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De Gobbi A, Lupi A, Massari D, Stellato A, Behr AU, Costa G, Fiorello M. Camposampiero tubeless percutaneous nephrolithotomy (tPCNL): Easy, quick, effective, safe. Urologia 2023:3915603231210352. [PMID: 37933830 DOI: 10.1177/03915603231210352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To describe our technique to perform tubeless percutaneous nephrolithotomy (tPCNL) using hemostatic matrix (i.e. Floseal®) for the closure of the percutaneous tract, developed through the experience gained in our endourology specialized center. To evaluate the procedure efficacy and safety. METHODS tPCNL performed in our center with Floseal® application from February 2017 to December 2019 were retrospectively reviewed. Clinical and surgical data were collected in order to evaluate the success of the procedure and possible complications. Camposampiero technique is reported in detail. RESULTS Sixty-nine patients (45 males, mean age 58 years old) were included. In all patients the procedure was completed successfully and in 88% of subjects no further treatments were necessary; a low complication rate (6.9%) was reported. CONCLUSION In our experience, tPCNL with Floseal application is feasible, safe, and effective.
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Affiliation(s)
- Alberto De Gobbi
- U.O.C. Urologia, Ospedale di Camposampiero, ULSS 6 Euganea, Camposampiero, Italy
| | - Amalia Lupi
- Istituto di Radiologia, Dipartimento di Medicina - DIMED, Università degli Studi di Padova, Padova, Italy
| | - Domenico Massari
- U.O.C. Urologia, Ospedale di Camposampiero, ULSS 6 Euganea, Camposampiero, Italy
| | - Alberto Stellato
- U.O. Radiologia, Ospedale di Camposampiero, ULSS 6 Euganea, Camposampiero, Italy
| | - Astrid Ursula Behr
- U.O.C. Anestesia e Rianimazione, Ospedale di Camposampiero, ULSS 6 Euganea, Camposampiero, Italy
| | - Giuseppe Costa
- U.O.C. Urologia, Ospedale di Camposampiero, ULSS 6 Euganea, Camposampiero, Italy
| | - Mario Fiorello
- U.O.C. Urologia, Ospedale di Camposampiero, ULSS 6 Euganea, Camposampiero, Italy
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Zhang H, Chen Y, Liu P, Zhang L, Cao J. Evaluation of the safety and efficiency of color Doppler ultrasound-guided percutaneous nephrolithotomy in clinical practice: results from a retrospective study. Ren Fail 2023; 45:2275714. [PMID: 37929948 PMCID: PMC10629412 DOI: 10.1080/0886022x.2023.2275714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/21/2023] [Indexed: 11/07/2023] Open
Abstract
This study evaluated the clinical value of color Doppler ultrasound-guided percutaneous nephrolithotomy (PCNL) in avoiding bleeding caused by punctured blood vessels. Herein, we retrospectively included patients who underwent color Doppler ultrasound-guided PCNL or PCNL using the conventional channel technique from August 2018 to August 2022. The clinical characteristics of patients during surgery, complications, and hospital stay were recorded and compared. Overall, 228 patients were enrolled, with 126 patients (age, 47.6 ± 13.2 years; men: 57.14%) in the color Doppler ultrasound-guided PCNL group and 102 patients (age, 46.6 ± 12.3 years) in the B-mode ultrasound-guided puncture group. The total operation time (63.5 ± 15.5 vs. 61.3 ± 16.3 min, p = .5236) and stone clearance rate (86.50% vs. 83.33%, p = .7139) were similar between the two groups. However, the puncture time for the color Doppler ultrasound-guided PCNL group was longer than that for the B-mode ultrasound-guided puncture group (5.1 ± 2.3 vs. 2.6 ± 1.6 min, p = .0019). Moreover, the length of postoperative hospital stay in the color Doppler ultrasound-guided PCNL group reduced significantly by ∼1 day compared with that in the B-mode ultrasound-guided puncture group (4.5 ± 1.6 vs. 5.6 ± 2.1 days, p = .0087). The blood transfusion rate (1.58% vs. 4.9%, p = .0399), sedation-related adverse event rate (0.79% vs. 2.9%, p = .0332), perineal hematoma incidence (0% vs. 2.94%, p < .0001), and serum decreased hemoglobin levels (12.2 ± 9.7 vs. 23.5 ± 10.1 g/L, p < .001) after color Doppler ultrasound-guided PCNL were significantly lower than those after B-mode ultrasound-guided puncture. The stone clearance rate was similar between the two groups, with a similar operation time. Moreover, color Doppler ultrasound-guided PCNL shortened the postoperative hospital stay and decreased Hb levels, blood transfusion rate, and perineal hematoma incidence.
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Affiliation(s)
- He Zhang
- Department of Urology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
| | - Yuangui Chen
- Department of Urology, Naval Speciality Medical Center, Shanghai, China
| | - Peng Liu
- Department of Urology, Shanghai 411 Hospital, Shanghai, China
| | - Lin Zhang
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jianwei Cao
- Department of Urology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University, School of Medicine, Shanghai, China
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Gauhar V, Traxer O, García Rojo E, Scarcella S, Pavia MP, Chan VWS, Pretore E, Wroclawski ML, Corrales M, Tiong HY, Lim EJ, Teoh JYC, Heng CT, de la Rosette J, Somani BK, Castellani D. Complications and outcomes of tubeless versus nephrostomy tube in percutaneous nephrolithotomy: a systematic review and meta-analysis of randomized clinical trials. Urolithiasis 2022; 50:511-522. [PMID: 35674819 PMCID: PMC9468100 DOI: 10.1007/s00240-022-01337-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 05/23/2022] [Indexed: 10/26/2022]
Abstract
We aimed to perform a systematic review of randomized trials to summarize the evidence on the safety and stone-free rate after Tubeless percutaneous nephrolithotomy (PCNL) (ureteral stent/catheter, no nephrostomy) compared to Standard PCNL (nephrostomy, with/without ureteral stent/catheter) to evaluate if the tubeless approach is better. The inverse variance of the mean difference with a random effect, 95% Confidence Interval (CI), and p values was used for continuous variables. Categorical variables were assessed using Cochran-Mantel-Haenszel method with the random effect model, and reported as Risk Ratio (RR), 95% CI, and p values. Statistical significance was set at p < 0.05 and a 95% CI. 26 studies were included. Mean operative time was significantly shorter in the Tubeless group (MD-5.18 min, 95% CI - 6.56, - 3.80, p < 0.00001). Mean postoperative length of stay was also significantly shorter in the Tubeless group (MD-1.10 day, 95% CI - 1.48, - 0.71, p < 0.00001). Incidence of blood transfusion, angioembolization for bleeding control, pain score at the first postoperative day, the number of patients requiring postoperative pain medication, fever, urinary infections, sepsis, perirenal fluid collection, pleural breach, hospital readmission, and SFR did not differ between the two groups. Incidence of postoperative urinary fistula was significantly lower in the Tubeless group (RR 0.18, 95% CI 0.07, 0.47, p = 0.0005). This systematic review shows that tubeless PCNL can be safely performed and the standout benefits are shorter operative time and hospital stay, and a lower rate of postoperative urinary fistula.
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Affiliation(s)
- Vineet Gauhar
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Olivier Traxer
- Department of Urology Hôpital Tenon, Sorbonne University, Paris, France
| | - Esther García Rojo
- Department of Urology, Hospital Universitario HM Sanchinarro, HM Hospitales and ROC Clinic, Madrid, Spain
| | - Simone Scarcella
- Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Maria Pia Pavia
- Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Vinson Wai-Shun Chan
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Eugenio Pretore
- Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Ancona, Italy
| | - Marcelo Langer Wroclawski
- Hospital Israelita Albert Einstein, BP-a Beneficência Portuguesa de São Paulo, Sao Paulo, SP, Brazil.,Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Mariela Corrales
- Department of Urology Hôpital Tenon, Sorbonne University, Paris, France
| | - Ho Yee Tiong
- Department of Urology, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Ee Jean Lim
- Department of Urology, Singapore General Hospital, Singapore, Singapore
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, S.H. Ho Urology Centre, Hong Kong, China
| | - Chin-Tiong Heng
- Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Jean de la Rosette
- Department of Urology, Medipol Mega University Hospital, Istanbul Medipol University, Istanbul, Turkey
| | | | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Faculty of Medicine, School of Urology, Università Politecnica delle Marche, Via Conca 71, 60126, Ancona, Italy.
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Ahuja V, Luthra A, Chauhan R, Meena SC, Parmar K. Intermittent peri-tubal instillation of dexamethasone and ropivacaine on postoperative analgesia after percutaneous nephrolithotomy: A prospective randomized controlled trial. Int J Urol 2022; 29:876-883. [PMID: 35598084 DOI: 10.1111/iju.14929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/27/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Percutaneous nephrolithotomy and placement of nephrostomy tube are performed for renal stones >2 cm in diameter. Attempts have been made to infiltrate local anesthetics with or without adjuvants into the surgical site to reduce pain. We hypothesized that there would be a significant prolongation of the analgesic effect of local anesthetic instillation along the nephrostomy tube due to the adjuvant dexamethasone. METHODS After ethical approval and Clinical Trials Registry - India registration (CTRI/2020/03/024332), 64 American Society of Anesthesiologists classification 1 and 2 adult patients were enrolled in this randomized double-blinded prospective study divided into Group R-received 20 mL 0.2% Ropivacaine and Group R + D-received 20 mL 0.2% Ropivacaine with dexamethasone 8 mg, injected through a multi-lumen wound infiltration catheter. RESULTS The demographic profile of patients was similar in both groups. The mean duration of analgesia was longer in Group R + D (21.3 ± 2.1 hrs) versus Group R (10 ± 1.9 hrs, P = 0.001). The mean numeric rating scale scores of Group R + D were significantly lower at all time intervals (P = 0.001). Also, the cumulative dose of ropivacaine and the total use of fentanyl postoperatively in Group R was much higher (70 ± 10.4 vs 56 ± 8.9 μg, P = 0.02). The C-reactive protein levels were significantly lower in Group R + D (13.8 ± 1.5 vs 23.1 ± 1.2 mg/L, P = 0.001 and 16.5 ± 1.3 vs 28.5 ± 1.7 mg/L, P = 0.001, at 24 and 48 hrs, respectively). CONCLUSION We conclude that dexamethasone can be used as a suitable adjuvant to intermittent local anesthetic infiltration after percutaneous nephrolithotomy with a nephrostomy tube for the prolongation of analgesia.
