Dexmedetomidine was associated with a longer recovery time than a midazolam/fentanyl combination when used for sedation and analgesia during outpatient extracorporeal shock wave lithotripsy in this study. The incidence of rescue sedative and analgesic need was also significantly higher when dexmedetomidine was used.

Deep dorsal vein embolization for venogenic impotence is simple, effective and safe, and appears to be cost-effective. The results obtained in this limited number of patients are promising and justify trials in larger groups.

Extracorporeal shock wave lithotripsy (ESWL) is considered the standard treatment for most renal and upper ureteral stones. Some centers use ESWL to treat bile duct stones and pancreatic calculi. Although ESWL is generally considered safe and effective, major complications, including acute pancreatitis, perirenal hematoma, urosepsis, venous thrombosis, biliary obstruction, bowel perforation, lung injury, rupture of an aortic aneurysm and intracranial hemorrhage, have been reported to occur in less than 1% of patients. Here, we present an extremely rare case of acute necrotizing pancreatitis occurring after ESWL for a rightsided urinary stone, which was treated by non-operative percutaneous interventions.Key words complication, extracorporeal shock wave lithotripsy, necrotizing pancreatitis. Case reportA 39-year-old man was referred to the Department of Urology at the Baskent University Faculty of Medicine for hematuria and right flank pain in May 2004. On computed tomography (CT) scan, the patient was found to have a 4 × 2 mm calculus in the right renal pelvic region. There also were dilatations of the right pelvicaliceal system and the proximal ureter ( Fig. 1). As the obstructing stone was non-opaque, we decided to treat it with extracorporeal shock wave lithotripsy (ESWL). ESWL (Siemens Lithostar Modularis, Siemens Medical Solutions, Iselin, NJ, USA) was performed with 3500 shocks at 15 kv. The procedure was uneventful. However, 6 h later, the patient complained of gradually increasing, serious abdominal and back pain, and was referred to general surgery.On physical examination, the patient's abdomen showed muscular defense and distension. Bowel sounds were hypoactive. The patient has neither history of biliary lithiasis nor chronic alcohol consumption. Laboratory data demonstrated an elevated white blood cell level of 21 × 10 3 /µL, serum amylase level of 3903 U/L (normal range, 30-110 U/L), and serum lipase level of 9250 U/L (normal range, 13-60 U/L). Liver function tests of transaminases, bilirubin, gama glutamyl transferase, lactic dehydrogenase were all in normal laboratory ranges. Serum calcium and parathormone levels were also normal. Results of abdominal and chest radiographs were normal and without signs of bowel perforation or obstruction. An abdominal CT scan was performed and demonstrated parenchymal edema of the pancreas. In addition, there were small areas of necrosis (25 × 24 mm) on the corpus and tail regions of the organ (Fig. 2). Intraabdominal fluid in perirenal, peripancreatic and pelvic regions was also determined. The gallbladder, and intrahepatic and extrahepatic biliary systems were completely normal. Also, a residual millimetric stone on the right renal pelvis with minimum pelvic dilatation was seen, suggesting that the lithotripter had been focused on the target stone correctly.The International Symposium on Acute Pancreatitis in 1992 defined pancreatic necrosis as the presence of one or more diffuse or focal areas of non-viable pancreatic parenchyma, 1 so based on the patie...

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