Chronic postoperative pain (CPOP) is a serious health issue that affects millions of patients every year. The incidence of CPOP is the highest after amputations, inguinal hernioplasty, thoracotomies, cardiac surgery and breast surgery. In addition...

Urosepsis is defined as sepsis caused by urinary tract infection (UTI). Urosepsis represents a quarter of all cases of sepsis in adults. Complications of UTIs are the most common risk factor for urosepsis development. These infections, especially pyelonephritis, often occur in patients with structural or functional malformations that interfere with normal urine flow. The problem of a significant increase in UTIs with multiresistant bacteria should be emphasized, especially in patients with recurrent UTI and their frequent treatments. As the urogenital tract is one of the most common sources of infection in sepsis in general, a detailed assessment of the tract should be carried out in all septic patients. Even though urosepsis is associated with a relatively good prognosis and lower mortality than sepsis of another etiology, it occurs rapidly and progresses at a significant speed. Since urosepsis is mainly the result of obstruction of the urinary tract, the development of septic shock can most often be prevented by implementing early deobstruction. Knowledge of the most common causes of urosepsis and the category of high-risk patients will provide clinicians with the tools with which to prevent its occurrence.

Background: Postoperative delirium (POD) is one of the most common surgical complications in elderly patients. This study investigated the incidence of and perioperative risk factors for POD following urological surgery. Methods: A total of 162 male patients aged ≥50 years undergoing elective major urological surgery under general anesthesia from May 2024 to March 2025 were included in this prospective observational study. Delirium was assessed using CAM-ICU twice a day for five postoperative days. Groups with and without delirium were compared, and perioperative predictors of delirium were analyzed. Multivariate regression analysis was used to identify independent risk factors for POD. Results: Overall, 16% of patients developed delirium during the follow-up period. Patients with POD were significantly older (mean age, 73.3 ± 5.2 years vs. 66.3 ± 7.2, p < 0.001), had more comorbidities, and lived in rural areas. Atrial fibrillation and COPD were particularly significant. The incidence of POD was higher in patients with mild/moderate alcohol consumption than in those who never drink. Analysis of intraoperative factors revealed a significant difference between groups in the presence of intraoperative hypotension and blood transfusion. Patients with delirium had more severe postoperative pain. Optimal cutoff values of age (≥67.5), number of comorbidities (≥2), preoperative MMSE score (≤25.5), and postoperative NRS score (≥4.85) were determined using ROC curves. The multivariate analysis identified age ≥ 67.5 years, COPD, mild/moderate alcohol consumption, preoperative MMSE score ≤ 25.5, intraoperative hypotension, and postoperative NRS score ≥ 4.85 as independent risk factors in this cohort. Conclusions: Considering that some of the above risk factors can be modified, it is necessary to emphasize that the prevention of POD is possible and should be one of the treatment priorities in older patients.

Background and Objectives: Ketamine and magnesium sulfate (MgSO₄) are NMDA receptor antagonists that act through distinct mechanisms. Preclinical data indicate that their analgesic interaction is sequence-dependent: ketamine administered before MgSO₄ produces synergistic antinociception, whereas the reversed sequence is antagonistic. The primary outcomes were postoperative pain intensity (Numerical Rating Scale, NRS 0–10, at rest and on movement) and cumulative intravenous morphine consumption over 48 h, evaluated in patients undergoing open radical nephrectomy to test the hypothesis of sequence-dependent analgesic interaction. Materials and Methods: In this randomized, double-blind, placebo-controlled trial, 208 patients scheduled for elective open radical nephrectomy received two sequential intravenous boluses intraoperatively: Drug A immediately after induction, Drug B 10 min later. Agents were ketamine 0.2 mg/kg, MgSO₄ 15 mg/kg, or placebo (0.9% NaCl) in all nine possible combinations. Primary outcomes were postoperative pain intensity (NRS 0–10, at rest and on movement) and cumulative intravenous morphine consumption, assessed at 14 time points over 48 h. Secondary outcomes included sedation, nausea, vomiting, and the presence of hallucinations. Results: The ketamine → MgSO₄ (K → Mg) sequence significantly reduced NRS pain scores compared to placebo at multiple time points, including 30 min, 1 h, 3 h, 6 h, and 32 h postoperatively, with differences exceeding the minimum clinically important difference of 2 NRS points at the earliest assessments. The MgSO₄ → ketamine (Mg → K) sequence did not differ from placebo at any time point. Cumulative morphine consumption was comparable across groups. No hallucinations or psychomimetic events were observed. Conclusions: Intraoperative ketamine followed by MgSO₄ (K → Mg) provides clinically meaningful postoperative analgesia after open radical nephrectomy; the reversed sequence (Mg → K) offers no benefit over placebo. These findings provide the first clinical confirmation of sequence-dependent NMDA receptor antagonism and support the K → Mg protocol as a safe, simple addition to multimodal perioperative analgesia. Trial registration: ISRCTN registry, ISRCTN83633282.

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.

Background/Objectives: Frailty is well-recognized as a predictor of adverse postoperative outcomes. The Clinical Frailty Scale (CFS) is a widely recommended frailty assessment tool due to its simplicity and rapid bedside applicability; however, it has never been validated in Serbia. The aim of this study was to translate, culturally adapt, and validate the CFS in Serbia, in patients undergoing elective major surgical procedures. Methods: This cross-sectional study included 149 patients aged ≥50 years undergoing elective major urological oncology surgery. Frailty was assessed preoperatively using three scales: the CFS, the Edmonton Frail Scale (EFS), and the FRAIL scale. The CFS evaluations were independently performed by two raters and repeated after 7 days. Concurrent validity was evaluated via Spearman’s correlation between the CFS, the EFS, and the FRAIL scale. The “known-group” construct validity of the CFS was assessed using the test for trends across clinically relevant groups. Both inter-rater and test–retest reliability were assessed using the intraclass correlation coefficient (ICC). Results: The CFS was translated and culturally adapted into the Serbian language in accordance with ISPOR guidelines. The Serbian version of the CFS demonstrated both excellent inter-rater reliability (ICC = 0.957; 95% CI 0.941–0.968), and test–retest reliability (ICC = 0.958; 95% CI 0.943–0.970). A strong positive correlation was observed between the CFS and both the EFS (ρ = 0.698) and the FRAIL scale (ρ = 0.614). A known-group comparison confirmed the construct validity of the CFS. Conclusions: The Serbian version of the CFS is a reliable, valid, and clinically feasible tool for preoperative identification of frailty in patients aged 50 years and older undergoing major elective uro-oncological procedures.