fibrin glue as a sealant in stentless laparoscopic pyeloplasty a randomised controlled trial ahmed farouk资料.pdf

该【fibrin glue as a sealant in stentless laparoscopic pyeloplasty a randomised controlled trial ahmed farouk资料 】是由【赖大文档】上传分享，文档一共【7】页，该文档可以免费在线阅读，需要了解更多关于【fibrin glue as a sealant in stentless laparoscopic pyeloplasty a randomised controlled trial ahmed farouk资料 】的内容，可以使用淘豆网的站内搜索功能，选择自己适合的文档，以下文字是截取该文章内的部分文字，如需要获得完整电子版，请下载此文档到您的设备，方便您编辑和打印。ArabJournalofUrologyISSN:(Print)2090-598X(Online)Journalhomepage:https:///taju20Fibringlueasasealantinstentlesslaparoscopicpyeloplasty:ArandomisedcontrolledtrialAhmedFarouk,AhmedTawfick,MahmoudReda,,WaleedMousa,&HassanShakerTocitethisarticle:AhmedFarouk,AhmedTawfick,MahmoudReda,,WaleedMousa,&HassanShaker(2019)Fibringlueasasealantinstentlesslaparoscopicpyeloplasty:Arandomisedcontrolledtrial,ArabJournalofUrology,17:3,228-233,DOI:.1611990Tolinktothisarticle:https:///.1611990?2019TheAuthor(s).PublishedbyInformaUKLimited,tradingasTaylor&::111ViewrelatedarticlesViewCrossmarkdataFullTerms&essandusecanbefoundathttps://ion/journalInformation?journalCode=taju20ARABJOURNALOFUROLOGY2019,,,228–233https:///.1611990LAPAROSCOPY/ROBOTICS:ORIGINALARTICLEFibringlueasasealantinstentlesslaparoscopicpyeloplasty:ArandomisedcontrolledtrialAhmedFarouk,AhmedTaw?ck,MahmoudReda,,WaleedMousa,,AinShamsUniversityHospitals,Cairo,EgyptABSTRACTARTICLEHISTORYObjective:Toevaluatethevalueofadding?bringlue,asasealantmaterial,totheanasto-Received28October2018moticlineduringstentlesslaparoscopicpyeloplasty(LPP).Accepted8April2019Patientsandmethods:Inall,92patientswithpelvi-uretericjunctionobstruction(PUJO),KEYWORDSscheduledforLPP,wererandomisedintotwogroups(46ineachgroup).GroupA,underwentLaparoscopicpyeloplasty;transperitonealstentlessLLPsealedwith?bringlue,whilstGroupBunderwentthesame?bringlue;PUJobstruction;procedurewithout?:,wefoundasigni?cantstatisticaldi?,ingroupsAandBrespectively(P=).Aprolongedleaklastingfor>5days,whichstoppedurredinthreepatients(%)inGroupAandsix(%)inGroupB(P=).Apersistent14-dayleakthatneededinterventiondevelopedintwopatients(%)inGroupAand?ve(%)inGroupB(P=).OnepatientinGroupBdevelopedurinoma1weekafterdischarge,?cantdi?erencebetweenthegroupsforpostoperativecomplicationsintheearly3-(%)and36patients(%),ingroupsAandBrespectively(P=).Conclusion:Adding?:CONSORT:ConsolidatedStandardsofReportingTrials;DTPA:diethylene-triamine-penta-aceticacid;LPP:laparoscopicpyeloplasty;PUJO:PUJobstruction;T?:clear-ancehalftime(renogram)Introductionsigni?cantmorbidity[4].Additionally,removingthemrequiresanadditionalprocedureandexpo-PUJobstruction(PUJO)-Hynesdismem-beredpyeloplastyisthe‘goldstandard’fortreatingTheoretically,stentscanactasforeignbodies?PUJO,promisedvascularityandbrosisatthe90%[1].,laparoscopicpyelo-riskofinfection,avoidstheriskofthepatientdevel-plasty(LPP)hasbeendevelopingasanalternativeopingstentsyndromeandtheneedforcystoscopicingmoreorlessastandardremoval[5].Therefore,thereistrendtowardsstent-,especiallywhenwatertightclosurecanberesultsofopenpyeloplastywiththeadvantageofachieved[6,7].beingminimallyinvasive[2].AsthereisprolongedleakageandhospitalstayThemeritsofintubatedvsnon-intubatedrepairinstentlessLPP,[8–10],itisplausible,atleasttheoretically,hatadding?bringlueonthesuturelineasleakageandtomaintaintheanastomosispatent,asealantmaterialcouldbeusedtodecreaseurin-aspostoperativelyoedemaattheanastomoticsitearyleakageandpromotehealing[11].Thus,inthelusionofthelumen[3].However,presentstudy,weaimedtoassessthevalueandindwellinguretericstentscancauseproblemsande?ectivenessofadding?bringlue,asasealantsigni?cantadversee?ects,fort,infec-material,totheanastomoticsuturelineduringtion,migration,andencrustation,?ckMurmer_******@LectureofUrology,DepartmentofUrology,AinShamsUniversityHospitals,Cairo11591,Egypt.?2019TheAuthor(s).PublishedbyInformaUKLimited,tradingasTaylor&(/licenses/by//),whichpermitsunrestricteduse,distribution,andreproductioninanymedium,(CONSORT)?owchart(Figure1).TheprimaryendpointofthisstudywastoevaluateAllpatientsunderwenttheprocedureundergeneralurinaryleakage,–60°lat-;BetweenMarch2013andJune2016,187patientstherenalpelvisandupperureterwereidenti?edandpresentedtotheoutpatienturologyclinicoftheuni-,-,-underwenttransperitonealdismemberedLPPbasedtulatedposteriorlyfor2–:pletedbytwoseparatecontinuoussuturesofInclusioncriteria:4-0polyglycolicacid(Vicryl?;EthiconInc.,Somerville,NJ,USA),atbothsidesoftheapexofuretericspatula-●Signi?cantloinpaintiontothecorrespondingmostdependentpartofthe●Signi?cantpelvi-calycealdilatation(Grade>II).