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Genitourinary tract imaging - part 4

Phòng thí nghiệm dữ liệu được xem xét: nitơ urê máu đặc biệt là, creatinine, prothrombin, thời gian thromboplastin, tỷ lệ bình thường hóa quốc tế (INR), và tiểu cầu. Lý tưởng nhất, phòng thí nghiệm dữ liệu có nên gần đây (dưới 3 tháng tuổi). Bất thường trong INR sửa chữa bằng cách khấu trừ | 48 Uppot et al Laboratory data are reviewed particularly the blood urea nitrogen creatinine prothrombin thromboplastin time international normalized ratio INR and platelets. Ideally laboratory data should be recent less than 3 months old . Abnormalities in INR must be corrected by withholding anticoagulation mediations ie heparin giving vitamin K or correcting the coagulation abnormality with fresh frozen plasma. Platelets should also be administered prior to or during the procedure for patients with low platelet counts. Ideally INR should be less than or equal to 1.5 and platelets less than or equal to 50 000 th cmm. Conscious sedation The majority of interventional urologic procedures are performed using both local and conscious sedation. A few nonfocal renal biopsies may be performed using only local anesthetic. Prolonged and extensive ablation cases or patients at high risk for conscious sedation because of prior myocardial infarction stroke and respiratory disease may need to undergo sedation by an anesthesiologist. Conscious sedation used at the authors institution includes midazolam and fentanyl. Locally lidocaine is administered at a maximum dosage of 300 mg 30 cc of 1 lidocaine . Midazolam dose is weight based at 0.5 mg kg to 1 mg kg and fentanyl dose is 1 mcg kg to 3 mcg kg. Before any procedure requiring conscious sedation patients will need to be fasting to avoid the risk of aspiration during conscious sedation. Interventional urologic procedures Biopsy Indications for biopsy include to establish a diagnosis of benign or malignant to stage a known malignancy and to establish a diagnosis of malignancy in diffuse disease. Interventional urologic biopsies include nonfo-cal renal biopsies focal renal biopsies renal cyst aspiration adrenal biopsy ureteral biopsy percutaneous bladder biopsies and transrectal or transglu-teal prostate biopsies 1-7 . The remainder of this section will review the indications methods success rate and potential complications of .