Ancillary Procedures Research Articles

Artificial Intelligence Analysis of Periorbital Rejuvenation.

Periorbital rejuvenation surgery aims to restore a youthful appearance to the face. Despite the popularity of these procedures, few objective measurements exist to evaluate their impact on perceived facial aging. This study aims to quantify the impact of brow lift and blepharoplasty on age as perceived by convolutional neural network (CNN) algorithms. A retrospective review was performed on patients who underwent upper blepharoplasty, lower blepharoplasty, and/or brow lift at a single cosmetic practice between 2018 and 2023. Collected data included patient demographics, procedure performed, fat pad resection, and pre- and postoperative frontal images. Each photo was analyzed by four artificial intelligence (AI) platforms to estimate the change in perceived age following surgery. The estimated age reduction was compared between procedures. Of the 153 included patients, 118 underwent blepharoplasty, 12 underwent brow lift, and 23 had both blepharoplasty and brow lift. Across all AI platforms, the mean age estimation percent error was 10.6%, with a tendency for AI to underestimate compared to true age. Univariate analysis revealed an age reduction following any surgery of 1.03 years (p<0.001). When controlling for other variables, brow lift patients saw a mean age reduction of 1.432 years (p=0.031). Upper and lower blepharoplasty, patient characteristics, and ancillary procedures were not found to be independently associated with significant age reduction. Brow lifts provide significant reduction in perceived age. When planning for periorbital rejuvenation, a thorough preoperative evaluation should be performed, and additional consideration should be given to brow lifting procedures.

Predictors of outcomes in conservative management of high-grade renal trauma

BackgroundManagement of high-grade renal trauma is debatable, with the recent evidence embracing a conservative approach in the management of even grade 5 renal injuries. The study aimed to analyze the clinical profile of patients with high-grade renal trauma, assessing their management strategies, outcomes, complications, and need for ancillary procedures.MethodsA retrospective analysis of prospectively maintained data was performed involving blunt abdominal trauma patients with high-grade renal injuries (Grade 4 and 5) presenting to our hospital from January 2018 to December 2022. Patient data analyzed included demographics, clinical presentation, injury characteristics, complications, ancillary procedures, and mortality rates. All patients underwent renal functional assessment using an isotope renogram scan at the 3-month follow-up. Data collected were entered into a database and subjected to descriptive analysis using Jamovi version 2.3.28.ResultsThe study included 45 patients with a mean age of 29 years and a male-to-female ratio of 41:4. Most patients (n = 42) were managed conservatively. Thirty-eight patients had grade 4 injuries, and seven had grade 5 injuries. Twenty-six patients suffered renal parenchymal injuries alone, three patients had renal vascular injuries alone, and 16 patients had both parenchymal and vascular injuries. Grade 5 renal injury (p < 0.001), vascular high-grade injury (p < 0.001), angioembolization (p < 0.001), and blood transfusions (p = 0.021) were significantly associated with the incidence of poorly functioning kidney in high-grade renal trauma patients managed conservatively. Multinomial logistic regression analysis revealed angioembolization (p < 0.001), poorly functioning kidney post-trauma (p < 0.001), and blood transfusions (p < 0.001) were significantly associated with high-grade renal vascular injuries compared to high-grade renal parenchymal injuries.ConclusionConservative management is advisable for high-grade renal trauma in hemodynamically stable patients. High-grade vascular injuries are more severe than parenchymal injuries and correlate with poorer renal functional outcomes. Grade 5 renal injury, predominantly vascular high-grade injury, and the requirement for angioembolization and blood transfusions serve as significant predictors of poorly functioning kidneys post-trauma. Urologists should consider these predictors when counseling patients regarding potential outcomes following conservative management of high-grade renal trauma.

Additional Procedures at the Time of Total Ankle Replacement Do Not Increase Risk of Short-term Complications: A Matched Cohort Analysis.

