Search

Background: Prostate-specific antigen (PSA) rises in all types of retentions and also in carcinoma prostate. The raised levels of PSA levels due to urinary retention may raise a false suspicion of carcinoma prostate in these patients. Unlike chronic urinary retention (CUR), the effect of acute urinary retention (AUR) on serum PSA levels had been studied in detail as evident from the past literature. Objectives: The objectives of the study were first to estimate and interpret serum PSA levels in adult males with CUR due to prostatic pathology, second to assess the need of taking prostatic biopsy based on the studied PSA trends, and finally to assess the prostatic histopathology in cases of persistently high PSA levels after 6 weeks. Materials and Methods: This was an observational follow-up study including 41 patients diagnosed with CUR due to prostatic etiology, matching the inclusion and exclusion criteria. On presentation, serum PSA levels were recorded. Retention was relieved by either per urethral catheterization or suprapubic catheterization. PSA levels were recorded after 24 hours, 1 week, 3 weeks, and 6 weeks and PSA trends were noted. Prostatic biopsy was advised for only those subjects in whom PSA did not attain the baseline value of 4 ng/mL within 6 weeks. The histopathological report of the biopsy was followed in each patient for studying its association with PSA trends. Results: Mean PSA at the time of presentation was 17.92 ng/mL. PSA trends showed that in the majority of the patients "Suspected benign group" (80.49%, n = 33), PSA returned to <4 ng/mL within 6 weeks of catheterization. Six patients, the "Borderline group" (14.63%), showed a downtrend in their PSA trends but could not attain baseline value. PSA trends in only two patients, the "Suspected malignant group" (4.87%), showed a comparative constant or an uptrend. All patients in the "Suspected benign group" and a majority of the "Borderline group" patients (83.33%) had a histopathologically confirmed benign prostatic pathology. Out of the two highly suspected malignant cases, only one patient (50%) had carcinoma prostate on final histopathology. Conclusion: PSA rises mainly in carcinoma prostate, but it falsely rises in all urinary retentions. The relationship between AUR and PSA had been studied in detail as evident from the past literature but needs to be established in patients with CUR. A period of 4 to 6 weeks can be safely employed for waiting for PSA to fall back to normal in CUR. A biopsy is required only for patients in which PSA is constantly high to rule out carcinoma prostate. [ABSTRACT FROM AUTHOR]

Background and objective: The objective of the present study was to determine the effectiveness of erector spinae plane block (ESPB) for pain relief in patients undergoing percutaneous nephrolithotomy. Methods: Sixty-four patients of either sex, American Society of Anaesthesiology (ASA) Grade I/II for surgery were enrolled. After informed consent, all participants received subarachnoid block with 3ml of 0.5% injection heavy bupivacaine. Participants in the block group received ultrasound-guided ESPB with 30 ml of 0.5% ropivacaine, whereas participants in the control group received routine analgesia as per our hospital’s protocol for percutaneous nephrolithotomy procedure which is tramadol 100 mg intravenously. This prospective, single-blind, randomized, controlled study was conducted after approval from the institutional ethics committee (SRHU/HIMS/RC/2019/291) and written informed consent was obtained for surgery under spinal anesthesia. Pain score (visual analog scale, VAS) was evaluated by the anesthesiologist who was not involved in the study at 30 minutes and 2, 4, 6, 8, 12, 18, and 24 hours postoperatively and patient was monitored with electrocardiogram, noninvasive blood pressure, heart rate, and pulse oximetry. Unpaired t test was used for comparison between the groups. Results: Both the groups were appropriately matched for age, ASA physical status, weight, and duration of surgery. The total dosing of rescue analgesia, that is, tramadol was considerably more in the control group in comparison with the ESPB group in the first postoperative day (P=0.000; 218.75 ± 82.06 mg vs. 103.12 ± 47.41 mg, respectively). Similar results were obtained in the VAS pain score. Conclusion: ESPB helped in providing considerable postoperative pain relief in patients undergoing percutaneous nephrolithotomy. [ABSTRACT FROM AUTHOR]

Background: Delayed gastric emptying is observed in end-stage renal disease (ESRD). Aims: Evaluation of gastric emptying after recommended fasting period and on oral administration of prokinetic in ESRD patients using ultrasonography (USG). Settings and Design: Randomized, double-blind, prospective, controlled study. Materials and Methods: After institutional ethics committee approval, 200 patients were divided randomly into two equal groups. Three sessions of USG evaluation of gastric antrum were done in supine and right lateral position for assessing gastric emptying, first at 8 am, second after the light meal at 8.30 am, and third after 6 h of light meal. Group A received placebo (sugar-coated pill) and Group B received tablet metoclopramide hydrochloride 10 mg after second session of USG. In each session, measurement of anteroposterior and craniocaudal diameters of gastric antrum was done, and then cross-sectional area was estimated. Three-point grading system (Perlas) was used to perform qualitative evaluation. Statistical Analysis: Comparison of normally distributed continuous variables was performed using Student's t-test. Nominal categorical data were compared using Chi-squared test. Nonnormal distribution continuous variables were compared using Mann–Whitney U-test. Results: 6 h of fasting after light meal showed that Group A only had 14% incidence of complete gastric emptying, whereas Group B had 71% as compared by Perlas grading. Gastric antral cross-sectional area measured both in supine (480.89 ± 84.92) and right lateral (575.40 ± 92.62) position of Group A was more than Group B supine (394.15 ± 62.80) and right lateral (470.25 ± 73.63) position (P < 0.05). Conclusion: USG of ESRD patients preoperatively can evaluate gastric contents to assess risk of pulmonary aspiration and guide anesthetic management. Metoclopramide is a good drug to enhance gastric emptying in ESRD patients within the recommended fasting period. [ABSTRACT FROM AUTHOR]

Purpose of Review: To review the recently published literature related to miniperc., Recent Findings: Miniperc has generated lot of enthusiasm in the last few years. Miniperc utilizes tract size of 20 F or less, hence the complication rates are much less. Hematocrit drop is significantly reduced and blood transfusion rates have gone down. Reduced pain and hospital stay without affecting success rate is the remarkable achievement of this procedure. Although initially it was supposed to be for small sized stones, many authors have utilized miniperc even for large and complex stones with good clearance rate., Summary: Miniperc has several advantages over standard percutaneous nephrolithotomy. In comparison with retrograde intrarenal surgery and shock wave lithotripsy, it offers better clearance rate. Hemorrhagic complications of miniperc are significantly less, making it an attractive procedure for treating renal stones.