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Affiliation(s)
- Varnika Ahuja
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Ankur Luthra
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Rajeev Chauhan
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Shyam C Meena
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
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Sofi K, Turki S, Mir S, Khan N, Khawaja R, Wani M. A comparative study of epidural anesthesia with dexmedetomidine infusion versus general anesthesia for percutaneous nephrolithotomy. Anesth Essays Res 2021; 15:306-311. [PMID: 35320957 PMCID: PMC8936872 DOI: 10.4103/aer.aer_124_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 12/25/2021] [Indexed: 11/09/2022] Open
Abstract
Background: There has been considerable debate regarding the ideal anaesthetic technique for Percutaneous Nephrolithotomy (PCNL). PCNL is usually performed under general anaesthesia (GA) in prone position. The prone position under GA is associated with various complications. To address these complications, our study was carried out to determine whether epidural anaesthesia [EA] with dexmedetomidine sedation can be a better alternative to GA for PCNL. Aims and Objectives: To compare the efficacy and feasibility of performing PCNL under EA in combination with dexmedetomidine infusion. Methods and Material: Out of 225 patients observed in this study, 115 patients (group A) underwent PCNL under EA with dexmedetomidine infusion and 110 patients (group B) underwent PCNL under GA. Results: Mean time to the first dose of rescue analgesia was significantly increased in Epidural group (328.17 ± 63.74) compared to GA group (72.09 min, p < .0001) and the mean Visual analog scale [VAS] scores were significantly lower in epidural compared to GA group at different time intervals during the first 24 h after surgery (p<0.05). Patients in epidural group had significantly less post-operative nausea, vomiting (6.1 % vs 13.6 %), and significantly less shivering (12.2% vs 33.6%). Mean patient satisfaction score in epidural group was significantly higher (8.75 ± 1.29 vs 8.14 ± 1.39, p=0.001); however, the mean surgeon satisfaction score was comparable among the two groups (8.76 ± 1.39 in Group A and 8.61 ± 1.35 in Group B, p=0.421). Conclusions: Our study shows that EA is an equally effective alternative to GA for PCNL, with more patient satisfaction, less postoperative pain, early ambulation and postoperative recovery, less systemic analgesic requirements and less adverse effects.
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Yıldızhan M, Asil E. Tubeless PNL can safely be applied to selected patients in pediatric stone disease. Turk J Urol 2020; 47:164-169. [PMID: 33085603 DOI: 10.5152/tud.2020.20066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/21/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the results of tubeless percutaneous nephrolithotomy (TPNL) and standard percutaneous nephrolithotomy (SPNL) for the management of nephrolithiasis in children. MATERIAL AND METHODS The data for 48 patients aged lesser than 18 years who underwent percutaneous nephrolithotomy (PNL) between January 2010 and June 2018 were reviewed retrospectively. The patients were classified into 2 categories depending on tube placement. A total of 21 patients were treated with TPNL and 27 with SPNL technique. The surgical method employed was selected depending on intraoperative complications. The size of the endoscopic instrument (mini/standard) to be used was decided according to the stone burden and surgeon preference. RESULTS A complete stone-free rate (SFR) was achieved in 85.7% (n=18) of the TPNL group and 85.2% (n=23) of the SPNL group (p=0.959). In the TPNL group, two patients with clinically significant stones underwent retrograde intrarenal surgery, and one patient with clinically insignificant residual stone remained under follow-up. In the SPNL group, two patients with clinically significant stones underwent repeat mini-PNL surgery, the stones being fragmented with shock wave lithotripsy in one patient, and 1 one patient with insignificant residual stone remained under follow-up. No significant differences were observed in terms of intraoperative and postoperative complications, mean SFRs, or operative and fluoroscopy times. However, a statistically significant difference was observed in lengths of hospital stay (p<0.001). CONCLUSION TPNL is a safe and effective procedure in children. No significant difference was found between TPNL and SPNL in terms of stone clearance; however, patients undergoing TPNL had significantly shorter hospital stays.
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Affiliation(s)
| | - Erem Asil
- Department of Urology, Ankara City Hospital, Ankara, Turkey
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Pimentel Torres J, Oliveira JN, Morais N, Anacleto S, Rodrigues RM, Mota P, Leão R, Lima E. Efficacy and safety of renal drainage options for percutaneous nephrolithotomy. MINERVA UROL NEFROL 2020; 72:629-636. [PMID: 31920064 DOI: 10.23736/s0393-2249.19.03643-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Percutaneous nephrolithotomy (PCNL) is the gold-standard for treatment of renal stones larger than 20 mm. Traditionally, a nephrostomy tube (NT) is placed, causing discomfort and prolonged hospitalization but some surgeons prefer the tubeless technique (TL). Simultaneously, the effectiveness of ureteral stents after PNCL is doubtful. We investigated the safety of the TL technique as well as that of the single loop (SL) over double loop (DL) stents. METHODS Three hundred and twenty-one individuals submitted to PCNL in a single center were retrospectively reviewed. Statistical analysis was performed to compare procedures regarding safety and effectiveness (stone size, residual stones, operative time, peri- and post-operative complications, need for blood transfusion and length of hospital stay) between two groups regarding presence or absence of NT placement (NT [N.=198] vs. TL [N.=123]); and according to the type of stent used (SL [N.=74] vs. DL [N.=247]). RESULTS NT was associated with a higher complications rate compared to the TL (30.3% and 13%, respectively; P=0.001) and longer hospitalization (4 vs. 2 days; P=0.001). Regarding ureteral stents, they cause similar morbidities (20.7% and 24.4%; P=0.881), and median length of stay (3 days; P=0.947). NT and DL were more frequent in patients with higher stone burden. CONCLUSIONS Tubeless PCNL encompasses lower morbidity and should be considered as an option for select patients, particularly with less stone burden and uncomplicated procedures. Regarding ureteral stents, SL is a safe option and does not require further procedures for removal.
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Affiliation(s)
| | - João N Oliveira
- Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
| | - Nuno Morais
- Department of Urology, Hospital of Braga, Braga, Portugal
| | - Sara Anacleto
- Department of Urology, Hospital of Braga, Braga, Portugal
| | | | - Paulo Mota
- Department of Urology, Hospital of Braga, Braga, Portugal.,Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
| | - Ricardo Leão
- Department of Urology, Hospital of Braga, Braga, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Estevão Lima
- Department of Urology, Hospital of Braga, Braga, Portugal.,Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
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Aghamir SMK, Heidari R, Bayesh S, Salavati A, Elmimehr R. Are Nephrostomy and Ureteral Stent Necessary after Multi-Access Percutaneous Nephrolithotomy? Curr Urol 2019; 13:141-144. [PMID: 31933592 DOI: 10.1159/000499279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 08/17/2018] [Indexed: 11/19/2022] Open
Abstract
Introduction Totally tubeless percutaneous nephrolithotomy (PCNL) is a well-established technique used in single -access procedure nevertheless these results challenge the multi-access PCNL as a contra-indication to application of this technique. Aims To compare complication rates and safety of use of this technique after multi-access PCNL. Methods A Total of 130 patients with renal stones were enrolled in this cohort study. Totally tubeless PCNL with single access (Group A, n = 70) and multi-access (Group B, n = 60) were done and bleedings were assessed by measuring hemoglobin (Hb) drop, blood transfusion rate and need for angioembolization besides leakage rates which were also recorded. Results In the 130 patients who underwent totally tubeless PCNL, no leakage from puncture site nor angioembolization cases were identified. There was no significant statistical differences between 2 groups regarding Hb drop (1.91 in single access versus 2.20 in multi-access), transfusion rate and length of hospital stay (p > 0.05). Stone-free rate was increased from 91% in single access to 97% in multi access by adding percutaneous access sites (from 91% in single access to 97% in multi-access). Conclusions Multi-access totally tubeless PCNL seems feasible and has comparable complication rates including Hb drop besides providing the advantage of higher stone-free rates using multi-access tracts.