This retrospective cohort study compared short-term complication rates following total ankle arthroplasty (TAA), alone or with concomitant procedures. Secondary independent risk factors were also examined as they related to postoperative outcomes. The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried using Current Procedural Terminology (CPT) codes to identify patients who underwent TAA (27702) between 2010 to 2021. Patients were divided into cohorts based on the presence or absence of ancillary procedures. Propensity score matching was employed to account for demographic differences, and statistical analyses were performed to compare short-term complication rates between matched cohorts. A total of 2225 patients were identified, with 1432 (64.4%) receiving TAA alone and 793 (35.6%) with ancillary procedure(s). After matching, 793 patients were included in each cohort. The ancillary cohort had longer operative times (P < .001) and length of hospital stay (LOS) (P < 0.001). Rates for extended LOS were significantly higher in the ancillary cohort than in the simple cohort (P = .01). No other complications varied significantly between cohorts, including the incidence of any adverse event (AAE). American Society of Anesthesiologists classification of 4 was found to be an independent risk factor for development of AAE (odds ratio [OR] = 1.091, P = .04). Matched subgroup analysis excluding tendon lengthening as a concomitant procedure found that the ancillary cohort still had longer operative time (P < .001) and LOS (P < .05) than patients undergoing simple TAA. Without significant difference in rates of AAE other than extended LOS, the relative safety of ancillary TAA appears similar to that of TAA alone. Such knowledge can help inform surgical decision-making and assuage safety concerns for patients requiring additional corrective procedures at the time of TAA. Level III, retrospective comparative study.

Posterior medial canthal thermoplasty in facial palsy: A simplified technique

Abstract Purpose: The purpose of this study was to describe a new, simple, quick, reproducible, and minimally invasive surgical technique for medial canthal tendon (MCT) dehiscence and deformity in patients with facial palsy. Methods: A retrospective study of 10 patients having medial ectropion and MCT laxity in patients with facial palsy was included in the study. All patients underwent the simplified technique of posterior medial canthal thermoplasty and anchorage with 6/0 Vicryl. Ancillary procedures such as lateral tarsal strip, lower lid spacer, suborbicularis oculi fat lift, upper lid blepharotomy, and mullerectomy were also performed where warranted as a holistic treatment approach. Results: The study cohort included 10 patients. All patients had satisfactory outcomes concerning medial canthus position and lid-to-globe apposition. 9/10 patients had satisfactory punctum alignment. Conclusions: This technique is a safe alternate and reproducible procedure compared to the conventional open technique of anchoring the lid to the posterior lacrimal crest which is a challenging procedure even in experienced hands.

CBCT in Dental Implantology: A Key Tool for Preventing Peri-Implantitis and Enhancing Patient Outcomes.

(1) Introduction: Trust is a cornerstone of the patient-physician relationships. Unforeseen complications in the health care system could jeopardize patients' trust in their physicians. (2) Aim: This article presents a quantitative figure regarding foreseeing the necessity of a three-dimensional quantitative visualization of bone structure and concurrently preparing for an ancillary procedure by a dentist to successfully perform the surgery that could minimize unforeseen complications; (3) Materials and method: This retrospective study has been derived based on an analysis of 1134 patients who had received 4800 dental implants from January 2001 to August 2020, out of which 200 cases were randomly selected for this study. Each procedure during implant treatment was categorized as OPG (Orthopantomography) or OPG with CBCT as per all the procedures which included and were coded as follows, 1: Surgery & Restoration, 2: GBR (Guided Bone Regeneration), 3: GTR (Guided Tissue Regeneration), 4: Block Bone Graft, 5: Spreading, 6: Splitting, 7: Internal Sinus, 8: External Sinus, 9: PRF (Platelet Rich Fibrin). Any of the 200 cases in which implant placement could not have been performed for reasons related to a lack of CBCT were selected for this study. The surgery was aborted halfway through without implant placement in these cases due to a lack of bone quantity and/or lack of primary stability. These cases were registered for re-evaluation and statistical analysis; (4) Results: 7% of the cases that used OPG alone led the surgeon to unexpectedly abort in the middle of the surgery without implant placement. All (100%) of the patients who had CBCT during treatment planning were able to receive implants during the surgery. None of the patients left the surgery without receiving implants if CBCT was used (0%); (5) Discussion: Radiographic image quality is defined as the amount of information within the image that allows the radiologist to make a diagnostic decision with a particular level of certainty (Martin et al., 1999) and hence the importance of CBCT. The unexpected 7% of devastating situations for patients who started surgery but did not have implant placement led to [A] aborting the surgery, [B] procedural difficulties requiring an alternative treatment plan, [C] a negative impact on the patient's behavior, and [D] wanting to change doctor due to a lack of trust; (6) Conclusion: This study indicates that in implant dentistry patients' mistrust could be avoided by 7% if CBCT is obtained. It also shows the significance of cone-beam computed tomography as an adjunct to panoramic radiography during the diagnosis and treatment planning phase. The use of panoramic radiography alone can lead to a 7% likelihood of misdiagnosis. A lack of CBCT during treatment planning negatively affects the outcome of surgical procedures.

