Results: We identified 556 adverse events related to stone baskets. The device configuration was tipped in 48% of cases, tipless in 36%, forceps in 8% and the Stone Cone (TM) in 8%. Malfunction type included detachment of a portion of the basket in 49% of cases, breakage CB-5083 without detachment in 39% and inability to withdraw the basket in 12%. Compared to the early
period studied (1996 to 2004) there was a 3-fold increase in adverse events from 2005 to 2007 and a 6-fold increase from 2008 to 2009. Of adverse events 79% and 11% were managed by endoscopy and open surgery, respectively. Of the patients 42 experienced serious complications requiring major surgery, including ureteral reconstruction in 7, reimplantation in 4 and nephrectomy in 7.
Conclusions: With the increased use of stone baskets in the upper collecting system the number of adverse events has increased. Urologists should remain vigilant to prevent, recognize and manage these events.”
“Purpose: Management
for blunt high grade renal injury is controversial with most disagreement concerning indications for exploration. At our institution all patients are considered candidates for conservative treatment regardless of injury grade or computerized tomography appearance with clinical status the sole determinant for intervention. We define clinical factors predicting the need for emergency intervention as well the development of complications.
Materials CHIR-99021 in vivo and Methods: We analyzed the records of 117 patients with high grade renal injury (III to V) secondary to blunt trauma who presented to our institution in an 8-year period. Patients were categorized by the need for emergency intervention and, in those treated
conservatively, by complications. We generated logistic regression models to identify significant clinical predictors of each outcome.
Results: Grade III to V injury occurred in 48 (41.1%), 42 (35.9%) and 27 patients (23%), respectively. Of the 117 patients 20 (17.1%) required emergency intervention. On multivariate analysis only grade V injury (RR 4.4, 95% CI 1.9-10.5, p = 0.001) and the need for platelet transfusion (RR 8.9, 95% CI 2.1-32.1, p <0.001) significantly selleck screening library predicted the need for intervention. A total of 90 patients (82.9%) who did not require emergency intervention underwent a trial of conservative treatment, of whom 9 (9.3%) experienced complications requiring procedural intervention. On multivariate analysis only patient age (RR 1.06, 95% CI 1.02-1.1, p = 0.004) and hypotension (RR 12, 95% CI 1.9-76.7, p = 0.009) were significant predictors.
Conclusions: High grade injury can be successfully managed conservatively. However, grade V injury and the need for platelet transfusion predict the need for emergency intervention while older patient age and hypotension predict complications.