Purpose: To describe our experience in the management of retained encrusted ureteral stents using a single session combined endourological approach. Materials and Methods: Patients with retained encrusted ureteral stents who had been submitted to a single session combined endourological approach from June 2010 to June 2018 were prospectively evaluated. Patients were divided according to the Forgotten-Encrusted-Calcified (FECal) classification. The stone burden, surgical intervention, number of interventions until stone free status, operation time, hospital stay, complications, stone analysis, and stone-free rate were compared between groups. ANOVA was used to compare numerical variables, and the Mann-Whitney or Chi-square test to compare categorical variables between groups. Results: We evaluated 50 patients with a mean follow-up of 2.9±1.4 years (mean±SD). The groups were comparable in terms of age, sex, laterality, BMI, comorbidities, ASA, reason for stent passage, and indwelling time. The stone burden was higher for grades IV and V (p=0.027). Percutaneous nephrolithotomy was the most common procedure (p=0.004) for grades IV and V. The number of procedures until the patients were stonefree was 1.92±1.40, and the hospital stay (4.2±2.5 days), complications (22%), and stone analysis (66% calcium oxalate) were similar between groups. The stone-free rate was lower in grades III to V (60%, 54.5%, and 50%). Conclusions: The endoscopic combined approach in the supine position is a safe and feasible technique that allows removal of retained and encrusted stents in a single procedure. The FECal classification seems to be useful for surgical planning.
movement) recovery, hospital discharge order written, actual hospital discharge, opioid consumption, and overall postoperative ileus-related morbidity. Categorical and linear variables were compared using Fisher's exact and Mann Whitney U tests, respectively.RESULTS: There was no significant differences in mean patient age, gender distribution, type of urinary diversion, or PCA usage between groups. There were no significant side effects reported in patients receiving alvimopan. Alvimopan significantly decreased time to return of bowel function (GI-2: 104Ϯ33hr vs. 142 Ϯ 53hr, pϽ0.01; GI-3: 102Ϯ34hr vs. 140Ϯ53hr, pϽ0.01). Hospital length of stay was significantly shorter in patients treated with alvimopan (5.8Ϯ1.3d vs. 7.5Ϯ2.9d, pϽ0.05). The 30-day readmission rate for vomiting, adynamic ileus, or partial small bowel obstruction in patients receiving alvimopan was 0% compared to 10.4% in the control group.CONCLUSIONS: Consistent with clinical trial data in general surgery series, alvimopan use following radical cystectomy shortened hospital length of stay and decreased time to return of bowel function by approximately 1.5 days. These results support the clinical benefit of alvimopan in patients undergoing radical cystectomy.
First worldwide broadcast with remote mix using Dolby Atmos. More than 40 channels canalized from the Sambódromo to the Globo studios in Jacarepaguá, mixed with Dolby Atmos technology.
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