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Affiliation(s)
| | - Reza Heidari
- Department of Urology, Sina Hospital, Tehran University of Medical Sciences
| | - Seyedehsara Bayesh
- Seyedehsara Bayesh, Students' Research Committee, Islamic Azad University, Tehran Medical Sciences Branch, Tehran, Iran
| | - Alborz Salavati
- Department of Urology, Sina Hospital, Tehran University of Medical Sciences
| | - Reza Elmimehr
- Department of Urology, Sina Hospital, Tehran University of Medical Sciences
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Li Q, Gao L, Li J, Zhang Y, Jiang Q. Total tubeless versus standard percutaneous nephrolithotomy: a meta-analysis. MINIM INVASIV THER 2019; 29:61-69. [PMID: 30849258 DOI: 10.1080/13645706.2019.1581224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Qiubo Li
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liang Gao
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Li
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuanfeng Zhang
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qing Jiang
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Shen CH, Hsiao SC, Jou YC, Cheng MC, Lin CT, Chen PC, Lai WH, Chen PY. Safety and efficacy of percutaneous nephrolithotomy in patients with large stones: A retrospective study. UROLOGICAL SCIENCE 2019. [DOI: 10.4103/uros.uros_10_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Looney AT, Daly PJA, Cullen IM, MacMahon P, Kelly IMG. To tube or not to tube? Utilising a tubeless antegrade ureteric stenting system in a tertiary referral hospital. Ir J Med Sci 2018; 188:283-288. [PMID: 29696559 DOI: 10.1007/s11845-018-1826-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/19/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION To assess the benefits and complications of developing a practice of single-stage primary ureteral stenting in a university hospital. METHODS A practice change developed from the traditional practice of multi-stage stenting to single-episode stent placement. To evaluate this change of practice, we retrospectively analysed data of 70 patients who underwent primary tubeless antegrade ureteric stenting and compared this group to the previous 54 patients who had a covering nephrostomy. RESULTS There was an overall success rate of 91.3% (85/93 stents having had tubeless antegrade stenting). There were no major and 33 minor complications. The comparative group of 54 patients whose stents had a covering nephrostomy had a median length of stay of 13.2 days compared to 7.4 days for the tubeless group. CONCLUSION Single-stage primary ureteric stenting is a safe practice to employ and has universal benefits for both the patient and the health service.
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Affiliation(s)
- Aisling T Looney
- Department of Urology, Department of Surgery, University Hospital Waterford, Ardkeen, Waterford, Ireland.
| | - Padraig J A Daly
- Department of Urology, Department of Surgery, University Hospital Waterford, Ardkeen, Waterford, Ireland
| | - Ivor M Cullen
- Department of Urology, Department of Surgery, University Hospital Waterford, Ardkeen, Waterford, Ireland
| | - Peter MacMahon
- Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Ian M G Kelly
- Department of Interventional Radiology, University Hospital Waterford, Ardkeen, Waterford, Ireland
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12
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Lai WH, Jou YC, Cheng MC, Shen CH, Lin CT, Chen PC, Hu MM, Chen CC. Tubeless percutaneous nephrolithotomy: Experience of 1000 cases at a single institute. UROLOGICAL SCIENCE 2017. [DOI: 10.1016/j.urols.2016.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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13
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El Tayeb MM, Borofsky MS, Lingeman JE. The Circle Nephrostomy Tube: An Attractive Nephrostomy Drainage System Following Complex Percutaneous Nephrolithotomy. Urology 2017; 103:251-255. [PMID: 28108324 DOI: 10.1016/j.urology.2017.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/09/2016] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To describe our experience with the circle nephrostomy tube (NT) (Cook Medical), a drainage system uniquely designed for use after multiple-access percutaneous nephrolithotomy (PNL). METHODS A retrospective review of 1317 consecutive patients undergoing 1599 PNLs at IU Health Methodist Hospital was performed. All multiple access cases utilizing circle NTs were reviewed and analyzed. The method of insertion of circle NT was demonstrated. RESULTS A total of 1843 accesses were obtained in 1599 renal units (RUs): 380 upper pole, 129 interpolar, and 1334 lower pole. Multiple accesses in this series were required in 282 RUs (17.6%). Following multiple-access PNL, circle NTs, Cope loop, and reentry Malecot NTs were inserted in 91 RUs (32.3%), 208 RUs (73.8%), and 31 RUs (11%), respectively. None of the patients who had circle NT experienced clogging, dislodgement, or obstruction of the tube. The cost of circle, Cope loop, and Malecot NTs are 121.73 USD, 95.20 USD, and 81 USD, respectively. CONCLUSION Circle NTs are easy to insert, secure, cost-effective compared with inserting two NTs. Circle NTs provide excellent drainage and facilitate secondary procedures.
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14
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Bhat S, Lal J, Paul F. A randomized controlled study comparing the standard, tubeless, and totally tubeless percutaneous nephrolithotomy procedures for renal stones from a tertiary care hospital. Indian J Urol 2017; 33:310-314. [PMID: 29021656 PMCID: PMC5635673 DOI: 10.4103/iju.iju_52_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction: Percutaneous nephrolithotomy (PCNL) is an effective treatment for renal stones. Due to the significant pain and morbidity after standard PCNL because of nephrostomy tubes, various modifications of PCNL are being performed. We report a randomized trial comparing these modalities. Materials and Methods: A total of 75 patients were randomized into three groups of 25 each: standard PCNL with nephrostomy tubes (Group 1), tubeless PCNL with ureteric stent and no nephrostomy (Group 2), and totally tubeless PCNL without ureteric catheter or nephrostomy (Group 3). Randomization was done at the end of the procedure for those patients satisfying the inclusion criteria based on duration of surgery, single puncture tract, intraoperative bleeding, stone burden, intact pelvicalyceal system, and no residual stones at the end of procedure. The outcomes measured were hemoglobin (Hb) drop, hemorrhage, need for blood transfusion, pyrexia, urine leak, pain score, analgesic requirement, and duration of hospital stay. Results: There was no significant difference in hemorrhage, Hb drop, need for blood transfusion, and postoperative pyrexia among the groups. All patients except one in the standard group only had variable amount of urinary leak. The analgesic requirement and duration of hospital stay attained statistical significance in favor of tubeless and totally tubeless groups compared to the standard. Conclusions: Tubeless and totally tubeless PCNL are safe and effective method of renal stone management. Totally tubeless PCNL significantly reduced postoperative pain and morbidity compared to the tubeless method.
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Affiliation(s)
- Suresh Bhat
- Department of Urology, Government Medical College, Kottayam, Kerala, India
| | - Jithin Lal
- Department of Urology, Government Medical College, Kottayam, Kerala, India
| | - Fredrick Paul
- Department of Urology, Government Medical College, Kottayam, Kerala, India
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Tepeler A, Başıbüyük İ, Tosun M, Armağan A. The role of ultra-mini percutaneous nephrolithotomy in the treatment of kidney stones. Turk J Urol 2016; 42:261-266. [PMID: 27909619 DOI: 10.5152/tud.2016.32644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In our study we aimed to evaluate outcomes of ultra-mini-percutaneous nephrolithotomy (UMP) performed for the treatment of kidney stones. MATERIAL AND METHODS Between October 2014 and September 2015, a single surgeon performed UMP on a total of 49 consecutive patients with symptomatic kidney stones at our center. Pregnants, anticogulant users, patients with bleeding diathesis pyonephrosis, and partial/complete staghorn stones were excluded from the study. Patient characteristics, operative data and postoperative outcomes were assessed in detail. RESULTS The UMP was performed on 50 (34 right/16 left) renal units of the 48 (28 male/20 female) patients included in this study. The mean age and body mass index was 36.5 (2-83) years and 26.2 (17.6-32.8) kg/m2, respectively. Mean stone size was calculated as 22.2 (10-55) mm. The mean durations of the operations and fluoroscopic examination were calculated as 65.4 (20-120) minutes and 89.4 (9-322) seconds, respectively. The mean duration of hospitalization was 1.4 (1-5) days. In 52% of the patients the procedure was terminated tubeless. Mean hemoglobin drop was 0.6 (0-3) g/dL. Our series experienced a 10% complication rate. The UMP procedure was successful in 96% of the renal units at the 1st month control visit assessment. CONCLUSION The outcomes of our study have demonstrated that UMP is an effective and safe treatment modality, especially in the treatment of medium-sized renal calculi.
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Affiliation(s)
- Abdulkadir Tepeler
- Department of Urology, Bezmialem Vakif University School of Medicine, İstanbul, Turkey
| | - İsmail Başıbüyük
- Department of Urology, Bezmialem Vakif University School of Medicine, İstanbul, Turkey
| | - Muhammed Tosun
- Department of Urology, Bezmialem Vakif University School of Medicine, İstanbul, Turkey
| | - Abdullah Armağan
- Department of Urology, Bezmialem Vakif University School of Medicine, İstanbul, Turkey
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Percutaneous Nephrolithotomy: Current Clinical Opinions and Anesthesiologists Perspective. Anesthesiol Res Pract 2016; 2016:9036872. [PMID: 27110239 PMCID: PMC4826713 DOI: 10.1155/2016/9036872] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/01/2016] [Accepted: 03/13/2016] [Indexed: 11/17/2022] Open
Abstract
Percutaneous nephrolithotomy (PCNL), a minimally invasive method for removal of renal calculi, was initially started in the 1950s but gained popularity about two decades later and has now become standard practice for management. There has been an immense improvement in technique and various guidelines have been established for treatment of renal stones. However, it has its own share of complications which can be attributed to surgical technique as well as anesthesia related complications. PubMed and Google search yielded more than 30 articles describing the different complications seen in this procedure, out of which 15 major articles were selected for writing this review. The aim of this review article is to describe the implications of the complications associated with PCNL related to the anesthesiologist. The anesthesiologist is as much responsible for the management of the patient perioperatively as the surgeon. Therefore, it is mandatory to be familiar with the various complications, some of which may be life threatening and he should be able to manage them efficiently. The paper also analyses the advantages and drawbacks of the available options in anesthesia, that is, general and regional, both of which are employed for PCNL.