‘lips’ofthespatulatedureterwere●Splitrenalfunctionlowerby10%paredtoanastomosedtotherenalpelvis,startingwiththepos-?rst,●Clearancehalftime(T?;renogram)>,5–8mLsemi-solid?bringluewaspre-paredandappliedbyintroducinganopen-tip16-FExclusioncriteria:catheterthroughthe10-?bringluewasthenloadedintoawide-nozzled60-mL●Non-secretingkidneywithsplitfunctionofsyringeandthegluetheninjectedthroughthecathe-<15%.,no●Previousrenalsurgery.?bringluewasinjected.●,a16-Ftubedrainwasinsertedfrom●Childrenaged<,underlaparoscopicguidance,anditwas●<:operativetimeSamplesizewascalculatedusingtheSTATAprogramfromapplyingthe?rstportuntilapplyingthetube(StataStatisticalSoftware:release12;StataCorp.,Collegedrain,plications,postoperativepainStation,TX,USA),settingthetype-1error(α)(determinedusingavisualanaloguescale,range0–10),thepower(1-β),amountanddurationofurinaryleakage,,-monthfollow-upthepatientsweconductedapilotstudy,??bringluefromautologousbloodaminimalsamplesizeof39casespergroup,assuminga10%drop-outrate;therequiredsamplewasthereforeThe?bringluewaspreparedusingtwoconstituents,?rstponentwaspreparedasfollows:100mLbloodAfterobtaininginformedconsentformsfromthefromthepatientwaswithdrawnonsodiumcitratepatientsandexplainingtothemtheinvestigational10%.Thissamplewascentrifugedfor8minat1923natureofthestudy,%wasmixedwithpartoftheremovedbysimple1::–,theanastomoticsutureline°Cfor20minandthenre--wassealedwith?bringlue,whilstinGroupBno?brintateofthiscentrifugationbeing??brino-FacultyofMedicine’°Cfor15min,the?brinogenpelletsThepreoperativeassessmentofpatientsincluded:,pelvi-ponentwaspreparedbymixingthrombintoultrasonography,IVUwithdelayed?lm,(F-15)(40mmol/L).Thisrenogram(diethylene-triamine-penta-aceticacidmixturewassavedat37°[DTPA])withLasix,,binedtogiveThestudydesignandwork?(n=187)Excluded(n=95)Notmeetinginclusioncriteria(n=75)oparticipate(n=20)Otherreasons(n=0)Randomised(n=92)AllocationAllocatedtoexperimentalAllocatedtoexperimentalcondition(n=46)condition(n=46)ReceivedallocatedinterventionReceivedallocatedintervention(n=46)(n=46)DidnotreceiveddallocatedDidnotreceiveddallocatedintervention(n=0)intervention(n=0)Follow-upLosttofollow-up(n=4)Losttofollow-up(n=4)Discontinuedintervention(n=0)Discontinuedintervention(n=0)Analysisafter3monthsAnalysed(n=42)Analysed(n=42)Excludedfromanalysis(n=0)Excludedfromanalysis(n=0)?’st-testandMann–WhitneytestswereThecollecteddatawererevised,coded,-testwasSciences(SPSS?),(SPSSInc.,IBMCorp.,pareacontinuousvariableofthesameArmonk,NY,USA).-squaredandFisher’sexacttestswereusedexpressedasmean(SD)orasmedian(range)parequalitativevariablesofthetwostudycasesofnon--<?,wheretheno??cantdi?erencewasfoundbetweenbothgroupsMedicine’-forvisceralorvascularinjury,andtherewerenocon-(Table2).wasnotfundedbyexternalsourcesandtherewasnoIntheearlypostoperativeperiod,nosigni?cantcon??erencewasfoundforpostoperativepain,amountanddurationofleakage,timetodrainremoval,,thenumberofpatientsthathadprolongedurinaryleakagewasmorethanTherewerenostatisticallysigni?cantdi?erencesdoubleintheno?bringroupvsthe?bringroup(10betweenthetwostudygroupsforpatients’demo-and24patients,respectively),whichwashighlysta-graphics.(Table1)tisticallysigni?cantlydi?erent(P=).Fromthose,urredin?vepatientsinGroupofbothgroups,exceptforsplitrenalfunction,whereAand12patientsinGroupBintheimmediatepost-the?bringroup(GroupA)-operativeperiod,butdidnotlastfor>?bringroup(GroupB;Table1).Prolongedleakagecontinuedforof>5daysinthreeFortheintraoperativedata,therewasasigni?cantpatients(%)inGroupAandsix(%)inGroupdi?erencebetweenthe?brinandno?bringroupforB,whichstoppedspontaneouslybeforetheendof14operativetime,whichwashigherinthe?bringroup,days,astatisticallyinsigni?cantdi?erence(P=).atamean(SD)()(),two(%)and?vepatients(%),inAdditionally,therewasasigni?cantdi?erencegroupsAandBrespectively,’(?brin)GroupB(no?brin)PAge,years,mean(SD;range)(;–)(;–),n(%)34()28()()18()FemaleA?ectedside,n(%)20()15()()31()LeftSigni?cantloinpain,n(%)36()38()-secretingkidney10()6()-calycealdilatationatIVU34()36()?,min,mean(SD;range)(:–)(;–),%,mean(SD;range)34