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Feasibility of Anesthesia-Free Ureteroscopic Lithotripsy in Elderly Patients with Urinary Tract Infections
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Duk Yoon Kim, Hyun Jin Jung, Eun Kyoung Yang, Won Yeol Cho
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Urogenit Tract Infect 2023;18(2):60-63. Published online August 31, 2023
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DOI: https://doi.org/10.14777/uti.2023.18.2.60
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 Abstract
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- Purpose: Patients with underlying diseases, particularly in the elderly, urinary tract obstruction with a ureter stone would progress to severe conditions. Some of them have poor general conditions to endure anesthesia. Therefore, this study validated the feasibility of ureteroscopic stone removal without anesthesia for elderly patients with ureter stones who were under impending septic conditions or severe urinary tract infections.
Materials and Methods: Thirty-four patients (16 males and 18 females) were included in this study. All of them had serious problems, making it difficult to endure anesthesia. Most of them were inserted pre-operative percutaneous nephrostomy catheter, and ureteroscopic lithotripsy was performed successfully after intravenous analgesic injection (pethidine 25 mg).
Results: The mean age was 71.8±10.84 years. The locations of the stones were upper ureter in 11, mid-ureter in 6, and lower ureter in 17 cases. Urine and blood cultures identified bacteria from 17/34 patients. Escherichia coli was the most common (10/17), followed in order by Klebsiella pneumoniae and Staphylococcus epidermidis in 5 and 2 cases, respectively. Most patients had an abnormal white blood cell count (19,400±4,233.3/l) and elevated C-reactive protein levels (110.3±83.6 mg/L). No patient had to stop the operation because of intolerable pain. The mean of the visual analog pain scale was 3.2±0.86. The overall success rate was 100%.
Conclusions: The trial of ureteroscopic lithotripsy after administering analgesics could improve the condition of elderly patients whose general condition is too poor to endure anesthesia without serious complications.
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Korean Translation of the GRADE Series Published in the BMJ, ‘Use of GRADE Grid to Reach Decisions on Clinical Practice Guidelines When Consensus Is Elusive’ (A Secondary Publication)
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Hyun Jin Jung, Eu Chang Hwang, Do Kyung Kim, Ho Won Kang, Ja Yoon Ku, Hong Wook Kim, Jae Hung Jung, Guideline Development Committee in the Korean Association of Urogenital Tract Infection and Inflammation
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Urogenit Tract Infect 2020;15(3):83-89. Published online December 31, 2020
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DOI: https://doi.org/10.14777/uti.2020.15.3.83
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- This article is the last of a series providing guidance for the use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system for rating the quality of evidence and grading the strength of recommendations in systematic reviews and clinical practice guidelines. Formulating recommendations with the applicable evidence can be difficult due to the large and diverse nature of guideline committees. This article describes a simple technique called the GRADE grid for clarifying the opinions from guideline panels, dealing with disagreement, and achieving consensus among guideline panels. The grid may be helpful for any guideline groups who want to use GRADE to develop their guidelines and achieve consensus or understand the patterns of uncertainty that surround the interpretation of scientific evidence.
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Korean Translation of the GRADE Series Published in the BMJ, ‘GRADE: Incorporating Considerations of Resources Use into Grading Recommendations’ (A Secondary Publication)
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Hong Wook Kim, Jae Hung Jung, Do Kyung Kim, Ho Won Kang, Ja Yoon Ku, Hyun Jin Jung, Eu Chang Hwang, Guideline Development Committee in the Korean Association of Urogenital Tract Infection and Inflammation
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Urogenit Tract Infect 2020;15(2):57-62. Published online August 31, 2020
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DOI: https://doi.org/10.14777/uti.2020.15.2.57
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- This article is the fifth translation of a GRADE series published in the BMJ for incorporating the considerations of resources use into grading recommendations. Clinical recommendations inevitably involve judgments about the allocation of resources use (costs). Although costs differ from typical healthcare outcomes, such as mortality, morbidity, and quality of life, costs are another potentially important outcome that differs across and within a jurisdiction. A balance sheet is a useful method for determining if the net benefits are worth the incremental costs. Resource use, not just monetary values, should always be presented in an evidence profile. Formal economic modeling may or may not help judge the certainty of the evidence for resource use.
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Korean Translation of the GRADE Series Published in the BMJ, ‘GRADE: Grading Quality of Evidence and Strength of Recommendations for Diagnostic Tests and Strategies’ (A Secondary Publication)
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Jae Hung Jung, Do Kyung Kim, Ho Won Kang, Ja Yoon Ku, Hyun Jin Jung, Hong Wook Kim, Eu Chang Hwang, Guideline Development Committee in the Korean Association of Urogenital Tract Infection and Inflammation
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Urogenit Tract Infect 2020;15(1):16-25. Published online April 30, 2020
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DOI: https://doi.org/10.14777/uti.2020.15.1.16
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PDFSupplementary MaterialPubReaderePub
- This article is the fourth translation of a GRADE series published in the BMJ, which graded the quality of evidence and strength of recommendations for diagnostic tests or strategies, as a comprehensive and transparent approach for developing recommendations. Randomized trials for diagnostic approaches represent the ideal study design for intervention studies. On the other hand, cross-sectional or cohort studies with a direct comparison of the test results with an appropriate reference standard can provide high-quality evidence. The guideline panel must be reminded that the test accuracy is a surrogate for patient-important outcomes, so such studies often provide a low quality of evidence for recommendations regarding diagnostic tests, even when the studies do not have serious limitations. Diagnostic accuracy studies showing that a diagnostic test or strategy improves important patient outcomes will require the availability of effective treatment, reduction of test-related adverse effects or anxiety, or improvement of the patients’ well-being from prognostic information. Therefore, it is important to assess the directness of the test results regarding the consequences of diagnostic recommendations that are important to patients.