Why Deep Plane Face and Neck Lifting Results in the Maximum Short- and Long-term Results? My Primary Choice for Rhytidectomy in My Practice.

I converted to the extended deep plane facelift and neck lift with a shorter skin flap elevation in the face to achieve a more complete release of the facial ligaments to obtain more mobilization of the skin/superficial musculoaponeurotic system composite flap, and a more medial suspension resulting in improved correction of the midface, nasolabial fold, marionette fold and jowl. Treatment of the deep neck structures allowed for more refinement of the submentum in the deep neck lift procedures as well. In this article, we shall review the surgical technique of the deep plane facelift and neck lift as well as postoperative management pearls, the management of complications from the procedure, and the incorporation of ancillary procedures.

Precise Classification, and Accurate Diagnosis: Key Elements for Effective Treatment and Management of Headache Disorders

Introduction Tension-type headaches (TTH) are a significant health concern that demands precise diagnostic approaches and effective management strategies. A nuanced understanding of their pathophysiology and diagnostic challenges is not just pivotal, but a responsibility we share, for enhancing patient care. Aim This article aims to explore the complex realm of TTH diagnosis and management, underlining the need for precision in diagnostics and the intricate balance of cost-effectiveness. It also delves into the diverse therapeutic options available for treating TTH, presenting a stimulating challenge for healthcare professionals, researchers, and medical students. State of Knowledge Initial diagnosis involves excluding secondary headaches by identifying red flags indicative of serious underlying conditions. A detailed medical history, complemented by patient-recorded pain diaries, enhances diagnostic accuracy. Ancillary procedures like neuroimaging, despite cost-effectiveness debates, are often preferred by clinicians to mitigate diagnostic risks. Validated tools such as the MIDAS and HIT-6 questionnaires provide valuable insights into headache-related disability. Differential diagnosis among headache types relies on recognizing distinctive clinical features. Summary (Conclusions) Effectively managing TTH necessitates a multifaceted approach, incorporating pharmacological, non-pharmacological, and lifestyle interventions tailored to individual patient needs. Collaborative efforts spanning legal, technological, and research domains are crucial for advancing headache diagnostics and therapeutics. While technological advancements offer promise, interdisciplinary collaboration remains fundamental in optimizing patient care outcomes.

Prospective Evaluation of Extracorporeal Shockwave Lithotripsy in Renal and Upper Ureteric Stone Treatment: Clinical Assessment and Results.

Extracorporeal shockwave lithotripsy (ESWL) is a widely accepted non-invasive treatment for renal and upper ureteric stones smaller than 2 cm due to its safety and efficacy. Despite advancements in minimally invasive techniques, extracorporeal shockwave lithotripsy remains an important modality. This prospective observational study aimed to evaluate the outcomes of ESWLin managing renal and upper ureteric stones measuring less than 2 cm in terms of stone clearance. In a study conducted at a university-affiliated tertiary care hospital, 119 patients with renal and upper ureteric stones underwent extracorporeal shockwave lithotripsy over a 12-month period. Data on patient demographics, stone characteristics, treatment procedures, and complications were collected. Follow-up assessments were performed at two-week intervals for up to two months post-treatment. The mean age of patients was 39.78 years, with a mean stone size of 1.2 cm. Right kidney stones were more prevalent (61.3% [n=76]). Complications included fever (19.3% [n=23]), gross haematuria (24.3% [n=29]), and steinstrasse (21.8% [n=26]). The success rate of extracorporeal shockwave lithotripsy was 81.5% (n=97), with 18.5% (n=22) of patients requiring surgical intervention due to incomplete fragmentation or residual fragments >4 mm. Stone size and density played significant roles in treatment success. Despite advancements in minimally invasive techniques, ESWLretains its significance as a noninvasive and effective treatment option for renal and upper ureteric stones smaller than 2 cm. Its success depends on various factors, including the stone site, size, and composition. ESWL offers advantages such as minimal morbidity, shorter hospital stays, and better patient compliance. Complications such as steinstrasse are manageable with conservative measures or ancillary procedures. While ESWL may be losing ground in some cases, its noninvasive nature and favourable outcomes make it a valuable option in the armamentarium for stone management.