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Karakoyunlu N, Ekici M, Yesil S, Zengin K, Goktug G, Ozok U. Comparison of complications associated with standard and totally tubeless percutaneous nephrolithotomy according to modified Clavien grading: a multicenter retrospective study. Kaohsiung J Med Sci 2014; 30:613-8. [PMID: 25476099 DOI: 10.1016/j.kjms.2014.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 08/06/2014] [Accepted: 04/29/2014] [Indexed: 10/24/2022] Open
Abstract
The aim of this study was to compare the complications of standard and totally tubeless percutaneous nephrolithotomy (PCNL) based on the modified Clavien complication grading system. We retrospectively evaluated the complications of 290 consecutive patients who had undergone standard or totally tubeless PCNL at four institutes between January 2010 and August 2012 based on the modified Clavien scale. The totally tubeless cases were classified as Group 1 and the cases to which a Malecot re-entry catheter was applied were classified as Group 2. The postoperative complications were recorded according to the modified Clavien complication grading system. Statistically significant differences were observed only in the first-degree injury class between the two groups based on the modified Clavien classification. The requirement for blood transfusion and prolonged percutaneous access site leakage were more frequent in Group 2, but these differences were not statistically significant. We also performed a pain evaluation by monitoring postoperative analgesia demands. In Group 1, the analgesic demand rates in the 1(st) and 6(th) postoperative hours were 64.6% and 31.5%, respectively. In Group 2, the analgesic demand rates were 87.5% and 58.75% in the 1(st) and 6(th) postoperative hours, respectively. The mean ± standard deviation of analgesic doses in the first 6 hours was 0.96 ± 0.7 and 1.46 ± 0.6 in Groups 1 and 2, respectively. These differences were statistically significant. Based on our results, we can conclude that the tubeless technique has fewer complications, improved postoperative patient comfort, shorter hospitalization times, and a reduced need for analgesics, suggesting that tubeless PCNL should be the standard approach. For suitable cases, this technique may be used safely as the standard PCNL approach.
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Affiliation(s)
- Nihat Karakoyunlu
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
| | - Musa Ekici
- Department of Urology, Hitit University, School of Medicine, Çorum, Turkey
| | - Suleyman Yesil
- Department of Urology, Gazi University, School of Medicine, Ankara, Turkey
| | - Kursad Zengin
- Department of Urology, Bozok University, School of Medicine, Yozgat, Turkey
| | - Goksel Goktug
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Ugur Ozok
- Department of Urology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Portis AJ, Laliberte MA, Tatman P, Lendway L, Rosenberg MS, Bretzke CA. Retreatment After Percutaneous Nephrolithotomy in the Computed Tomographic Era: Long-term Follow-up. Urology 2014; 84:279-84. [DOI: 10.1016/j.urology.2014.02.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/08/2014] [Accepted: 02/02/2014] [Indexed: 11/16/2022]
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Agrawal MS, Sharma M, Agarwal K. Tubeless percutaneous nephrolithotomy using antegrade tether: a randomized study. J Endourol 2014; 28:644-8. [PMID: 24456239 DOI: 10.1089/end.2013.0693] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Tubeless percutaneous nephrolithotoomy (PCNL), although an accepted technique by now, continues to suffer from two major limitations: The need for postoperative cystoscopy for ureteral stent removal and inability to perform a "second-look" procedure for any residual fragments. We share our experience with a modification of the standard tubeless PCNL technique that allows us to overcome these shortcomings. PATIENTS AND METHODS A total of 166 patients selected to have PCNL were randomized into two groups of 83 each. In group A (control group), the patients underwent standard PCNL with the insertion of a nephrostomy tube at completion; in group B (intervention group), modified tubeless PCNL was performed with a Double-J (DJ) stent inserted with a tether attached to its proximal end, taken out through the percutaneous tract. The nephrostomy tube in group A was removed postoperatively on the second or third day, whereas those in group B had the stent removed directly by pulling the attached tether within the office setting 10 to 14 days postoperatively. RESULTS The need for postoperative analgesia was significantly higher in group A compared with group B (mean dose of tramadol needed, 128 mg vs 81.3 mg) (P<0.001). Four patients in group A had postoperative urinary leakage from the nephrostomy site, whereas there were no leaks in patients in group B. Group B patients spent significantly shorter average time in hospital (21.6 hours) compared with group A (54 hours) (P<0.001). Two of the patients in group B needed a second-look procedure, performed by the insertion of a guidewire down the stent, which was pulled out partially by its tether. Presence of the tether in the flank or the process of subsequent removal did not cause any discomfort to any patient. CONCLUSION The present study demonstrates that tubeless PCNL with a tethered DJ stent overcomes its main drawback, namely, the need for cystoscopy for stent removal, and also allows access to the pelvicaliceal system for second-look nephroscopy.
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Rifaioglu MM, Onem K, Buldu I, Karatag T, Istanbulluoglu MO. Tubeless percutaneous nephrolithotomy: yes but when? A multicentre retrospective cohort study. Urolithiasis 2014; 42:255-62. [PMID: 24468916 DOI: 10.1007/s00240-014-0638-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 01/08/2014] [Indexed: 10/25/2022]
Abstract
The aim of our study is to determine the predictive factors for placement of percutaneous nephrostomy tube (PNT) in percutaneous nephrolithotomy (PCNL) procedure and to evaluate the optimal cutoff points of the predictive factors. 229 patients, who had undergone percutaneous nephrolithotomy operation between February 2009 and February 2013 were reviewed retrospectively. Five patients were excluded from the study because of solitary kidney. All characteristics of 224 patients, stones and operative data were investigated. Patient and stone-related factors, such as age, BMI, history of previous surgery or SWL, characteristics of the stone, renal parenchymal thickness (RPT), as well as procedural factors, such as percutaneous access number and location were analyzed by univariate and multivariate tests. The continuous variables were analyzed using Receiver operating characteristic curve analysis. There were no differences in sex, age, BMI and hemoglobin decrease between the groups. Previous operation status, RPT, stone size, multiplicity of the stone, stone localization, blood transfusion presence, access points, access number and operation time were found statistically different according to univariate analysis. Multivariate analysis showed that RPT, operation time and stone size were the independent factors that affected the PNT insertion. For RPT, operation time and stone size, the optimal cutoff points for insertion PNT were 13.75 mm, 75.5 min and 890 mm(2), respectively. Tubeless PCNL should be chosen in patients with stone area less than 890 mm(2), and parenchymal thickness thicker than 13.75 mm and procedure with operation period <75.5 min.
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Affiliation(s)
- Murat M Rifaioglu
- Urology Department, Medical Faculty, Mustafa Kemal University, 31005, Antakya, Serinyol, Hatay, Turkey,
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Nalbant I, Ozturk U, Sener NC, Dede O, Bayraktar AM, Imamoglu MA. The comparison of standard and tubeless percutaneous nephrolithotomy procedures. Int Braz J Urol 2013; 38:795-800; discussion 801. [PMID: 23302416 DOI: 10.1590/1677-553820133806795] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2012] [Indexed: 03/16/2023] Open
Abstract
PURPOSE To compare totally tubeless and standard percutaneous nephrolitotomy procedures on many parameters. MATERIALS AND METHODS Percutaneous nephrolitotomy was performed on 195 patients between June 2009 and May 2012. The data of those patients were evaluated retrospectively. Totally tubeless cases were enrolled to Group 1, and Group 2 consisted of non-tubeless cases (re-entry or Foley catheter). RESULTS Group 1 included 85 cases and group 2 a total of 110 patients. Paper tracing values for the kidney stones were 321.25 ± 102.4 mm(2) and 324.10 ± 169.5 mm(2) respectively. Mean fluoroscopy time was 4.9 ± 1.9 min and 5.08 ± 2.7 min, mean operation time was 78.8 ± 27.9 min and 81.9 ± 28.77 min and mean decrease in hematocrit was 2.6 ± 1.6 and 3.74 ± 1.9 respectively. All these comparisons were statistically significant. Length of hospitalization was 1.6 ± 1.1 and 3.5 ± 1.5 days for Groups 1 and 2 respectively. Mean superficial pain score was 5.8 ± 1.6 and 6.7 ± 1.2 respectively for both groups after 1 hour. At 6 hours, the scores changed to 3.87 ± 1.22 and 4.84 ± 1.3 respectively. The analgesic dose was 1.00 ± 0.7 and 1.53 ± 0.6 for the groups respectively at 6 hours. All the statistical differences were significant for these three parameters. CONCLUSIONS We believe that, because of their post operative patient comfort and decreased length of hospital stay, totally tubeless procedures should be considered as an alternative to standard percutaneous nephrolitotomy.
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Affiliation(s)
- Ismail Nalbant
- Department of Urology, Ministry of Health, Yenimahalle State Hospital, Ankara, Turkey
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Tubeless percutaneous nephrolithotomy is effective and safe in short- and long-term urinary drainage. Urolithiasis 2013; 41:341-6. [PMID: 23604092 DOI: 10.1007/s00240-013-0560-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 04/10/2013] [Indexed: 10/26/2022]
Abstract
We aimed to investigate the safety and efficacy of tubeless percutaneous nephrolithotomy (PCNL) with ureteral catheter or double-J stent in comparison with standard PCNL in our study. We retrospectively evaluated 707 of 1,469 patients with stone area under 800 mm(2) and only one subcostal nephrostomy access that was underwent PCNL between March 2004 and October 2011 in our clinic. Patients with 14F nephrostomy tube (Malecot or Re-entry catheter), with ureteral stent and with antegrade double-J stent were included into Group 1 (n = 180), Group 2 (n = 148) and Group 3 (n = 120), respectively. The mean hospitalization time of patients in Group 1 was significantly longer. The mean VAS was significantly higher in Group 1. On the other hand the mean fluoroscopy and operation time of patients in Group 2 were significantly shorter in comparison with other groups. Number of patients with postoperative transfusion requirement was significantly higher in Group 1. The number of patients with postoperative narcotic analgesic requirement was also significantly higher in Group 1. The most frequent complication in our study was prolonged drainage. The postoperative complications were seen more frequently in Group 1. Both ureter catheter and double j stent were more comfortable, effective and safe in urinary drainage following PCNL with single sub-costal access. On the other hand, double-J stent has a disadvantage as requirement additional cystoscopy for removal. We suggest ureter catheter or double-J stent to preserve short- and long-term urinary drainage.
