Aleksandar Vuksanovic

Introduction: Extracorporeal shock wave lithotripsy (ESWL) used to be performed under general anesthesia. Today, although it is a painful procedure, it is performed under analgosedation. The aim of the study was to determine the severity of acute pain associated with ESWL using two comparative protocols for preemptive analgesics: tramadol vs. ketoprofen plus tapentadol. Methods: A clinical prospective randomized cohort study included 200 patients of both sexes aged 18-80 years who were divided into two groups: group 1 received a combination of ketoprofen 100 mg/ tramadol 50 mg i.m. 30 minutes before surgery; group 2 received tapentadol IR 50 mg orally, 1 hour before surgery. Pain intensity (NRS) and complications were recorded before, during and at the end of the procedure, respectively. Results: No difference was found in the preoperative characteristics of patient population, size and localization of the stone. Dimensions of kidney-localized stones were significantly higher in group 2 compared to group 1 (T test .000). There was a statistically significant increase in pain intensity before and during the procedure as well as pain intensity decrease during and after the procedure in each group (T test .000). In group 2, 10% of patients experienced severe pain during the procedure, compared to 3%of patients in group 1 (Mann-Witney 0.005). In the severe pain subgroups of each patient group, drowsiness occurred in 5% of patients in group 2, which was significantly more than the 1% in group 1 (overall incidence in both groups was 25%). Conclusion: Although both protocols offered average moderate pain intensity during the procedure, severe pain and nausea were observed more frequently in the tapentadol group, which was related to stone size and JJ stent insertion.

To identify independent risk factors for the development of bladder cancer after surgical management of upper urinary tract transitional cell carcinoma (UUT-TCC). Between January 1999 and December 2008, 154 patients were treated surgically for UUT-TCC at the Clinic of Urology, Clinical Center of Serbia. Patients with a previous history of bladder cancer and patients with concomitant bladder cancer were excluded from the study. In all, 92 patients were then available for evaluation. The median follow-up after surgery was 39.5 months. Univariate and multivariate analyses using the logistic regression model were performed. The intravesical disease-free rate and survival were calculated using the Kaplan–Meier method, and the log-rank test was used to determine statistical differences. In this study, 21.7% patients treated for UUT-TCC developed subsequent bladder tumors. Tumor multifocality was the only independent predictor associated with the development of subsequent bladder cancer (P = 0.028, RR = 3.52). Intravesical recurrence-free survival rates for these 92 patients at 1, 3, 5, and 7 years were 85.8, 80, 79.3, and 78.3%, respectively. Patients with tumors extending to multiple sites were significantly more likely to present subsequent intravesical recurrence (P = 0.006). The development of bladder cancer had no significant effect on the survival of patients who underwent surgical treatment of UUT-TCC, compared to patients without bladder cancer development (P = 0.660). Neither did the type of surgery mode affect patient survival (P = 0.245). This study is limited by biases associated with its retrospective design. The multiplicity of the UUT-TCC is an independent risk factor for the occurrence of bladder cancer.