The Development of Interim Measures Procedure in Cases Against Poland Before CJEU

Abstract This article presents a contemporary model of applying interim measures by the Court of Justice of the European Union, drawing on an increasingly rich body of case law in Polish cases. The disputes that the European Commission has engaged in with the Polish government, along with the non-standard obstruction in compliance with EU law, have become the basis for a new approach to this ancillary procedure offered by the Rules of Procedure of the Court. The article focuses on two sensitive areas where judicial intervention has proved necessary, the protection of the natural environment and ensuring the rule of law, especially in the operation of the national judiciary. There is no doubt that this body of work constitutes a significant contribution to the overall development of EU law, as it has led to the adoption of a completely new interpretation of Article 279 TFEU. According to the latest case law, the possibility of imposing financial penalties on member states is not limited to cases provided for in Article 260 TFEU, that is, non-compliance with a judgment finding a breach of EU law; these penalties can also be imposed in cases of non-compliance with the Court’s interim orders.

Feminizing Gender Affirming Breast Surgery: Procedural Outcomes at a Single Academic Institution.

Implant-based breast augmentation is a gold standard procedure for transfeminine patients to create a more feminine-appearing chest. In many cases, ancillary procedures are performed simultaneously to achieve an optimal aesthetic result. To determine the clinical outcomes of patients undergoing feminizing gender-affirming breast surgery in a single academic institution. A retrospective electronic chart review of feminizing gender-affirming breast surgery patients at Mayo Clinic, Rochester, from 2017 to 2022 was conducted. Patients' demographics and surgical outcomes were gathered. A survival analysis was performed to obtain the time-to-event complication rate. Over 5 years, 46 patients (92 breasts) were included. The mean age was 39 years (standard deviation [SD] ±15), and most had an above-normal body mass index (BMI) (58.7%). Thirty (65%) had previous gender-affirming surgeries. The mean implant volume was 289 mL (SD ±95; 140-520). Most implants were placed in a subglandular plane (81%) with an inframammary fold incision (91.3%). All implants used were smooth, round cohesive silicone gel implants. Ancillary procedures were performed in 32 patients (69.57%). Eight patients presented complications (4 major vs 4 minor) in a median postoperative follow-up of 372 vs 392 days; at 1-month follow-up, the probability of a complication having occurred is 2.17% (95% CI: 0%-6.3%) vs 5% (95% CI: 0%-11.5%), and at 1 year, the probability is 10.21% (95% CI: 0%-20.9%) vs 12.5% (95% CI: 0%-23.4%), which remains the same up to 4 years. Breast augmentation with implants is a safe procedure to achieve feminization of the breast with a low rate of complications.

Mitral Leaflet Shortening as an Ancillary Procedure in Obstructive Hypertrophic Cardiomyopathy