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Sharma AK, Nagabhushan M, Girish GN, Kamath AJ, Ratkal CS, Venkatesh GK. Analysis of the Feasibility and Efficacy of Ambulatory/Day Care Percutaneous Nephrolithotomy: An Initial Experience. ACTA ACUST UNITED AC 2013. [DOI: 10.3834/uij.1944-5784.2013.08.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Tzeng BC, Wang CJ, Huang SW, Chang CH. Doppler Ultrasound-guided Percutaneous Nephrolithotomy: A Prospective Randomized Study. Urology 2011; 78:535-9. [DOI: 10.1016/j.urology.2010.12.037] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Revised: 12/18/2010] [Accepted: 12/21/2010] [Indexed: 11/16/2022]
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Wang J, Zhao C, Zhang C, Fan X, Lin Y, Jiang Q. Tubeless vs standard percutaneous nephrolithotomy: a meta-analysis. BJU Int 2011; 109:918-24. [PMID: 21883839 DOI: 10.1111/j.1464-410x.2011.10463.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To systematically review and compare tubeless percutaneous nephrolithotomy (PCNL) with standard PCNL. MATERIALS AND METHODS We conducted a review of the English language literature on studies involving randomized controlled trials for PCNL. The studies chosen to be included in our review compared tubeless PCNL with standard PCNL and described the advantages of each in the outcomes. Two reviewers independently screened the studies for eligibility, evaluated their quality and extracted the data from the eligible studies, with confirmation by cross-checking. Data were processed using RevMan 5.0. RESULTS Seven studies involving 1365 cases met the inclusion criteria, and these were included in the meta-analysis. The patients' baseline characteristics were comparable in all the studies. By comparing the four common characteristics, we found no difference in efficacy between the two surgical approaches in terms of mean operation duration and postoperative haematocrit change (P > 0.05). We found that the mean analgesic requirement and number of days in hospital were lower for tubeless PCNL (P < 0.05). CONCLUSIONS Our results show that tubeless PCNL is a good option in non-complicated cases, with the advantages of reduced hospital stay and little need for postoperative analgesia. There was no difference between the two approaches in operation duration, or haematocrit change after surgery. As only few studies with small study populations were available, more high quality larger trials with longer follow-up are recommended.
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Affiliation(s)
- Jiawu Wang
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Beiko D, Lee L. Outpatient tubeless percutaneous nephrolithotomy: the initial case series. Can Urol Assoc J 2011; 4:E86-90. [PMID: 20694090 DOI: 10.5489/cuaj.886] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PCNL) has traditionally been performed on an inpatient basis. To the best of our knowledge, this is the first report of tubeless PCNL on a completely outpatient basis. The purposes of this study were to assess the safety and efficacy of outpatient PCNL. METHODS We reviewed the initial consecutive outpatient tubeless PCNLs performed at our institution by a single surgeon. Patients were discharged home the day of surgery only after meeting strict discharge criteria. Preoperative, intraoperative and postoperative data were collected prospectively. RESULTS Outpatient tubeless PCNL was performed in 3 patients. The mean maximum stone diameter was 14 mm. The average hospital stay was 175 minutes. All 3 patients were discharged home in stable condition after meeting all of the inclusion criteria. There were no emergency room visits or hospital readmissions postoperatively. The mean follow-up period was 47 days. All stones were calcium oxalate and the stone free rate was 100%. There were no minor or major complications. CONCLUSION In properly selected patients, outpatient tubeless PCNL is safe and effective. Our initial experience with outpatient PCNL has been favourable and warrants further investigation in a larger patient population.
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Affiliation(s)
- Darren Beiko
- Department of Urology, Queen's University, Kingston, ON
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Resorlu B, Kara C, Sahin E, Unsal A. Comparison of nephrostomy drainage types following percutaneous nephrolithotomy requiring multiple tracts: single tube versus multiple tubes versus tubeless. Urol Int 2011; 87:23-7. [PMID: 21720147 DOI: 10.1159/000324264] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 01/03/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Placement of multiple nephrostomy tubes is the standard practice after completion of multitract percutaneous nephrolithotomy (PCNL) to reduce hemorrhage and urinary extravasation.We compared the outcomes among tubeless, single nephrostomy drainage and multiple nephrostomy drainage tubes following PCNL requiring multiple tracts. METHODS We retrospectively analyzed the data of 115 patients who underwent PCNL using multiple (two or more) access tracts. Patients were categorized into three groups: one nephrostomy tube for each tract (group 1, n = 43); single nephrostomy tube placement (group 2, n = 51), and no nephrostomy drainage with antegrade placement of a double-J stent (group 3, n = 21). RESULTS The three groups had comparable demographic data. The differences in operative times, average hemoglobin decrease and complication rates for the three groups were not statistically significant. The average hospital stay in the tubeless group (mean 2.1 days) was significantly shorter than that in group 1 (4.2 days) and group 2 (3.5 days). The postoperative analgesic requirement was significantly higher in group 1 compared to group 2 (p < 0.05) and group 3 (p < 0.001). Stones were completely cleared in 83.7, 84.3 and 85.7% of patients, which increased to 90.7, 92.1, and 95.2% with adjunctive therapies in groups 1, 2 and 3, respectively. CONCLUSIONS Single or no nephrostomy drainage following multitract PCNL offers the potential advantages of decreased postoperative analgesic requirement, and hospital stay without increasing the complications.
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Affiliation(s)
- Berkan Resorlu
- Department of Urology, Kecioren Training and Research Hospital, Ankara, Turkey. drberkan79 @ gmail.com
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Abstract
Introduction and Objective: Placement of a percutaneous nephrostomy tube for drainage has been an integral part of the standard percutaneous nephrolithotomy (PCNL) procedure. However, in recent years, the procedure has been modified to what has been called ‘tubeless’ PCNL, in which nephrostomy tube is replaced with internal drainage provided by a double-J stent or a ureteral catheter. The objective of this article is to review the evidence-based literature on ‘nephrostomy-free’ or ‘tubeless’ PCNL to compare the safety, effectiveness, feasibility, and advantages of tubeless PCNL over standard PCNL. Materials and Methods: We performed a MEDLINE database search to retrieve all published articles relating to ‘tubeless’ PCNL. Cross-references from retrieved articles as well as articles from urology journals not indexed in MEDLINE, were also retrieved. Results: The majority of the studies have shown ‘tubeless’ PCNL to be a safe and economical procedure, with reduced postoperative pain and morbidity and shorter hospital stay. tubeless PCNL has been found to be safe and effective even in patients with multiple stones, complex staghorn stones, concurrent ureteropelvic junction obstruction, and various degrees of hydronephrosis. The technique has been successful in obese patients, children, and in patients with recurrent stones after open surgery. Conclusion: Tubeless PCNL can be used with a favorable outcome in selected patients (stone burden <3 cm, single tract access, no significant residual stones, no significant perforation, minimal bleeding, and no requirement for a secondary procedure), with the potential advantages of decreased postoperative pain, analgesia requirement, and hospital stay. However, for extended indications, like supine PCNL, multiple, complex and staghorn stones, and concurrent PUJ obstruction, the evidence is insufficient and should come from prospective randomized trials.
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Totally tubeless percutaneous nephrolithotomy: a prospective randomized controlled study. ACTA ACUST UNITED AC 2011; 39:459-65. [PMID: 21331773 DOI: 10.1007/s00240-011-0363-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Accepted: 01/28/2011] [Indexed: 10/18/2022]
Abstract
The purpose of this study was to perform a randomized controlled trial to evaluate the role, safety, and effectiveness of totally tubeless PCNL and whether this procedure is less morbid in terms of analgesia requirement, related complications and convalescence. A total of 131 patients, with impacted ureteropelvic junction stone or single renal pelvic stone larger than 20 mm, were prospectively randomized (using random numbers table) into two groups, and underwent conventional (63 patients) or totally tubeless (68 patients) PCNL. Preoperative data included urinalysis, urine culture, complete blood count, biochemistry study, renal ultrasonography, intravenous urography and Tc 99m DTPA clearance for determination of selective glomerular filtration rate. Intraoperative findings, operative time, and outcome were also recorded. All patients were followed regularly at clinic every 3 months during year 1 and every 6 months, thereafter, and Tc 99m DTPA clearance for the determination of selective glomerular filtration rate, renal ultrasonography and intravenous urography was performed to assess the kidney function 6 months later. There was no difference between the groups with regard to serum creatinine change, hemoglobin decrease, morphology improvement, resumption of normal activity and complication grading. The length of stay, pain visual analog scale and analgesic requirements favored the tubeless group with statistical significance. There was significant statistical difference in relative perfusion rate between preoperative and postoperative in both groups. This trial demonstrates that totally tubeless PCNL is safe and well tolerated in selected patients and associated with decreases in length of stay, postoperative pain and analgesia requirement. Most importantly, patients undergoing uncomplicated PCNL are not mandated to have a nephrostomy or ureteral stent placed for specific indications.
