Clinical efficacy of enhanced recovery after surgery in percutaneous nephrolithotripsy: a randomized controlled trial
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RESEARCH ARTICLE
Open Access
Clinical efficacy of enhanced recovery after surgery in percutaneous nephrolithotripsy: a randomized controlled trial Qing Li2*†, Li Wan1†, Shucheng Liu1, Mingyong Li1, Libo Chen1, Zhengwu Hou1 and Wang Zhang1
Abstract Background: To evaluate the feasibility, safety, applied value and efficacy of enhanced recovery after surgery (ERAS) for PCNL for the treatment of renal calculi. Although the ERAS is applied for many urological diseases, its application in percutaneous nephrolithotripsy (PCNL) is still limited. Methods: This was a prospective study of patients admitted to hospital January and December 2018 and who were only diagnosed with renal calculi and excepted for serious or uncontrollable basic diseases and patients with multiple operation history and medication history. Patients were randomized 1:1 to the ERAS and traditional operation groups starting on the day before operation and end on the day of discharge. Each group was 118 cases. The stone clearance rate, visual analogue scale (VAS) pain score, the occurrence of perirenal hematoma and effusion, the incidence of extravasation of urine, the incidence of fever, bleeding and blood transfusion, and postoperative hospital stay were observed. Results: The stone clearance rates were similar between the two groups (ERAS: 93.2% (109/117) vs. traditional: 89.8% (106/118), P = 0.800). The operation time was similar in the two groups (ERAS: 54 ± 12 vs. traditional: 58 ± 11 min, P = 0.656). VAS pain score that was 0.79 ± 0.76 in the ERAS group at 4 h after surgery and was significantly lower than 2.79 ± 0.98 in the traditional group (P 4 cm); (2) bilateral renal multiple calculi; (3) severe upper urinary tract malformations such as horseshoe kidney malformation, ureteropelvic stenosis (UPJO), giant ureter disease (POM), and other combined calculi that requires complicated surgery, longer operative time, multiple surgeries, or other factors affecting efficacy evaluation; (4) disease considered to affect the process of surgery, postoperative rehabilitation, prognosis and cost; (5) patient with septic shock; (6) requirement
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for emergency surgery like catheterization or fistula; (7) ipsilateral upper urinary tract surgery history, (8) active severe infection,(as PCT > 0.5, leukocyte + in urine and other patients with UROGENOUS sepsis diagnosis). (9) Patients taking anticoagulant drugs such as aspirin and warfarin in recent 1–2 weeks. The surgery could be performed only when the coagulation function was with normal results. PCNL was performed by a single surgeon under general anaesthesia in both group. After induction of anaesthesia, with the patient in lithotomy, a 4-F urethral catheter was inserted into the ureter via cystoscopy. Then the patient was repositioned to prone. Then, an 18-G access needle was placed into the preferred calyx under ultrasound guidance. A tiny incision was made in the skin and fascia, and then the 18-F fascial dilator was used to dilate the nephrostomy tract to pass the 18-F semirigid plastic sh
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