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Obesity is associated with many significant physiological changes. These considerations are important to surgery, especially in urological procedures. Obese patients often undergo surgical procedures and are at higher risk of complications. This investigation reviews physiological and anaesthesia considerations for obese and morbidly obese patients. In addition, urological surgeries and procedures should be considered for these higher risk patients. Clinical anaesthesiologists must use detailed assessment and, when appropriate, consultation in developing safe anaesthesia plans for these patients. Newer technologies have improved safety related to airway management, advanced airway devices, and regional anaesthesia with ultrasound-guided nerve blocks, which can reduce the need for opioids postoperatively. Recent developments in drug and monitoring technologies have also been developed and can be effective for obese and morbidly obese patients undergoing urological procedures and perioperative surgery, thus improving the likelihood of safety in this higher risk population.

Obesity is associated with many significant physiological changes. These considerations are important to surgery, especially in urological procedures. Obese patients often undergo surgical procedures and are at higher risk of complications. This investigation reviews physiological and anaesthesia considerations for obese and morbidly obese patients. In addition, urological surgeries and procedures should be considered for these higher risk patients. Clinical anaesthesiologists must use detailed assessment and, when appropriate, consultation in developing safe anaesthesia plans for these patients. Newer technologies have improved safety related to airway management, advanced airway devices, and regional anaesthesia with ultrasound-guided nerve blocks, which can reduce the need for opioids postoperatively. Recent developments in drug and monitoring technologies have also been developed and can be effective for obese and morbidly obese patients undergoing urological procedures and perioperative surgery, thus improving the likelihood of safety in this higher risk population. [ABSTRACT FROM AUTHOR]

Objective To investigate the cognitive status and influencing factors of urology nurses in preventing catheter-associated urinary tract infections(CAUTI). Methods From March to May 2022, 120 urology clinical nurses were selected as the research objects by convenience sampling method, and general information questionnaires and the CAUTI prevention cognition scale were distributed for questionnaire survey to investigate nurses' cognitive level of CAUTI. Results Totally 110 (91. 67%)valid questionnaires were collected. The knowledge score of urology nurses on preventing CAUTI was 87. 22 +-a> 8. 00, indicating a relatively low level of cognition . Multiple linear regression analysis showed that different age, length of service, professional title, and hospital level were the influencing factors of urology nurses' cognition of preventing CAUTI (P£¼0. 05). Conclusion The cognition of urology nurses on the prevention of CAUTI needs to be improved, and the training of urology nurses in low seniority, low professional title and secondary hospitals should be strengthened. (目的 调查泌尿外科护士预防导尿管相关尿路感染的认知现状, 分析影响因素。方法 2022年3月—5月采用便利抽样法选取广西壮族自治区医疗机构120名泌尿外科临床护士为研究对象, 发放一般资料调查表和预防导尿管相关尿路感染认知量表进行问卷调查, 调查护士导尿管相关尿路感染的认知水平。结果 回收有效问卷110(91. 67%)份。泌尿外科护士预防导尿管相关尿路感染的知识得分为(87. 22±8. 00)分, 处于较低水平。多元线性回归分析显示, 不同年龄、工龄、职称、医院级别是泌尿外科护士预防导尿管相关尿路感染认知的影响因素(P＜0. 05)。结论 泌尿外科护士对预防导尿管相关尿路感染的认知有待提高, 应加强对低年资、低职称和二级医院的泌尿外科护士培训。)

Perioperative paediatric major urology surgery pain management remains challenging. These surgeries require general anaesthesia (GA) combined with either regional analgesia technique or systemic morphine infusion for optimal pain relief. We aimed to compare and evaluate the effectiveness of both analgesic techniques. This single centre retrospective descriptive study involved 88 patients, aged 3 months to 12 years old with American Society of Anaesthesiologists (ASA) I or II status, who underwent major urology surgery under GA. Group A patients received perioperative systemic morphine while Group B received regional anaesthesia blocks (continuous caudal epidural infusion, single-shot caudal blocks or singleshot erector spinae blocks). We measured requirements of perioperative rescue intravenous (IV) fentanyl, pain scores using Face, Leg, Activity, Cry, Consolability (FLACC) scale, perioperative non-opioid IV analgesia usage and associated complications. Intraoperative rescue fentanyl in both groups was comparable. Intraoperative non-opioid analgesia and postoperative rescue fentanyl requirement were significantly higher in Group A compared to Group B (p<0.001). Median FLACC scores in Group A were higher than Group B (p<0.001) for first 12 hours post-surgery. Commonest complications in Group A was vomiting (38.6%) and peri-catheter leak in Group B (6.81%). Regional anaesthesia technique is superior to systemic morphine in providing analgesia in the first 12 hours post paediatric major urology surgery and is devoid of opioid side effects. [ABSTRACT FROM AUTHOR]