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Bilen CY, Gunay M, Ozden E, Inci K, Sarikaya S, Tekgul S. Tubeless mini percutaneous nephrolithotomy in infants and preschool children: a preliminary report. J Urol 2010; 184:2498-502. [PMID: 20961572 DOI: 10.1016/j.juro.2010.08.039] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Indexed: 12/26/2022]
Abstract
PURPOSE We retrospectively analyzed the outcomes of tubeless mini percutaneous nephrolithotomy in infants and preschool children, and compared them with age matched controls who underwent nephrostomy drainage. MATERIALS AND METHODS A total of 28 renal units in 26 children were operated on for stone disease using the mini percutaneous nephrolithotomy technique. Holmium laser and pneumatic lithotriptor were used for stone fragmentation. Children who underwent complete stone removal and had a clear nephrostomy tract only had a ureteral catheter placed. Those with residual stones or bleeding from the nephrostomy tract underwent nephrostomy drainage. We compared both groups with regard to patient and stone characteristics, and postoperative findings. RESULTS A total of 12 renal units had only a ureteral catheter for diversion, while 16 had nephrostomy drainage. Mean respective ages of the stentless and nephrostomy groups were 3 (range 0.58 to 6) and 3.3 years (1.5 to 6). Mean respective stone burdens were 192 (range 100 to 400) and 416 (775 to 1,380) mm2. Surgery and fluoroscopy times were shorter in the tubeless group. Complication rates were higher (6 of 14 vs 0 of 12) and duration of hospitalization was longer (4.9 [range 3 to 14] vs 3.1 days [2 to 6]) in the nephrostomy group. Stone-free rates were 91.6% in the tubeless and 78.5% in the nephrostomy groups. CONCLUSIONS Tubeless percutaneous nephrolithotomy was observed to be a safe option for selected children with stone disease. The success and safety of tubeless percutaneous nephrolithotomy depends on patient selection criteria, including low volume and infection-free stones that are removed completely without any bleeding from the access tract.
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Affiliation(s)
- Cenk Y Bilen
- Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey.
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Dirim A, Turunc T, Kuzgunbay B, Hasirci E, Tekin MI, Ozkardes H. Which factors may effect urinary leakage following percutaneous nephrolithotomy? World J Urol 2010; 29:761-6. [PMID: 20872223 DOI: 10.1007/s00345-010-0596-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Accepted: 09/15/2010] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To evaluate the factors that may effect urinary leakage following percutaneous nephrolithotomy (PCNL). METHODS Four hundred and thirty-three patients who underwent PCNL were reviewed retrospectively. The factors that may lead to leakage after surgery were analyzed as categorized into four groups according to individual variables (age, sex, body mass index); renal factors (previous surgery, extracorporeal shock wave lithotripsy history, presence of hydronephrosis); stone burden; and surgical features (access number, type of dilatation, presence of nephrostomy catheter). These data were compared for the presence and duration of urinary leakage. RESULTS There was no statistically significant correlation between individual factors and both the presence of leak (POL) and the duration of leak (DOL) (P > 0.05). Among renal factors, only presence and degree of hydronephrosis was significantly correlated with POL (P < 0.001) and DOL (P < 0.001). The mean cumulative stone burden neither had impact on POL nor correlated with DOL (P > 0.05). Among surgical factors, dilatation with a Nephromax dilator significantly increased incidence of POL when compared with an Amplatz dilator (P < 0.001), yet did not change DOL. Using an internal ureteral stent significantly decreased incidence of POL and DOL (P < 0.001). DOL increased with catheter diameter and stay time (P < 0.05). CONCLUSION Several yet simple factors appear to be effective in postoperative urine leakage from the access sites after percutaneous stone surgery. Precautions may also be simple if these factors are considered preoperatively.
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Affiliation(s)
- Ayhan Dirim
- Department of Urology, Baskent University School of Medicine, 5, Sokak, No. 48 Bahcelievler, 06490, Ankara, Turkey.
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Falahatkar S, Farzan A, Allahkhah A. Is complete supine percutaneous nephrolithotripsy feasible in all patients? ACTA ACUST UNITED AC 2010; 39:99-104. [DOI: 10.1007/s00240-010-0287-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 06/19/2010] [Indexed: 11/29/2022]
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Abstract
With the development of techniques for percutaneous access and equipment to disintegrate calculi, percutaneous nephroscopic surgery is currently used by many urologists and is the procedure of choice for the removal of large renal calculi and the management of diverticula, intrarenal strictures, and urothelial cancer. Although it is more invasive than shock wave lithotripsy and retrograde ureteroscopic surgery, percutaneous nephroscopic surgery has been successfully performed with high efficiency and low morbidity in difficult renal anatomies and patient conditions. These advantages of minimal invasiveness were rapidly perceived and applied to the management of ureteropelvic junction obstruction, calyceal diverticulum, infundibular stenosis, and urothelial cancer. The basic principle of endopyelotomy is a full-thickness incision of the narrow segment followed by prolonged stenting and drainage to allow regeneration of an adequate caliber ureter. The preferred technique for a calyceal diverticulum continues to be debated. Excellent long-term success has been reported with percutaneous, ureteroscopic, and laparoscopic techniques. Each approach is based on the location and size of the diverticulum. So far, percutaneous ablation of the calyceal diverticulum is the most established minimally invasive technique. Infundibular stenosis is an acquired condition usually associated with inflammation or stones. Reported series of percutaneously treated infundibular stenosis are few. In contrast with a calyceal diverticulum, infundibular stenosis is a more difficult entity to treat with only a 50-76% success rate by percutaneous techniques. Currently, percutaneous nephroscopic resection of transitional cell carcinoma in the renal calyx can be applied in indicated cases.
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Affiliation(s)
- Tae-Kon Hwang
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Jun-Ou J, Lojanapiwat B. Supracostal access: does it affect tubeless percutaneous nephrolithotomy efficacy and safety? Int Braz J Urol 2010; 36:171-6. [DOI: 10.1590/s1677-55382010000200006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2009] [Indexed: 11/21/2022] Open
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Srinivasan AK, Herati A, Okeke Z, Smith AD. Renal drainage after percutaneous nephrolithotomy. J Endourol 2009; 23:1743-9. [PMID: 19792862 DOI: 10.1089/end.2009.1545] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Exit strategy after percutaneous nephrolithotomy (PCNL) is an area of continuing innovation to improve postoperative morbidity and operative outcomes for patients. The two important components of an exit strategy after PCNL are hemostasis and renal drainage. We review the different techniques of renal drainage after PCNL-ie, nephrostomy tube, ureteral stents, and totally tubeless strategy with critical discussion of available evidence for and against each of these techniques. We conclude that the optimal renal drainage method depends on patient characteristics and the operative course; hence, it should be individualized. To simplify this, we group patients undergoing PCNL as routine, problematic, and complicated, based on increasing complexity of the procedure and procedural complications. In routine PCNLs, we favor placement of an ureteral stent or a small-bore nephrostomy tube. In problematic and complicated PCNLs, we think the evidence directs toward placement of a nephrostomy tube, small bore being an option in problematic PCNLs.
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Affiliation(s)
- Arun K Srinivasan
- The Arthur Smith Institute for Urology, North Shore Long Island Jewish Health System , New Hyde Park, NY, USA
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Yates DR, Safdar RK, Spencer PA, Parys BT. 'Nephrostomy-free' percutaneous nephrolithotomy: experience in a UK district general hospital. Ann R Coll Surg Engl 2009; 91:570-7. [PMID: 19686613 PMCID: PMC2966161 DOI: 10.1308/003588409x432437] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Percutaneous nephrolithotomy (PCNL) is the first-line treatment for large and complex renal calculi. Accepted UK practice is to insert a nephrostomy tube at the end of the procedure to drain the kidney and reduce potential complications. 'Tubeless' or 'nephrostomy-free' PCNL has been advocated in selected patients as it is thought to reduce length of hospital stay, analgesia requirements and pain experienced. We present our outcomes of a consecutive series (n = 101) of 'nephrostomy-free' PCNLs compared to standard PCNL over a 4-year period. PATIENTS AND METHODS Between January 2004 and October 2006, we performed 55 standard (with nephrostomy tube) PCNLs (Group 1). From October 2006 onwards, we changed our technique and have performed 46 consecutive 'nephrostomy-free' PCNLs (JJ stent inserted), independent of patient and stone factors (Group 2). We have compared the two groups in terms of length of hospital stay (LOS), analgesia requirements, transfusion rates, haemoglobin (Hb) decrease and immediate, early and late complications. RESULTS 'Nephrostomy-free' PCNL significantly reduced the length of hospital stay (2.8 vs 5.1 days; P < 0.001), morphine-based analgesia requirements (23% no morphine required vs 2.8%; P < 0.001), transfusion rate (2.5% vs 7%; P < 0.01) and mean Hb decrease (1.89 g/dl vs 2.25 g/dl; P > 0.05). Overall, no patient experienced a serious complication. All attempted 'nephrostomy-free' PCNLs were completed (stone clearance 95%) and no patient needed an unplanned nephrostomy. Only 5% in Group 2 needed their ureteric JJ stent removing earlier than planned secondary to pain. Both groups were comparable in terms of immediate, early and late complications, though three patients in Group 1 developed chronic loin pain and one patient in the 'nephrostomy-free' group developed a delayed perirenal haematoma. CONCLUSIONS 'Nephrostomy-free' percutaneous nephrolithotomy is a safe, effective and feasible procedure independent of patient and stone factors. It decreases the length of hospital stay, the pain experienced and the need for morphine-based analgesia; we feel it should be the standard of care for patients undergoing a PCNL.
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Affiliation(s)
- D R Yates
- Department of Urology, Rotherham District General Hospital, Rotherham, UK.
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Totally tubeless outpatient percutaneous nephrolithotomy: initial case report. Adv Urol 2009:295825. [PMID: 19478955 PMCID: PMC2685914 DOI: 10.1155/2009/295825] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 04/21/2009] [Indexed: 11/18/2022] Open
Abstract
We report the first case of totally tubeless outpatient percutaneous nephrolithotomy (PCNL). Our patient was discharged home safely less than 4 hours following uncomplicated PCNL with no nephrostomy tube, ureteral stent, or urethral catheter. Follow-up the next day in clinic confirmed that the procedure was successful, as the patient was clinically well and stone free. To our knowledge, this is the first case report of totally tubeless (no nephrostomy, no ureteral stent) PCNL performed on a truly outpatient basis.
