Search

INTRODUCTION AND OBJECTIVE: Inadequate pain control is a major barrier to same-day discharge after percutaneous nephrolithotomy (PCNL). This study was designed to evaluate whether the novel thoracic erector spinae plane block (ESPB) can reduce postoperative breakthrough pain and eliminate the need for intravenous (IV) opioids after PCNL. METHODS: A prospective cohort study of adult patients undergoing percutaneous nephrolithotomy (PCNL) was conducted at our institution from May 2020 to January 2021. Patients with a history of chronic pain and opioid use were excluded from the study. Participants in the intervention group received an ultrasound-guided T11 erector spinae plane block prior to the start of the procedure. Patients were admitted postoperatively and prescribed an oral pain regimen;IV opioids were prescribed only upon request. Verbal pain score ≥7) and opioid administration within 24 hours were analyzed as the primary outcome. RESULTS: A total of 56 patients undergoing PCNL were included in our study, of whom 23 successfully received ESPB. We found that 78% of patients in the ESPB group compared to 47% in the control group were successfully managed with oral analgesics alone without IV opioids or breakthrough pain (p=0.03). Although no difference in total 24-hour opioid usage was detected, ESPB significantly lowered the odds of having breakthrough pain after adjusting for factors such as age, sex, dilated tract size, and tract location (OR 0.21, 95% CI 0.050-0.78). CONCLUSIONS: ESPB greatly reduces breakthrough pain and IV opioid use after PCNL, and most patients who receive an ESPB can be managed with oral analgesics alone. The ESPB can be performed by urologists or by the regional pain specialists as part of a routine perioperative workflow. This holds great promise in facilitating sameday discharge after PCNL, a benefit that is especially impactful in the COVID-19 era.

A 48-year-old male with HIV/AIDS presented with an enlarging nodular lesion on the base of his penis. Histology revealed changes consistent with chronic viral infection and culture grew herpes simplex virus 2 (HSV-2). The lesion was refractory to valacyclovir and intralesional (IL) cidofovir therapy. Urology excised the mass and the defect was repaired primarily with good cosmetic result. Post-operative pathology confirmed HSV-2 despite the unusual appearance of the lesion consisting of nodular mass without gross ulceration.

Background: Prune belly syndrome (PBS) and congenital pouch colon (CPC) are rare congenital syndromes with a low incidence in the United States (U.S.) with most CPC cases being from India. In this case report, we describe, to the best of our knowledge, the first PBS variant and CPC patient in the U.S. Case Presentation: A 30-year-old G2P0010 woman was referred to a tertiary center after an 18-week ultrasound showed a fetal abdominal mass. A prenatal MRI showed a dilated loop of bowel containing a mixture of urine and meconium, oligohydramnios, and a protuberant abdominal wall. Born at 37 weeks, the child’s physical exam was notable for a distended abdomen with thin abdominal musculature, non-palpable bilateral testes, no anal opening, and flat buttocks. Intra-operatively, a dilated cecum/ascending colon was noted with an abrupt change in caliber at the transverse colon, bilateral enlarged ureters, a left testis at the internal ring and no visualized right testis. A colostomy and mucous fistula were created 5 cm from the sigmoid pouch. Conclusion: While most reported cases of CPC undergo single stage repair (one operation) at 1 day of life, our patient underwent the first procedure of a staged repair at 16 hours of life given his clinical instability at the time as well as his unknown urological anatomy in the setting of urinary obstruction. This case demonstrates the importance of fetal imaging, multidisciplinary approach at a tertiary care center, and reinforces a staged repair when necessary.