BackgroundMitral leaflet elongation is common in hypertrophic cardiomyopathy (HCM), contributes to obstructive physiology, and presents a challenge to the dual surgical goals of abolition of outflow gradients and abolition of mitral regurgitation. Anterior leaflet shortening, performed as an ancillary surgical procedure during myectomy, is controversial. MethodsThis was a retrospective study of all patients undergoing myectomy from January 2010 to March 2020, with analysis of survival and echocardiographic results. The study compared outcomes of patients treated with myectomy and concomitant mitral leaflet shortening with patients treated with myectomy alone. Over this time, the technique for mitral shortening evolved from anterior leaflet plication to residual leaflet excision (ReLex). ResultsMyectomy was performed in 416 patients aged 57.5 ± 13.6 years, and 204 (49%) patients were female. Average follow-up was 5.4 ± 2.8 years. Survival follow-up was complete in 415 patients. Myectomy without valve replacement was performed in 332 patients, of whom 192 had mitral valve shortening (58%). Mitral leaflet plication was performed in 73 patients, ReLex in 151, and both procedures in 32. Hospital mortality for patients undergoing myectomy was 0.7%. At 8 years, cumulative survival was 95% for both the myectomy combined with leaflet shortening group and the myectomy alone group, with no difference in survival between the 2 groups. There was no difference in survival between the anterior leaflet plication and ReLex groups. Echocardiography 2.5 years after surgery showed a decrease in resting and provoked gradients, mitral regurgitation, and left atrial volume and no difference in key variables between patients who underwent ancillary leaflet shortening and patients who underwent myectomy alone. ConclusionsThese results affirm that mitral shortening may be an appropriate surgical judgment for selected patients.

Society of Urologic Prosthetic Surgeons' Coding and Billing Position Statement on Ancillary/Adjunct Penile Prosthesis Surgical Procedures: Part I

ObjectiveTo create a society position statement on common adjunct penile prosthesis (PP) procedures. While the Medicare Current Procedural Terminology (CPT®) code book lists descriptions of procedures, it is very brief and lacks detail in the small subspecialty of prosthetic urology. At educational/research meetings, wide variation was found in how experts in prosthetic urology code the same procedures, and need for a standardized format in billing common ancillary surgery was voiced. MethodsA subcommittee within the Society of Prosthetic Urologic Surgeons (SUPS) developed a survey assessing coding options for several procedures commonly adjunct to PP placement, which was distributed in the fall of 2022. The results of the survey were used to develop consensus statements on coding adjunct PP procedures; statements were distributed among society membership and meetings for approval. ResultsThirty members replied to the survey; demographics were obtained as follows: 73% were trained in a fellowship, 50% identified as university/academic practitioners, and 50% in community/private practice; and 63% respondents place more than 50 implants annually. Only 1 of the 30 respondents stated confidence in coding for these ancillary procedures. Specifically, differences in how to code curvature correction procedures were observed throughout the survey results. ConclusionsOnly 1 in 30 prosthetic urologists expressed confidence in coding and billing of adjunct PP procedures, further confirming the need for a society position statement. Therefore, we generated a consensus society position statement on common surgeries that are adjunct to PP placement.

CONTENT EVALUATION OF DIAGNOSTIC AND TREATMENT INFORMATION QUALITIES OF YOUTUBE VIDEOS ON CARPAL TUNNEL SYNDROME

Introduction: One of the leading video sharing platforms is YouTube (YT). Due to their increased use, these can possibly create misconceptions about the condition, especially the associated treatment and signs and symptoms of carpal tunnel syndrome. Thus, this evaluates the information quality of YT videos about carpal tunnel syndrome (CTS). Methods: This is a descriptive-evaluated study focused on assessing the information qualities of CTS videos on YT. Using Macleod et al. information quality index (2015), modified Diagnostic Information Quality Assessment Checklist (DIQAC) and Treatment Information Quality Assessment Checklist (TIQAC) were utilized. DIQAC measures the elements explanation, history, physical examination and ancillary procedures; while TIQAC, presurgical, surgical procedure, rehabilitation and complication elements. YT videos from 2020 onwards were searched using keywords "carpal tunnel syndrome", "diagnosis" and "treatment", and screened for duplicates, non-related to topic and without audio. Out of 31 videos retrieved, 11 YT videos on CTS were evaluated by physical therapists to determine the reliability of YT videos on CTS. Results: Results showed that YT-CTS videos are highly reliable in the elements explanation (45%) and history (36.36%), moderate to reliable in ancillary procedure (54.54%) and moderately reliable in physical examination (36%), in terms of DIQAC scoring. Whereas in TIQAC scoring, YT-CTS videos obtained a highly reliable presurgical scoring (45.45%). Surprisingly, it is poorly reliable in complication scoring (45.45%), very poorly to poor reliable in rehabilitation scoring (72.72%), and very poorly reliable in surgical scoring (45.45%). Overall, diagnosis information quality is high (65%), but low treatment information quality (32%). Discussion: This demonstrates that YT videos are technological tool that a physical therapist or a clinicians can utilize to educate and diagnose. Treatment information can hardly be explained in videos, which can vary form case to case, and is best explained through medical advice of a doctor to his patient with CTS.

