Although rare, prostatic abscess is a serious condition that needs quick diagnosis and treatment. In our experience, TRUS-guided transrectal placement of a drainage tube is a feasible and safe treatment alternative for prostatic abscess; it is also easy to perform and well tolerated by the patients.
The aim of our study was to evaluate the efficacy and safety of ESWL using a modified lateral position in obese patients with renal stones. Nineteen obese patients with renal stones were enrolled (group A). The mean stone diameter was 1.3 cm (0.7-1.9 cm). The mean BMI was 35.1 kg/m² (31-41 kg/m²). Patients were placed in the lateral position, with the energy source facing their body posteriorly and the site where the stone was located in direct contact with the water cushion. Success rate (defined as the percentage of patients who were stone-free or with insignificant fragments after 3 months), mean number of ESWL sessions, mean duration of ESWL session and complications were recorded. The results were compared with those of 17 obese patients (Group B) with similar baseline characteristics treated in the standard supine position. All ESWLs were performed using the Dornier lithotripter SII. Both success rate (68.4 vs. 64.7% for groups A and B, respectively) and mean number of sessions (2.2 vs. 2.6) did not differ significantly between the two groups (p = 0.5). Interestingly, the time required to complete ESWL was significantly shorter for group A patients (56 min) compared to group B (73 min) (p = 0.001). No severe complications (including hematoma, pyelonephritis) were recorded. Our data indicate that ESWL in the modified lateral position for renal calculi in obese patients seems to be feasible and safe. In addition, it is faster than in the supine position since it overcomes technical difficulties. Further studies with a large number of patients are required to support our findings.
Objective: To evaluate the possibility of performing minipercutaneous nephrolithotomy (mini-PCNL) under assisted local anesthesia in a selected group of patients. Patients and Methods: Twenty-one patients with unilateral renal obstruction requiring mini-PCNL were enrolled in the study. Prior to surgery, all patients received: a) paracetamol 1.2 g intravenous (i.v.); b) parecoxib (COX2 inhibitor) 40 mg i.v., and c) infiltration of the surgical field with local anesthetic (20 ml of 1% lidocaine). Prior to the dilatation, all patients received midazolam 2 mg i.v. and fentanyl 100 mg i.v. Percutaneous renal tract access was created with ultrasound guidance. All patients were informed of the possibility of experiencing short periods of discomfort or pain, and all patients completed a postoperative visual analogue pain scale questionnaire. Results: All 21 patients completed the study, and the procedure was well-tolerated. Only three patients complained of mild pain and received additional fentanyl. Intraoperative problems and postoperative complications were mainly attributed to the mini-PCNL procedure itself rather than to the analgesic regimen administered. No complications related to the modality of anesthesia were encountered. The mean visual analogue pain scale score at the end of the procedure was 2.9 ± 0.9. Patients were directly transferred back to the ward immediately after the operation. Conclusions: Our study indicates that mini-PCNL can be performed safely and effectively under assisted local anesthesia in a selected group of patients.
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