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This integrative review examined the efficacy, implementation, and caregivers of patients in enhanced recovery programs (ERPs) in abdominal surgery with an emphasis on radical cystectomy. This body of work evaluates ERP as a globally recognized method to decrease the physiological stress of surgery and reduce hospital length of stay. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical effect of manual intervention on relieving the pain stimulus and lower urinary tract symptoms（LUTS） of male patients after catheter removal, and to guide effective intervention measures to alleviate the discomfort of patients after catheter removal.Methods From February 2020 to February 2021,a totoal of 266 male patients admitted to the Department of Urology of this Hospital and needed catheter removel were divided into the study group and the control group by computer random number table method, with 133 cases in each group.The control group pulled out the catheter according to the routine operation process.The study group used manual intervention to clamp the catheter before pulling out the catheter until the patient complained of urination.When pulling out the catheter, the penis was raised to 60 with the abdominal wall.During the removal process, the catheter was slowly removed by rotating left and right alternately.The pain score after catheter removal, LUTS during urination and the rate of catheter replacement were compared between the two groups.Results LUTS and pain in the study group were significantly better than those in the control group, and the difference were statistically significant（P<0.05）;There was no significant difference between the two groups in the rate of urinary tube replacement（P>0.05）.Conclusion In the process of catheter removal for male patients, the improvement of the removal technique based on the routine operation process can reduce the pain during catheter removal and LUTS after catheter removal. [ABSTRACT FROM AUTHOR]

Introduction: Preoperative polymicrobial urine cultures are common, but the associated risk of nosocomial infection is currently unknown. We aimed to analyze the risk of postoperative infection in patients with preoperative polymicrobial urine cultures. Methods: This was a prospective cohort study conducted from November 2018 to October 2020. Polymicrobial urine cultures were defined by at least the presence of 3 bacteria without leukocyturia threshold on two consecutive samples in the month preceding the surgical procedure. Data on postoperative infections were collected during hospitalization until day 30. A postoperative infection was defined by the occurrence of clinical signs (fever, chills, and suppurated process on the surgical site) associated with the prescription of an antibiotic therapy. Results: Sixty-eight patients were included, and seven developed a postoperative infection with a microbe identified in blood or urine cultures. There was a significant association between leukocyturia ≥104 (p = 0.02) and the administration of intraoperative antibiotic prophylaxis (p < 0.001). In contrast, there was no significant association between postoperative infections for patients with polymicrobial preoperative urine cultures and having received or not an empirical antibiotic therapy. Conclusion: The rate of postoperative infection in patients with polymicrobial urine culture before urological procedure was 10.2%. Further studies are needed to assess the antibiotic prophylaxis to be used in this situation. [ABSTRACT FROM AUTHOR]

Robotic-assisted laparoscopic prostatectomy (RALP) is the surgical standard of care for patients with localized prostate cancer. Although uncommon, the procedure involves a potential risk of injury to adjacent anatomical structures. We report on a unique case of iatrogenic ureteral injury during RALP that required subsequent robotic-assisted laparoscopic ureteral reimplantation for definitive repair. A 57-year-old male underwent RALP using the Da Vinci Xi system (Intuitive Surgical, Sunnyvale, CA). The procedure was unremarkable and a 20 French Foley catheter was placed with plans for removal after one week following a negative cystogram. On postoperative day two, his creatinine level elevated to 2.69 mg/dL from a baseline of 1.40 mg/dL, left-sided flank pain increased, and non-contrast CT imaging revealed moderate left proximal hydroureteronephrosis and no other abnormalities. Aside from mild nausea on postoperative day one, he had no other symptoms. An integrated stent was unable to be placed by urology at this time. Subsequently, a left percutaneous nephrostomy tube was placed under fluoroscopic guidance. After this intervention, the patient's symptoms improved and the decision was made not to proceed with operative re-exploration at this time to attempt identification of the obstruction. Three weeks later, the patient underwent cystoscopy with attempted left retrograde ureteropyelography and left ureteroscopy due to suspected distal obstruction. This revealed complete obstruction of the intramural portion of the ureter, presumed to be secondary to suture ligation at the time of the vesicourethral anastomosis. Seven weeks postoperatively, the patient underwent robotic-assisted laparoscopic left ureteral reimplantation. Thereafter, the patient had a resolution of his left hydroureteronephrosis and acute kidney injury. This case describes an intravesical ureteral ligation during RALP. An iatrogenic intravesical ureteral ligation has far less guiding literature than a more common ureteral transection. Additionally, ureteral transection is often identified and managed intraoperatively, while the ureteral ligation presented in this case is far less likely to be apparent during surgery. Early identification will allow for rapid reoperation to manage the injury. We hypothesize that during the vesicourethral anastomosis, the left intramural ureter was ligated. Importantly, with the use of a 3-0 V-Loc stitch for the vesicourethral anastomosis, its barbed nature would not facilitate simple surgical removal. In conclusion, when performing RALP, the depth of the bladder-sided vesicourethral anastomotic stitch should be carefully considered to avoid a similar injury., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Baetzhold et al.)