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Korean Translation of the GRADE Series Published in the BMJ, ‘GRADE: Going from Evidence to Recommendations’ (A Secondary Publication)
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Eu Chang Hwang, Do Kyung Kim, Ho Won Kang, Ja Yoon Ku, Hyun Jin Jung, Hong Wook Kim, Jae Hung Jung, Guideline Development Committee in the Korean Association of Urogenital Tract Infection and Inflammation
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Urogenit Tract Infect 2019;14(3):99-103. Published online December 31, 2019
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DOI: https://doi.org/10.14777/uti.2019.14.3.99
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- This article is the third translation of a GRADE series published in the BMJ for developing and presenting recommendations for managing patients. The strength of a recommendation reflects the extent to which we can be confident that desirable effects of an intervention outweigh any undesirable effects. GRADE classifies the strength of recommendations as strong or weak. The strength of recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, quality of the evidence, variability in values and preferences, and the appropriate usage of resources.
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Korean Translation of the GRADE Series Published in the BMJ, ‘GRADE: What Is “Quality of Evidence” and Why Is It Important to Clinicians?’ (A Secondary Publication)
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Ho Won Kang, Jae Hung Jung, Do Kyung Kim, Ja Yoon Ku, Hyun Jin Jung, Hong Wook Kim, Eu Chang Hwang, Guideline Development Committee in the Korean Association of Urogenital Tract Infection and Inflammation
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Urogenit Tract Infect 2019;14(2):64-70. Published online August 30, 2019
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DOI: https://doi.org/10.14777/uti.2019.14.2.64
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- This article is second translation of a GRADE series published in the BMJ to create a highly structured, transparent, and informative system for rating quality of evidence for developing recommendations. The process to develop a guideline, we should formulate a clear question with specification of all outcomes of importance to patients. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) offers four levels of evidence quality: high, moderate, low, and very low for these patient-important outcomes. Randomized trials begin as high quality evidence and observational studies as low quality evidence. Although randomized trials begin as high quality evidence, quality may be downgraded as a result of study limitations (risk of bias), inconsistency (variability in results), indirectness, imprecision (wide confidence intervals), or publication bias. While the quality of evidence derived from observational studies starts at ‘low’ but may be upgraded based on a very large magnitude of effect, a dose-response gradient, and if all plausible biases would reduce an apparent treatment effect.
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Korean Translation of the GRADE Series Published in the BMJ, ‘GRADE: An Emerging Consensus on Rating Quality of Evidence and Strength of Recommendations’ (A Secondary Publication)
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Do Kyung Kim, Eu Chang Hwang, Ho Won Kang, Ja Yoon Ku, Hyun Jin Jung, Hong Wook Kim, Jae Hung Jung, Guideline Development Committee in the Korean Association of Urogenital Tract Infection and Inflammation
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Urogenit Tract Infect 2019;14(1):28-32. Published online April 30, 2019
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DOI: https://doi.org/10.14777/uti.2019.14.1.28
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- Clinical practice guidelines are statements that include recommendations intended to optimize patient care based on a systematic review of the evidence assessing the benefits and harm of alternative care options. Guideline developers should use an explicit, judicious, and transparent methodology to make trustworthy guidelines. Although there are a variety of frameworks that can help translate enormous medical knowledge into recommendations, the most widely adopted tool for grading the quality of evidence and making recommendations is GRADE (Grading of Recommendations, Assessment, Development and Evaluations). This article is the first translation of a series published in the BMJ with regard to the GRADE Approach for Evidence Based Clinical Practice Guideline Development to provide informative knowledge for moving from evidence to recommendations to Korean guideline developers.
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Infected Lymphocele Extending to the Leg after Robot-Assisted Radical Prostatectomy and Pelvic Lymph Node Dissection
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Hyun Jin Jung
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Urogenit Tract Infect 2017;12(3):134-136. Published online December 31, 2017
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- Lymphocele infection is a rare complication after radical prostatectomy and pelvic lymph node dissection (PLND). Here, we present a case of lymphocele infection that extended to the leg two months after robot-assisted laparoscopic radical prostatectomy and PLND. The patient was a 60-year-old man whose chief complaints were fever, chills, and right thigh pain. Computed tomography showed infected lymphocele with right thigh abscess. After percutaneous drainage and intravenous antibiotics, the infection and right thigh abscess were resolved.
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Superficial Angiomyxoma of the Scrotum
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Hyun Jin Jung, Duk Yoon Kim
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Korean J Urogenit Tract Infect Inflamm 2013;8(2):133-135. Published online October 31, 2013
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- Superficial angiomyxoma is a rare benign multilobulated cutaneous tumor, comprised of a prominent myxoid matrix and numerous blood vessels. It usually located on trunk, head and neck or lower extremity. Scrotal superficial angiomyxoma is extremely rare. We report a case of superficial angiomyxoma on the scrotum of a 69-year-old man.
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