World Journal of Urology最新文献

Purpose: Enhanced recovery after surgery (ERAS) is an evidence-based perioperative care approach aimed at attenuating surgical stress response and facilitating patient recovery. This study compared postoperative outcomes between an ERAS perioperative model to a traditional, unstandardized perioperative care practice in patients undergoing robotic nephrectomy.

Materials and methods: A total of 206 patients who underwent robotic renal surgery were stratified into traditional and ERAS cohorts. In total, 111 patients received the ERAS pathway, and 95 received traditional care. Data was collected through a retrospective review of electronic medical records. The primary outcome was length of hospital stay (LOS). The secondary outcomes included patient recovery milestones, pain scores, opioid use, patient complications, 30-day readmission rates, incidence of surgical site infection, and total hospital costs.

Results: Implementation of the ERAS pathway was associated with shorter hospital stay (median LOS 2.2 days vs. 2.3 days p = 0.011), lower post-operative pain scores and lower total opioid requirements at all analyzed time points (0-1, 1-24, and 24-48 h). No statistically significant differences were observed in adverse events, rates of ileus, time to first flatus, surgical site infection, or oral intake. Hospital costs were similar between groups. 30-day readmission was higher in the traditional care cohort (9% vs. 2% p = 0.035).

Conclusions: ERAS was associated with reduced length of hospital stay, improved pain scores, reduced opioid use, and lower incidence of hospital readmission in patients undergoing robotic nephrectomy.

Background and objective: In prior times surgical treatment was the standard treatment of severe renal injuries while nowadays there is an increasing favor of conservative or interventional treatment.

Methods: Data retrieved from the TraumaRegister DGU® included 138,447 trauma patients (Max. AIS ≥ 3) in Germany from 2008 to 2022.

Key findings: The incidence of kidney trauma decreased from 3.8% in 2008 to 2.7% in 2022 (p < 0.001). Higher grades of renal injury were associated with increased risks of kidney and multiorgan failure (AAST II: 29.0%; AAST V: 51.5%), dialysis (AAST II: 5%; AAST V: 18.9%), sepsis (AAST II: 9.2%; AAST V: 15.8%) and in-hospital mortality (AAST II: 9.4%; AAST V: 32.8%). The rate of surgical treatment remained constant with about 20%. The strongest predictor for operative treatment was AAST severity (reference: AAST grade II): Odds ratio for grade III was 4.50 (95% confidence interval 3.63-5.58, for grade IV 24.6 (19.1-31.8), and for grade V 58.9 (39.7-87.4). Further predictive factors were other abdominal injuries and the need for blood transfusions. Partial or radical nephrectomy was predominantly performed in high-grade renal injuries, with 62.1% (n = 36) in AAST V and 25.0% (n = 26) in other high-grade traumas. Interventional bleeding control was most frequent in AAST III (21.7%, n = 13) and AAST IV (19.2%, n = 20).

Conclusion: Although the incidence of renal injuries has slightly declined, the rate of surgical interventions remains unchanged. Factors favoring surgery included hemodynamic instability and further abdominal trauma. Nephrectomies were mainly performed in high-grade renal trauma, while interventional bleeding control was more frequent in lower AAST grades.