Objectives: This study aimed to establish whether hypothermia was present in patients who required a blood transfusion and underwent a urology procedure, as well as identify staff knowledge and understanding., Patients and Methods: A staff survey was conducted with respondents from a range of clinical settings, with some staff working across more than one area. A retrospective review of 46 medical records was conducted between January 2021 and July 2022. All data were exported into an Excel spreadsheet and analysed., Results: Staff (70%) were unaware of guidelines informing thermoregulation practices; however, 90% understood the importance of normothermia in the perioperative environment. Medical record review demonstrated temperature monitoring and intervention implementation varied across the perioperative journey, with 20% of patients hypothermic on admission and 89% of the cohort having two or more risk factors., Conclusion: There is no formal process for the management of inadvertent perioperative hypothermia throughout the patient journey at the hospital. A variety of intrinsic factors (age, patient comorbidities, American Society of Anaesthesiologists score) and external factors (patient waiting times, anaesthetic modality, type of procedure, environmental influences), impact each patient's risk of inadvertent perioperative hypothermia.

Background: Yucatan stands out as the state with the highest prevalence of urolithiasis in Mexico, placing significant demands on healthcare services, such as consultation and surgical intervention. Staghorn calculi are related to recurrent urinary tract infections, and their management is always surgical. The stone-free rate is a parameter used to measure the success of surgery, with residual stones considered those persisting four weeks after surgical management. There are understudied prognostic factors that can predict the success of achieving stone-free status, taking into account the number of stones, their location, and the anatomical variations of the patient's collecting system. The study aims to determine the prognostic factors for residual lithiasis in patients with staghorn calculi treated with percutaneous nephrolithotomy at the High Specialty Regional Hospital of the Yucatan Peninsula., Methods: A case-control study was performed including 188 patients, aged 18 years or older, and diagnosed with staghorn calculus from January 2022 to June 2023, grouping the patients according to their stone-free rate evidence on postoperative computed tomography. Data were collected from the records of the Urology Department at a high-specialty hospital in Yucatan. The groups were analyzed, aiming to establish an association between preoperative factors and postoperative outcomes measured in terms of stone-free rate., Results: A total of 188 patients with staghorn calculi were included, with a predominance in females (58.5%) and a mean age of 45.4 ± 11.9 years. The most common comorbidity was hypertension (29.8%), and 27.7% had a history of recurrent urinary tract infections. Regarding the Sampaio classification, B1 was the most prevalent in our population with 66 cases (35.1%), while Type A2 was the least common (13.8%). According to what was obtained through the multivariate logistic regression model, the calyceal anatomy Type A1 and A2 were associated with residual lithiasis ( p = 0.016 OR: 2.994 CI: 1.223-7.331), and Grade IV was associated with a higher rate of residual lithiasis ( p =0.005 CI: 1.586-13.100). A statistically significant association was found between stone burden and the presence of residual lithiasis ( p =< 0.001)., Conclusion: Guy's Score Grade IV showed a higher incidence of residual lithiasis, seemingly associated with stone burden, leading to the conclusion that both factors were categorized as predictors for the development of post-surgical residual lithiasis. Regarding anatomical variations according to Sampaio, it was observed that types A1 and A2 showed a lower rate of stone-free status. Therefore, we also consider them as variables that may influence the achievement of success in endourological management. Personalized patient assessment allows for more accurate prognostic factors, enabling a more comprehensive surgical planning in the presence of staghorn calculi., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Garcia-Chairez et al.)