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Percutaneous nephrolithotomy: tubeless or not tubeless? ACTA ACUST UNITED AC 2009; 37:153-8. [PMID: 19326109 DOI: 10.1007/s00240-009-0183-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 02/19/2009] [Indexed: 10/21/2022]
Abstract
The objective of this study is to evaluate the safety and outcomes of tubeless PCNL in comparison with standard PCNL. Since June 2002, we have performed 99 tubeless PCNL. Tubeless technique involves antegrade placement of a 6Fr double-J stent without nephrostomy tube at the end of the procedure. This series has been compared with a total of 110 patients in which revision of operative reports ruled out the presence of intraoperative conditions necessary to candidate a patient to tubeless procedure but standard PCNL was performed because prior to its introduction or because of surgeon's attitude afterward. Mean stone burden was 5.4 for standard group and 4.9 cm(2) for tubeless group, respectively. Mean BMI was 24.1 in the first group and 23.6 in the second one. In this retrospective study, complications rate, postoperative pain, length of hospitalization and convalescence were evaluated by chart review. Hematocrit drop did not differ significantly between tubeless PCNL and standard PCNL (5.5 vs. 5.9%). Conversely, there was statistically significant difference between tubeless and standard PCNL in terms of the amount of analgesics (49.5 vs. 84.2 mg), immediate postoperative patients' discomfort, hospitalization (2.2 vs. 5.3 days) and time to resume normal activities (11.0 vs. 16.5 days). In conclusion, in our series, tubeless approach did not determine increase in complication rate. Conversely, tubeless PCNL reduced analgesics' requirement, patients' discomfort, hospitalization and time to recovery. As such, at our institution, tubeless PCNL has become routine procedure that actually is feasible in almost two-third of renal calculi suitable for percutaneous treatment.
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Saussine C, Lechevallier E, Traxer O. NLPC tubeless. Prog Urol 2008; 18:901-7. [DOI: 10.1016/j.purol.2008.09.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 09/02/2008] [Indexed: 11/30/2022]
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Singh I, Singh A, Mittal G. Tubeless percutaneous nephrolithotomy: is it really less morbid? J Endourol 2008; 22:427-34. [PMID: 18355137 DOI: 10.1089/end.2007.0269] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To prospectively evaluate and study the role, relative safety, and effectiveness of "tubeless" percutaneous nephrolithotomy (PCNL) and whether it is really less morbid vis-à-vis PCNL with a nephrostomy tube; to compare the postoperative pain, analgesia requirement, hospital stay, return to work time, and other parameters in patients undergoing tubeless PCNL and standard PCNL. PATIENTS AND METHODS Sixty selected patients underwent PCNL. A single urologist (IS) was the surgeon, and a resident administered random chit numbers, and recorded pain scores and results of all the chosen parameters. Patients who fulfilled the entry criteria for a tubeless PCNL protocol were randomized to either the omission of a nephrostomy tube (tubeless PCNL with Double-J stent) or to the placement of a 22F nephrostomy tube. The recorded data were analyzed with respect to several parameters. RESULTS The mean age, stone burden, and preoperative hemoglobin, blood urea, and serum creatinine values were not significantly different between the two groups. However, the operative time (P < 0.001), analgesia requirement (P < 0.001), and hospital stay and time to return to normal activity (P < 0.001) were significantly lower in the tubeless PCNL group. CONCLUSIONS Significantly less pain, lower analgesia requirement, and shorter hospital stay with early return to normal activities were observed in the tubeless PCNL group v the primary nephrostomy tube PCNL group. Tubeless PCNL in selected patients is a secure, effective, and less morbid procedure that does not compromise patient safety and concerns. We recommend that tubeless PCNL be the preferred procedure in selected patients for management of nephrolithiasis.
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Affiliation(s)
- Iqbal Singh
- Division of Urology, University College of Medical Sciences (University of Delhi) and GTB Hospital, Delhi, India.
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Aghamir SMK, Mohammadi A, Mosavibahar SH, Meysamie AP. Totally Tubeless Percutaneous Nephrolitotomy in Renal Anomalies. J Endourol 2008; 22:2131-4. [DOI: 10.1089/end.2008.0015] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - Ali Pasha Meysamie
- Department of Community Medicine, Medical Faculty/Tehran University, Tehran, Iran
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Gupta N, Mishra S, Suryawanshi M, Seth A, Kumar R. Comparison of Standard with Tubeless Percutaneous Nephrolithotomy. J Endourol 2008; 22:1441-6. [DOI: 10.1089/end.2007.0338] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- N.P. Gupta
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mishra
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Manav Suryawanshi
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Amlesh Seth
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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Crook TJ, Lockyer CR, Keoghane SR, Walmsley BH. A randomized controlled trial of nephrostomy placement versus tubeless percutaneous nephrolithotomy. J Urol 2008; 180:612-4. [PMID: 18554657 DOI: 10.1016/j.juro.2008.04.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Indexed: 11/25/2022]
Abstract
PURPOSE We established whether totally tubeless percutaneous nephrolithotomy with no nephrostomy or ureteral stent is a safe management technique. MATERIALS AND METHODS Patients were randomized to have a nephrostomy placed (group 1 control) or none (group 2 treatment). A total of 25 patients were randomized to each group. Cases were considered uncomplicated and suitable for randomization if there was no significant bleeding or residual stone load, the pelvicaliceal system was intact and there was no evidence of a residual ureteral stone. The primary outcome measure was length of stay, and secondary outcomes were analgesic requirements and postoperative complications such as bleeding, infection or ureteral obstruction. Hospital readmission rates and stone clearance rates were also recorded. RESULTS Mean stone size was 21.6 vs 17.5 mm. There were no transfusions in either group. Hemoglobin change was 2.03 vs 1.18 gm/dl and mean creatinine increase was 0.029 vs -0.111 mg/dl. There were no differences in hemorrhage, infection and serum parameters. There were no readmissions in either group. Mean length of stay was 3.4 vs 2.3 days (p <0.05). CONCLUSIONS This trial demonstrates that percutaneous nephrolithotomy without nephrostomy or stent is a safe and well tolerated procedure in selected patients. Length of stay was reduced with no major complications in either group. We believe that totally tubeless percutaneous nephrolithotomy may be considered an accepted standard of care for selected cases and it is possible to reserve placement of a nephrostomy tube or internal ureteral stent for specific indications.
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Affiliation(s)
- T J Crook
- Solent Department of Urology, St. Mary's Hospital, Portsmouth, United Kingdom.
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Crook TJ, Lockyer CR, Keoghane SR, Walmsley BH. Totally tubeless percutaneous nephrolithotomy. J Endourol 2008; 22:267-71. [PMID: 18095863 DOI: 10.1089/end.2006.0034] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To establish if totally tubeless percutaneous nephrolithotomy (PCNL) is a safe management technique. PCNL is a well-established option for upper tract stones. The procedure traditionally concludes with the placement of a nephrostomy drainage tube but in those patients in whom there has been minimal blood loss and complete stone clearance, it may not be necessary to place a nephrostomy. PATIENTS AND METHODS Totally tubeless PCNL was performed in uncomplicated cases, when there was no significant bleeding or residual stone load, an intact pelvicaliceal system, and no evidence of a residual ureteral stone. RESULTS 100 procedures were analyzed during a 10-year period from 1996 to 2006. The mean stone size was 15.9 mm (range 7-40 mm). Mean residual stone load was 1.74 mm (range 1-10 mm). Access was considered difficult in 2%. Transfusion rate was 1% with a mean fall in hemoglobin of 1.4 g/dL ([-0.4] - [+5.6] g/dL), and a mean rise in creatinine level of 0.3 micromol/L ([-43] - [+52] micromol/L). The minor sepsis rate was 5%, and the major sepsis rate was 1%. The readmission rate was 1%. The mean length of stay was 2.9 days (range 1-10 d). Secondary treatment was required in 5%, and stone clearance rate at 3 months was 90%. CONCLUSION This study demonstrates that PCNL without nephrostomy or stent is a safe and well-tolerated procedure in selected patients. It is the authors' belief that totally tubeless PCNL may be considered an accepted standard of care for selected patients, and it is possible to reserve placement of a nephrostomy tube or internal ureteral stent for specific indications.
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Affiliation(s)
- Tim J Crook
- The Solent Department of Urology, St Mary's Hospital, Portsmouth, United Kingdom.
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Portis AJ, Laliberte MA, Holtz C, Ma W, Rosenberg MS, Bretzke CA. Confident intraoperative decision making during percutaneous nephrolithotomy: does this patient need a second look? Urology 2008; 71:218-22. [PMID: 18308087 DOI: 10.1016/j.urology.2007.08.063] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Revised: 06/20/2007] [Accepted: 08/31/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate intraoperative decision making regarding the necessity of second-look nephroscopy after percutaneous nephrolithotomy. METHODS Percutaneous nephrolithotomy was performed cooperatively by a urologist and radiologist equipped with a high-resolution C-arm. Ultrasonic lithotripsy was performed followed by thorough flexible nephroscopy and fluoroscopy. At conclusion patients were prospectively classified as radiologically and/or endoscopically stone free. If confident that complete stone clearance had been atraumatically achieved, a ureteral stent was placed. If there was suspicion of trauma or residual calculi, a nephrostomy tube was inserted. Postoperative CT was performed and allowed fragment classification as stone free, less than 2 mm, 2 to 4 mm, or 4 mm or greater. RESULTS Average stone dimensions were 640.2 +/- 412.5 mm2 in 39 consecutive renal units. Computed tomographic imaging demonstrated that 26 renal units (66.7%) were stone free after primary procedure, with 5 (12.8%), 5 (12.8%), and 3 (7.7%) having fragments less than 2 mm, 2 to 4 mm, and greater than 4 mm, respectively. Of the 34 renal units considered endoscopically and fluoroscopically stone free, postoperative CT demonstrated 9 with residual fragments, all less than 4 mm. Of the 5 renal units not considered radiologically and endoscopically stone free, 4 had fragments on CT. Nephrostomy tubes were avoided in 33 patients. This intraoperative decision was supported by negative predictive values of 100%, 88%, and 73% at postoperative CT fragment detection thresholds of 4 mm, 2 mm, and 0 mm, respectively. CONCLUSIONS Rigorous fragment detection allows confident intraoperative decision making regarding the necessity of second-look nephroscopy.