Use of Validated Questionnaires to Predict Cosmetic Outcomes of Hypospadias Repair.

Hypospadias is a syndrome of penile maldevelopment. The primary goal of hypospadias surgery is to create a penis with normal appearance and function. Historically, the outcome of hypospadias repair has been assessed based on the need for reoperation due to urethroplasty complications (UC), including fistula formation, dehiscence, meatal stenosis, or development of a urethral stricture. The Glans-Urethral Meatus-Shaft (GMS) score is a standardized tool to predict UC. Analysis of the cosmetic outcomes of hypospadias repair based on the appearance of the reconstructed penis has been validated, and standardized scores have been published. The Hypospadias Objective Penile Evaluation (HOPE) score is a validated questionnaire used to assess postoperative cosmetic outcomes. Although predictors of surgical outcomes and UC have been well documented, predictors of optimal cosmetic outcomes are lacking in the literature. Furthermore, reoperation due to cosmetic considerations has been poorly reported. To identify predictors of cosmetic outcomes after hypospadias repair and to assess the reoperation rate according to cosmetic considerations. This prospective cohort study included 126 boys who underwent primary hypospadias repair. The severity of hypospadias, degree of penile curvature, glans width, preoperative HOPE, and GMS scores were documented. The standard technique for single-stage repairs, the tubularized incised plate urethroplasty, was performed. The primary endpoint was cosmetic outcomes evaluated by the HOPE score questionnaire six months postoperatively. Optimal cosmetic results were defined by HOPE scores ≥ 57. The study population consisted of the following cases: 87 (69%) subcoronal, 32 (25%) shaft, and 7 (6%) proximal hypospadias. Among the study participants, 102 boys (81%) had optimal cosmetic results (HOPE ≥ 57), and 24 boys (19%) had surgeries with suboptimal cosmetic outcomes (HOPE < 57). Ancillary procedures were performed in 21 boys (16%), of which 14 (11%) were solely for cosmetic considerations, and 7 were secondary to UC. Using the Receiver Operating Characteristic analysis of potential predictors of optimal cosmetic outcomes, the preoperative HOPE score had the highest area under the curve (AUC = 0.79; 95% CI 0.69-0.89, p < 0.001). After multivariable analysis, the degree of penile chordee (p = 0.013), glans width (p = 0.003), GMS score (p = 0.007), and preoperative HOPE score (p = 0.002) were significant predictors of cosmetic outcomes. Although meatal location predicted suboptimal cosmetic results in univariate analysis, it was not a factor in multivariable analysis. Over 80% of boys undergoing hypospadias repair achieved optimal cosmetic outcomes. More than 10% of cases underwent ancillary procedures, secondary solely to cosmetic considerations. Predictors of optimal cosmetic outcomes after hypospadias surgery included degree of chordee, glans width, and preoperative HOPE and GMS scores, which were the best predictors of satisfactory cosmetic results. Although meatal location is the main predictor of UC, it was not a predictor for cosmetic outcomes. Factors affecting cosmetic outcomes should be clearly explained to parents during the preoperative consultation.

Analysis of the Results of Extracorporeal Lithotripsy (ECL) in the Treatment of Stones of the Inferior Calcific Group (ICG): Does Variability in Calicial Anatomy Influence Them?