Background and objectives: Sevoflurane is widly used in pediatric anesthesia as children tolerate it well, but it often gives postoperative agitation. The objective of this study was to test the effect of small doses of ketamine together with midazolan in reducing agitation from sevoflurane in children. Methodology: We enrolled 80 children from 3-10 years old, undergoing urological surgery under general anesthesia, in this randomized double blind prospective study. Participants were randomly divided into two groups. The first group (Group M) received midazolam 0.5 mg/kg orally and the second group (Group KM) received oral midazolam plus ketamine 2 mg/kg. For general anesthesia, we used sevoflurane. Induction was done with fentanyl, thiopental and sexamethonium and then the patient was intubeted. Five different levels were used to measure the degree of agitation. Agitation was managed by fentanyl 1 µg/kg IV and total dose used was noted. Results: The demographic data were statistically equivalent in both groups. There was no significant difference between two groups regarding awakening period or hospital discharge. Patients in Group KM had a significantly lower agitation score compared to Group M. (Mann Whitney T=15; p<0.01). Fentanyl consumption was significantly greater in Group M compared to the Group KM. Conclusion: Adding small doses of ketamine by mouth beside midazolam reduces episodes of agitation after sevoflurane anesthesia in children undergoing urology procedures without delaying hospital discharge. [ABSTRACT FROM AUTHOR]

Surgery and especially cancer surgery is recognised as a risk condition for the development of venous trhomboembolism (VTE), deep venous thrombosis (DVT) and pulmonary embolism (PE). VTE is considered the most important non surgical complication of major urological procedures. Epidemiological data are based on studies published 10-30 years ago and mostly based on venographic diagnosis of DVT. Clinical revelance of asymptomatic detected DVT is under debate. The rationale for thromboprophylaxis is based on the high prevalence of VTE among hospitalized patients, the clinically silent nature of the disease in the majority of patients, and the morbidity, costs, and potential mortality associated with unprevented thrombi. Both DVT and PE produce few specific symptoms, and the clinical diagnosis is unreliable. Since the first manifestation of the disease may be fatal PE, it is inappropriate to wait for symptoms and then rely on the diagnosis and treatment of established VTE. The thromboprophylaxis strategies are still debated with regards to therapeutical choices (pharmacological and/or mechanic prophylaxis) and modalities. The strategy to be applied in patients chronically under anticoagulant or antiplatelet drugs (TAO) is also a controversial issue. METHODS: Literature review on VTE and antithrombotic prophylaxis in urological cancer surgery. RESULTS: Although the incidence of VTE is lower in urological patients than that in the others, thromboprophylaxis is still a debated topic for urologists. A protective role is the shorter duration of a lot of endourological procedure and the reduced need of general anesthesia. Nowadays patients are elderly and have multiple risk factors so they have to receive a valid and safe thromboprophylaxis. Even if the risk of bleeding is bigger in patients who received antithrombotic pro philaxys this do not allow to ignore the bigger risk/benefits ratio of the antithrombotic therapies. CONCLUSIONS: VTE is a serious complication of the urologic cancer surgery and remains the most common cause of death in these patients. New efforts must be done to reduce the risk ant to optimize the prophylapctic strategies particularly in patients with known risk factors. [ABSTRACT FROM AUTHOR]

Background and purpose. The number of octogenarians requiring surgery increases constantly. Data regarding perioperative morbidity and mortality in octogenarians is limited. Our aim was to assess surgery-related complications in octogenarians, undergoing urological surgery. Patients and methods. We prospectively collected data from octogenarians and a control group of younger patients undergoing an elective urological surgery in our institution. Recorded data included: age, gender, American Society of Anesthesiologists (ASA) score, co-morbidities, number of medications, operation extent, anaesthesia type, surgery duration and perioperative morbidity and mortality. Results. Forty-seven octogenarians and 80 patients with a median age of 59 years (range 19-75) enrolled prospectively. Gender ratio, surgeries extent and median operative time were similar among groups. General anaesthesia was more prevalent in the control group. ASA classification and duration of hospitalization were significantly higher in octogenarians. The rate of intra-operative complications was significantly higher in the octogenarians group 6.38% versus 3.75% (p=0.007), there was no significant difference in immediate post-operative and post-discharge complications among groups. One octogenarian patient died 2 days post-surgery, no death occurred in the control group. Conclusions. Octogenarians have higher rate of intra-operative morbidity, leading to longer hospital stay. More experienced surgeons and anaesthetists should be involved in the operation; and careful surgical technique, tapered anaesthesia and higher level of post-operative monitoring should be applied for patients in this age. [ABSTRACT FROM AUTHOR]