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Urinary Tract Calculi VI: Surgical Management01:25

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Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
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IntroductionIntravenous Urography (IVU) and Retrograde Pyelography (RP) are important diagnostic imaging techniques used to evaluate the urinary system. These methods help identify structural abnormalities, obstructions, and functional issues in the kidneys, ureters, and bladder. Both procedures use iodine-based contrast media to enhance the visibility of urinary tract structures on X-ray images, though they differ in their methods and indications.1. Intravenous Urography (IVU)Intravenous...
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Opioid-free percutaneous nephrolithotomy: an initial experience.

Raymond Khargi1, Alan J Yaghoubian2, Ryan M Blake2

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This study found that ketorolac, a non-opioid, was as effective as oxycodone-acetaminophen for pain control after percutaneous nephrolithotomy (PCNL). This non-opioid approach may reduce risks associated with opioid prescriptions.

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Area of Science:

  • Urology
  • Pain Management
  • Public Health

Background:

  • The opioid epidemic is a major US public health crisis.
  • Percutaneous nephrolithotomy (PCNL) conventionally requires opioid pain management.
  • Excessive opioid prescribing by physicians contributes to the epidemic.

Purpose of the Study:

  • To evaluate the feasibility of a non-opioid pain regimen for PCNL patients.
  • To assess post-operative outcomes in PCNL patients discharged without opioids.
  • To reduce opioid consumption in post-PCNL pain management.

Main Methods:

  • Retrospective comparison of PCNL patients receiving ketorolac (NSAID) versus oxycodone-acetaminophen (NARC).
  • Demographic, operative, and post-operative factors were analyzed.
  • Primary outcome: unplanned pain-related healthcare encounters. Secondary outcomes: non-pain encounters, readmissions, rescue medications, complications.

Main Results:

  • No significant difference in unplanned pain-related encounters between NSAID and NARC groups (11.4% vs. 14.3%).
  • The NARC group experienced more unplanned phone calls (60% vs. 34.3%).
  • Prior stone surgery was the only independent predictor of pain-related encounters post-PCNL.

Conclusions:

  • Ketorolac is a viable non-opioid alternative for post-PCNL pain management.
  • A non-opioid pathway can mitigate opioid risks without compromising analgesia.
  • Further prospective studies are needed to confirm feasibility.