Introduction: Lower calyceal stones always pose a problem of optimal management: the results of ESWL are insufficient, with the possibility of generating a large quantity of residual fragments and recourse to complementary treatments. The different anatomical varieties of the lower calcific group can vary the results of treatment at this site. The objective of the study is to analyze the influence of the anatomy of the lower calyceal group (LCG) on the results of ESWL. Materials: A prospective observational study involving 57 patients with LCG stones who were treated by ESWL in our department between January 2021 December 2022 according to the French recommendations of the AFU lithiasis committee. Unfavorable LCG anatomy was defined according to Sampaio's criteria: a length of the inferior stem caliceal lower &gt;10 mm, a width&lt;5 mm and an infundibulo-pelvic angle &lt; 90º. Fragment-free rate was assessed 3 months after ESWL with tomography urography (CTU). Failure was considered as the existence of fragments ≥ 3mm, the need for ancillary procedures after ESWL (ureterscopy, RIRS, PCNL or new ESWL), complications and risk factors associated with the development of perirenal hematoma were analyzed. Results: The median age was 48,5 years (range: 22-68), with 66,66% of the participants being men (38 men and 19 women). Approximately 14,03 % (n=8) of the patients were taking antiplatelet/anticoagulant drugs, and 8,77 % (n= 5) had High blood pressure. The median size of the lithiasis was 10 mm (range: 5-20 mm), with favorable LCG anatomy observed in 45,61 % (n= 26/57) of patients, including 34,61 % (n= 9/26) who required ancillary procedures after ESWL, compared to 64,51% (n= 20/31) in patients with unfavorable anatomy (54,39 % = 31/57). The stone-free after ESWL for both groups combined was 54,38 % (n= 31/57). Auxiliary procedures included ureteroscopy or RIRS. Two perirenal hematomas were observed in patients on antiplatelet/anticoagulant therapy, with a favorable outcome. ...

Comparing Same-Sitting Bilateral vs Unilateral Retrograde Intrarenal Surgery in the Elderly

ObjectivesTo compare same-sitting bilateral versus unilateral RIRS in elderly patients, focusing on postoperative complications and stone-free rates (SFR). MethodsData from two multicentre databases, FLEXOR (unilateral RIRS) and SSB-RIRS (bilateral RIRS), were analysed, considering only patients aged 70+ with preoperative CT. Patients were categorized into Group1 (bilateral RIRS) and Group2 (unilateral RIRS). Follow-up included imaging assessments and secondary treatments as needed. ResultsGroup1 included 146 patients, while Group2 had 495. Group1's patients were slightly older and had a higher prevalence of recurrent stone formation. Group2 often underwent RIRS for incidental stones. Group1 had larger and more pelvic stones. Laser lithotripsy and total operation times were significantly longer in Group1. Group2 had significantly higher overall SFR, although there were no significant differences in ancillary procedures for residual fragments. Group1 experienced more pelvicalyceal injuries needing stenting, postoperative fever, and post-op haematuria not requiring transfusion. ConclusionIn conclusion, bilateral RIRS can be carefully considered in elderly patients. Preoperative counselling is essential for both primary and repeat RIRS procedures, and further research is needed to optimize instrument and laser strategies for better outcomes in elderly RIRS patients.

Not Just Non-Consensual Pelvic Exams

Not Just Non-Consensual Pelvic Exams

Comparison of mini-percutaneous nephrolithotomy and retrograde intrarenal surgery for 1-2 cm renal stones: A single-center experience.

Background: The management of renal stones has undergone significant advancements in recent years, with percutaneous nephrolithotomy (PCNL) and Retrograde Intrarenal Surgery (RIRS) emerging as minimally invasive alternatives to traditional Pyelolithotomy. This study aims to assess the effectiveness of Mini-PCNL and RIRS for renal stones measuring 1-2 cm, focusing on operative time, stone clearance, hospital stay, and the need for ancillary procedures. Methodology: This retrospective study collected data from the medical records of patients admitted to The Department of Urology at The Kidney Centre, Karachi, between January 1, 2021, and August 31, 2022. The study included 100 patients who underwent RIRS and 129 patients who underwent Mini-PCNL. Results: It was found that the operative time was statistically similar in both groups. However, the length of hospital stay was significantly higher in the Mini-PCNL group (more than 2 days in 88.4%), whereas in the RIRS group, the majority of patients stayed ≤ 2 days (78%). Overall stone clearance was 82.1%, with a slightly higher clearance rate in patients who underwent Mini-PCNL (85.3%) compared to RIRS (78%), though the p-value was not statistically significant. Conclusion: For renal stones sized 1-2 cm, both RIRS and Mini-PCNL demonstrate efficient treatment options with comparable stone-free rates. RIRS appears more comfortable and less morbid than Mini-PCNL, with a shorter hospital stay. Although Mini-PCNL requires an extended hospital stay to treat 1- to 2-cm renal stones, it is associated with fewer complications and a reduced need for a JJ stent, making it a viable alternative to RIRS in certain cases.

