Objective To compare the effectiveness and safety of Super-Mini PCNL (SMP) and Retrograde Intrarenal Surgery (RIRS) in the management of renal calculi ≤ 2 cm. Patients and methods A prospective, inter-institutional, observational study of patients presenting with renal calculi ≤ 2 cm. Patients underwent either SMP (Group 1) or RIRS (Group 2) and were performed by 2 experienced high-volume surgeons. Results Between September 2018 and April 2019, 593 patients underwent PCNL and 239 patients had RIRS in two tertiary centers. Among them, 149 patients were included for the final analysis after propensity-score matching out of which 75 patients underwent SMP in one center and 74 patients underwent RIRS in the other. The stone-free rate (SFR) was statistically significantly higher in Group 1 on POD-1 (98.66% vs. 89.19%; p = 0.015), and was still higher in Group 1 on POD-30 (98.66% vs. 93.24%, p = 0.092) SFR on both POD-1 and POD-30 for lower pole calculi was higher in Group 1 (100 vs. 82.61%, p = 0.047 and 100 vs 92.61% p = 0.171). The mean (SD) operative time was significantly shorter in Group 1 at 36.43 min (14.07) vs 51.15 (17.95) mins (p < 0.0001). The mean hemoglobin drop was significantly less in Group 1 (0.31 vs 0.53 gm%; p = 0.020). There were more Clavien–Dindo complications in Group 2 (p = 0.021). The mean VAS pain score was significantly less in Group 2 at 6 and 12 h postoperatively (2.52 vs 3.67, 1.85 vs 2.40, respectively: p < 0.0001), whereas the mean VAS pain score was significantly less in Group 1 at 24 h postoperatively (0.31 vs 1.01, p < 0.0001). The mean hospital stay was significantly shorter in Group 1 (28.37 vs 45.70 h; p < 0.0001). Conclusion SMP has significantly lower operative times, complication rates, shorter hospital stay, with higher stone-free rates compared to RIRS. SMP is associated with more early post-operative pain though.
Purpose: We compared tamsulosin, silodosin, and alfuzosin in catheter-free trials after acute urinary retention (AUR) due to benign prostatic hyperplasia (BPH). This study aims at assessing the efficacy of tamsulosin, silodosin, and alfuzosin, and the factors affecting the success of catheter-free trials. Materials and Methods: An observational, prospective, randomized study of 49 men with AUR due to BPH was performed from July 2015 to August 2017. Participants were catheterized after the assessment of prevoid urine volume. The prostate size was measured, and IPSS at presentation was calculated. The participants were divided into tamsulosin, silodosin, and alfuzosin groups and were given a catheter-free trial after administration of alpha-blockers for three doses. Descriptive analysis, independent t-test, and Chi-square test were used for data analysis. Univariate and multivariate analyses were done using STATA software version 14.2. P < 0.05 was considered to indicate statistical significance. Results: The overall success of trial without catheter (TWOC) was 62.5% (30 out of 49). There was no difference in the efficacy of tamsulosin, silodosin, and alfuzosin in catheter-free trials after AUR due to BPH. The success of TWOC was affected by median lobe enlargement, and patients with Grade 3 intravesical protrusion of prostate were less likely to have a successful TWOC. Conclusion: TWOC after administration of three doses of alpha-blockers was shown to be useful in most patients irrespective of prostate size. There was no difference in the efficacy of tamsulosin, silodosin, and alfuzosin in catheter-free trials.
Calcium is the most abundant metabolite involved in the stone matrix. The CaSR gene controls calcium homeostasis, and genetic variation in the CaSR gene could lead to the development of renal stone disease. Therefore, the current study has been designed to assess the association of genetic variants of CaSR gene polymorphisms with renal stone disease. MethodA single-centric prospective study has been carried out on a total of 300 participants (150 cases and 150 controls). Serum levels of calcium, creatinine, parathyroid hormone, and 24 Hour urine metabolites were measured. Two polymorphisms, rs1801725 and rs1042636, of the CaSR gene, have been genotyped for each participant. T-test, Chi-square, and Receiving Operative Curve (ROC) curve analysis were used for statistical analysis. ResultRenal stone patients had signi cantly higher levels of serum parathyroid hormone, creatinine, and 24hr urine metabolites in comparison to the controls. CaSR gene variants rs1801725 (GG) and rs1042636 (AA) both have shown signi cant association with renal stone disease. In addition, individuals having speci c genotypes along with metabolic abnormalities such as hypercalcemia, and hyperparathyroidism are found to be at a higher signi cant risk of developing the renal stone disease. Further, ROC analysis also showed a higher risk (54%) for individuals carrying the GG/AA haplotype. ConclusionIn the present study, the haplotype of the CaSR gene has shown an association with renal stone disease. Individuals with hyperparathyroidism and hypercalcemia and risk genotype have a higher susceptibility to developing the renal stone disease.
Purpose Calcium is the most abundant metabolite involved in the stone matrix. The CaSR gene controls calcium homeostasis, and genetic variation in the CaSR gene could lead to the development of renal stone disease. Therefore, the current study has been designed to assess the association of genetic variants of CaSR gene polymorphisms with renal stone disease. Method A single-centric prospective study has been carried out on a total of 300 participants (150 cases and 150 controls). Serum levels of calcium, creatinine, parathyroid hormone, and 24 Hour urine metabolites were measured. Two polymorphisms, rs1801725 and rs1042636, of the CaSR gene, have been genotyped for each participant. T-test, Chi-square, and Receiving Operative Curve (ROC) curve analysis were used for statistical analysis. Result Renal stone patients had significantly higher levels of serum parathyroid hormone, creatinine, and 24hr urine metabolites in comparison to the controls. CaSR gene variants rs1801725 (GG) and rs1042636 (AA) both have shown significant association with renal stone disease. In addition, individuals having specific genotypes along with metabolic abnormalities such as hypercalcemia, and hyperparathyroidism are found to be at a higher significant risk of developing the renal stone disease. Further, ROC analysis also showed a higher risk (54%) for individuals carrying the GG/AA haplotype. Conclusion In the present study, the haplotype of the CaSR gene has shown an association with renal stone disease. Individuals with hyperparathyroidism and hypercalcemia and risk genotype have a higher susceptibility to developing the renal stone disease.
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