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Affiliation(s)
- Andrew J Portis
- Metropolitan Urologic Specialists PA, St. Paul, Minnesota, USA.
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Karami H, Jabbari M, Arbab AHMM. Tubeless percutaneous nephrolithotomy: 5 years of experience in 201 patients. J Endourol 2008; 21:1411-3. [PMID: 18052821 DOI: 10.1089/end.2007.0406] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Our aim was to evaluate the safety, effectiveness, and feasibility of tubeless percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS From June 2000 to September 2005, 201 patients with renal stones >2 cm underwent tubeless PCNL by a single surgeon. We report details of the outcomes. RESULTS The complete stone clearance rate was 91.04% (183 patients). After surgery, 18 patients (8.96%) had stones (mean size = 7 mm) detected on a plain abdominal radiograph or ultrasonographic examination and were referred for shockwave lithotripsy. The mean stone size was 30 mm (range 20-40 mm). The mean operative time was 35 minutes (range 30-60 min), and the mean hospital stay was 3.5 days (range 2-5 days). Postoperative ultrasonography did not reveal considerable fluid collection. There were no visceral injuries. Twenty-two (10.9%) patients received a transfusion, and 16 (7.9%) patients had urinary tract infection. CONCLUSION In our experience, tubeless PCNL is safe, effective, and feasible without any discomfort for patients.
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Affiliation(s)
- Hossein Karami
- Department of Urology, Urology and Nephrology Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Abou-Elela A, Emran A, Mohsen MA, Reyad I, Bedair AS, Kader MA. Safety and efficacy of tubeless percutaneous renal surgery. J Endourol 2008; 21:977-84. [PMID: 17941772 DOI: 10.1089/end.2006.0229] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We challenge the requirement for routine placement of a nephrostomy tube after percutaneous renal surgery, assessing the outcome, safety, and efficacy of tubeless procedures. PATIENTS AND METHODS A total of 128 patients underwent tubeless percutaneous renal surgery from May 2001 to May 2004: stone extraction in 120 patients and endopyelotomy +/- stone extraction in 8. The stone sizes ranged from 2 to 7 cm with a mean of 4.1 cm. An external ureteral catheter was used in 120 patients and was removed after 24 hours if a retrograde study revealed no extravasation. An antegrade Double-J stent was used in 8 patients and removed 4 to 6 weeks postoperatively. Among the 128 patients treated by the tubeless technique, we met situations that mandated insertion of a nephrostomy tube in 18. RESULTS The stone free-rate was 90.4%. The mean hospital stay was 1.7 days. The incidence of significant intraoperative bleeding was 1.5% and that of significant postoperative hematuria was 4.6%. Postoperative sonography revealed a small perirenal collection (<50 mL) in 10 patients (7.8%) and significant perirenal collections (100-250 mL) in 3 (2.3%). The postoperative retrograde study revealed minor extravasation in 14 patients (12%) and significant extravasation in 3 (2.3%) CONCLUSION Tubeless percutaneous renal surgery with an externalized ureteral catheter is a safe procedure that is suitable for any patient who can be rendered stone free with a single procedure regardless of the initial stone burden.
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Tubeless percutaneous neprolithotomy: the new gold standard. Int Urol Nephrol 2007; 40:603-8. [PMID: 18092142 DOI: 10.1007/s11255-007-9305-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2007] [Accepted: 10/29/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE We present our experience with tubeless percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS Between July 2004 and December 2006, 121 patients (82 males and 39 females) with 18-70 mm (mean 31.19 mm) renal stones underwent tubeless PCNL leaving only a 6 Fr externalized ureteric catheter. Their ages ranged between 4 and 80 years (mean 37.27). Two patients had bilateral disease, so a total of 123 renal units are included. The procedure was performed under general anesthesia in the prone (110 units) or supine position (13 units). A total of 133 punctures were performed. The punctures were single (114 units), double (8 units), or triple (1 unit). The approach was subcostal through the lower calyx (n=110) or middle calyx (n=10), or supracostal through the middle calyx (n=8) or upper calyx (n=5). RESULTS Mean operative time was 46.30 min (range 15-100). Mean reduction in hemoglobin level was 1.57 g (range 0.3-4) with blood transfusion rate 4.13%. Complication rate was 9.9% in the form of perirenal collection (five patients), urinary leakage (two patients), fever (four patients), and hydrothorax (one patient). The ureteric catheter was left for 7-72 h (mean 45.67). Postoperative analgesia was required in 22 patients (18.2%) with mean 22.9 mg diclofenac sodium per patient. Mean hospital stay was 50.69 h (range 12-96) with 106 units (86.18%) rendered stone free, 13 (10.57%) with insignificant residuals, and four units (3.25%) were left with significant residual stones. CONCLUSIONS Tubeless PCNL is a good option in non-complicated PCNL with the advantages of reduced hospital stay, low postoperative pain, and little need for postoperative analgesia.
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Sofer M, Beri A, Friedman A, Aviram G, Mabjeesh NJ, Chen J, Ben-Chaim J, Greenstein A, Matzkin H. Extending the application of tubeless percutaneous nephrolithotomy. Urology 2007; 70:412-6; discussion 416-7. [PMID: 17905084 DOI: 10.1016/j.urology.2007.03.082] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2006] [Revised: 02/02/2007] [Accepted: 03/05/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Tubeless percutaneous nephrolithotomy (PCNL) has been successfully performed in selected patients. We assessed its applicability for use without imposing preoperative restrictions. METHODS The study consisted of a prospective and consecutive series of 126 patients. Tubeless PCNL was performed when perforation, residual stones, and significant bleeding had been intraoperatively excluded by fluoroscopy, nephroscopy, and hemodynamic assessment. Staghorn stones, supracostal and/or multiple access, anatomic anomalies, previously operated kidneys, solitary kidneys, and operative time were not considered contraindications. The demographic, clinical, and intraoperative and postoperative data were statistically analyzed. RESULTS Using this protocol, we performed 66 (52%) tubeless and 60 (48%) regular PCNLs. The average patient age (54 years versus 52 years), stone burden (924 versus 1044 mm2), operative time (116 versus 130 minutes), complication rate (9% versus 13%), hemoglobin decrease (1.2 versus 1.1 mg/dL), and immediate stone-free rate (92% versus 90%) were similar for the tubeless and regular PCNL groups, respectively (P >0.05). The reasons for performing standard PCNL were an expected second-look procedure (n = 35, 58%), an impression of active bleeding (n = 16, 27%), significant extravasation (n = 5, 8%), and suspected hydrothorax (n = 4, 7%). The overall transfusion rate was 3%. The average analgesia requirement (pethidine HCL) was 0.4 and 1.2 mg/kg (P <0.01), the median hospital stay was 1 and 4 days (P <0.0001), and the median back-to-work time was 7 and 15 days (P <0.001) for the tubeless and regular PCNL groups, respectively. CONCLUSIONS The results of our study have shown that tubeless PCNL can be safely and effectively performed based on intraoperative factors, without preoperative contraindications. Compared with the standard procedure, tubeless PCNL was associated with reduced postoperative pain, hospital stay, and recovery time.
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Affiliation(s)
- Mario Sofer
- Department of Urology, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
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Mandhani A, Goyal R, Vijjan V, Dubey D, Kapoor R. Tubeless Percutaneous Nephrolithotomy—Should a Stent be an Integral Part? J Urol 2007; 178:921-4. [PMID: 17632155 DOI: 10.1016/j.juro.2007.05.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Indexed: 11/20/2022]
Abstract
PURPOSE We compared the outcome of tubeless percutaneous nephrolithotomy with or without Double-J(R) stent. MATERIALS AND METHODS From January 2004 to March 2006 patients with renal stones matched for age and stone size who underwent tubeless percutaneous nephrolithotomy were prospectively evaluated in 2 groups treated by 2 surgeons. Group 1 had a Double-J stent and group 2 did not. Inclusion criteria for tubeless percutaneous nephrolithotomy included contralateral normal kidney, intact pelvicaliceal system, complete stone clearance under fluoroscopy and single infracostal puncture. These groups were compared for analgesic requirement, hospital stay, and intraoperative and postoperative complications. RESULTS During a period of 27 months 52 patients (57 renal units) underwent tubeless percutaneous nephrolithotomy. Group 1 had 25 (28 renal units) and group 2 had 27 patients (29 renal units). Mean stone volume was 4.34 +/- 2.12 cm(3) in group 1 and 4.14 +/- 1.14 cm(3) in group 2. Mean pain score was 2.96 +/- 1.24 and 2.82 +/- 0.81 in groups 1 and 2, respectively. Analgesic (intramuscular or oral diclofenac sodium) requirement and mean hospital stay was comparable in groups 1 and 2, eg 170 +/- 110 vs 163.24 +/- 98.07 mg and 2.52 +/- 0.12 vs 2.35 +/- 0.12 days. Two patients in group 1 and 1 in group 2 had urinary leak from the percutaneous nephrolithotomy tract. Similarly 3 patients in group 1 had severe stent related problems and 1 required early removal of the Double-J stent. CONCLUSIONS Avoiding use of the Double-J stent may not compromise the safety of tubeless percutaneous nephrolithotomy.
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Affiliation(s)
- Anil Mandhani
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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