Frequency of Metabolic Syndrome in Patients with Type 2 Diabetes Mellitus

Background: The management of renal stones has undergone significant advancements in recent years, with percutaneous nephrolithotomy (PCNL) and Retrograde Intrarenal Surgery (RIRS) emerging as minimally invasive alternatives to traditional Pyelolithotomy. This study aims to assess the effectiveness of Mini-PCNL and RIRS for renal stones measuring 1-2 cm, focusing on operative time, stone clearance, hospital stay, and the need for ancillary procedures. Methodology: This retrospective study collected data from the medical records of patients admitted to The Department of Urology at The Kidney Centre, Karachi, between January 1, 2021, and August 31, 2022. The study included 100 patients who underwent RIRS and 129 patients who underwent Mini-PCNL. Results: It was found that the operative time was statistically similar in both groups. However, the length of hospital stay was significantly higher in the Mini-PCNL group (more than 2 days in 88.4%), whereas in the RIRS group, the majority of patients stayed ≤ 2 days (78%). Overall stone clearance was 82.1%, with a slightly higher clearance rate in patients who underwent Mini-PCNL (85.3%) compared to RIRS (78%), though the p- value was not statistically significant. Conclusion: For renal stones sized 1-2 cm, both RIRS and Mini-PCNL demonstrate efficient treatment options with comparable stone-free rates. RIRS appears more comfortable and less morbid than Mini-PCNL, with a shorter hospital stay. Although Mini-PCNL requires an extended hospital stay to treat 1- to 2-cm renal stones, it is associated with fewer complications and a reduced need for a JJ stent, making it a viable alternative to RIRS in certain cases.

Indocyanine green-marked fluorescence-guided off-clamp versus intraoperative ultrasound-guided on-clamp robotic partial nephrectomy: Outcomes on surgical procedure.

To compare surgical and functional outcomes between off-clamp robot-assisted partial nephrectomy with indocyanine-green tumour marking through preliminary superselective embolization and on-clamp robot-assisted partial nephrectomy with intraoperative ultrasound identification of the renal mass. One hundred and forty patients with a single renal mass underwent indocyanine-green fluorescence-guided off-clamp robot-assisted partial nephrectomy with preoperative superselective embolization (Group A, 70 patients) versus intraoperative ultrasound-guided on-clamp robot-assisted partial nephrectomy without embolization (Group B, 70 patients). We assessed operative time, intraoperative blood loss, complications, length of stay, renal function, need for ancillary procedures and blood transfusions. Mean tumour size was 24 versus 25 mm in Group A versus Group B (p= 0.19). Mean operative time was 86.5 versus 121.8 min (p= 0.02), mean blood loss was 72.8 versus 214.2 mL (p= 0.02), and mean haemoglobin drop on postoperative day 1 was 1.1 versus 2.6 g/dL (p= 0.04) in Group A versus Group B. One-month creatinine, hospital stay and enucleated tumour volume were comparable. Ten postoperative complications occurred in Group A (13.3%) and 11 in Group B (15.3%). Following superselective embolization, no patients required blood transfusions versus two patients in Group B. Postoperative selective renal embolization was needed in one case per group. Preoperative superselective embolization of a renal mass with indocyanine-green before off-clamp robot-assisted partial nephrectomy significantly reduces operative time and intraoperative blood loss compared to on-clamp intraoperative ultrasound-guided robot-assisted partial nephrectomy. A longer follow-up is needed to establish the effect on renal function.