transection of the sacrospinous ligament is a feasible, safe technique for selected patients with Alcock canal syndrome. Laparoscopic exploration of the pelvic nerves should be performed for further diagnosis and therapy before prematurely labeling the patient as refractory to the treatment.

Limb Salvage in Early Versus Delayed Revascularization of Acute Lower Limb Ischemia

Aim: To compare the limb salvage rate in early versus late presenting patients of Rutherford class IIB acute lower extremity ischemia undergoing revascularization. Study Design: Comparative/observational study Place and duration of study: Department of Surgery, CMH Peshawar from January 2019 to March 2021 Methodology: Twenty eight patients of both genders with ages 20 to 70 years presented with Rutherford class IIB acute lower limb ischemia were enrolled in this study. Patients were divided into two groups. Group I (presented after 6 hours of onset of symptoms) consisted of 20 patients and group II (presented within 6 hours of onset of symptoms) consisted of 8 patients. All the patients underwent femoral embolectomy. Limb salvage rate between both groups was examined at postoperative 3rd month. Data was analyzed by SPSS 24.0. P-value &lt;0.05 was taken as significant. Results: There were 16(80%) male and 4(20%) females with mean age 50.52±11.74 years in group I, in group II 6(75%) were male and 2(25%) were females with mean age 50.08±10.94 years. No significant difference was observed between both groups regarding age and gender with p-value &gt;0.05. In group I, limb salvage found in 19(95%) patients while in group II limb salvage found in 5(62.5%) patients, a significant difference was observed regarding limb salvage rate between both groups (p-value &lt;0.05). Mortality rate was high in group II (delayed presentation) as compared to group I (12.5% Vs 0%) with p-value &lt;0.05. Conclusion: The limb salvage rate was high in early presenting patients than late presenting patients with a significant difference. 30 days mortality rate and amputation rate were significantly high in delayed presentation as compared to early presented cases. Keywords: Acute lower limb ischemia, revascularization, limb salvage

Penile rehabilitation with low-intensity extracorporeal shock wave therapy in patients after prostate cancer surgery. Early physiological changes and postoperative follow-up outcomes.

To investigate the efficacy, safety and postoperative outcomes of using tadalafil and low-intensity extracorporeal shock wave therapy (Li-ESWT) on penile rehabilitation and preventing urinary incontinence after radical prostatectomy. In total, we included 66 patients who used only tadalafil (n=32) in group 1 and used tadalafil and treated by Li-ESWT (n=34) in group 2. We noted International Index of Erectile Function (IIEF) 5, daily incontinence pad measurements at preoperative, postoperative 3rd, 6th and 12th months respectively. We also evaluated penis blood flow and neovascularisation by penile doppler ultrasonography at postoperative 3rd and 12th months for all patients. Statistical analyses were performed with SPSS version 18. A P-value<.05 was considered significant. Preoperative demographic characteristics were similar in the two groups. There was a statistically significant improvement in IIEF-5, which started at the 6th month and continued increasingly at the 12th month in group 2 compared with group 1. Also, there was a significant decrease in incontinence rate in group 2 compared with group 1 in the sixth month. Combined use of tadalafil and Li-ESWT is highly effective and safe for the treatment of erectile dysfunction and for the prevention of urinary incontinence after prostate cancer surgery.