#16 Click here to see the previous editions September 02, 2023
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Hello and welcome to the Stone News by Devicare, where we discuss every 2 months the most recent and relevant studies in stone disease.

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Dear Stone Fans. Welcome to this late summer edition of Stone News.

Today we will review three great papers on stones disease. We will evaluate the true effect of pregabalin for postoperative pain after ureteroscopy. Also we will review the scores for septic shock prediction after PCNL and finally, the use of lead glasses and ALARA protocols to reduce radiation exposure. I hope this Stone News will keep you hopeful during the heatwaves.

img Randomized Controlled Trial of Single-dose Perioperative Pregabalin in Ureteroscopy
Rosen GH, et al J Urol. 2023
img 1'
https://pubmed.ncbi.nlm.nih.gov/37307424/ img

This randomized controlled trial was performed to address postoperative pain after ureteroscopy with a new treatment tendency to decrease opioid use.

In a single institution a placebo-controlled trial was performed in 118 patients undergoing ureteroscopy without contraindications to analgesics. In the therapeutic arm of the study patients were given 300 mg of pregabalin 1 prior surgery. One hour after surgery both groups were assessed with a visual analogue scale.

The authors saw that postoperative pain was higher in the group receiving pregabalin compared to placebo (3.7 vs 2.0, P = .004) indicating that it did not decrease postoperative pain as suspected. The authors conclude that this medication should not be used as it is unlikely to reduce postoperative pain.

img Quick Sequential Organ Failure Assessment Score Is a Better Predictor of Septic Shock After Percutaneous Nephrolithotomy: A Secondary Analysis of Two Multicenter Prospective Trials
Gerrity J. et al. J Edourol. 2023.
img 1'
https://pubmed.ncbi.nlm.nih.gov/37294208/ img

This evaluation from two prospective multicentric studies performed by the Edge Research Consortium, evaluated the use of the quick sequential organ failure assessment (qSOFA) as a possible superior tool over known SIRS criteria to predict septic shock in PCNL. 218 patients were assessed on the first postoperative day after PCNL. Only one patient required vasopressor support in the ICU. Although the possibility of both scores to predict post-PCNL septic shock is low, the authors conclude that qSOFA may offer greater specificity than SIRS criteria when predicting post-PCNL septic shock.

img Estimated Radiation Dose to the Lens During Endourologic Procedures: The Role of Leaded Glasses and the ALARA Protocol—An ESU/ESUT-YAU Endourology Group Collaboration
Bravo-Balado A. et al. J Endourol. 2023.
img 2'
https://pubmed.ncbi.nlm.nih.gov/37337653/ img

Radiation exposure remains a great risk for endourologists. Recently, as the eye lens is one of the most sensitive organs to radiation the European Atomic Energy Community reduced the annual equivalent dose limit from 150 to 20 mSv/year. In this paper, multicenter prospective data of annual eye dosimeters between 2017 and 2020 was collected. Four endourologists used an eye dosimeter in all endourologic procedures. 2 surgeons used eye protection with lead glasses, and one used an ALARA protocol.

All surgeons preformed an average of 100+ surgeries a year (one did 586 procedures). The median annual dose of lens radiation exposure was low and was not correlated to the number of cases. The urologists using glasses register lower radiation dose. The surgeron who used the ALARA protocol registered the lowest. Based on the data the use of glasses and an ALARA protocol should be implemented to reduce the exposure.

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