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Salar R, Gümüş K, Bahçeci T, Erbin A. Comparative analysis of re-entry malecot and nelaton catheters after standard percutaneous nephrolithotomy in adult patients: a cross-sectional study. Urolithiasis 2023; 51:109. [PMID: 37615770 DOI: 10.1007/s00240-023-01475-x] [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: 01/31/2023] [Accepted: 07/31/2023] [Indexed: 08/25/2023]
Abstract
Drainage catheters are used almost routinely to provide urinary drainage, prevent extravasation of urine, and create tamponade against bleeding after percutaneous nephrolithotomy (PNL). In the literature, there is no standardized approach to determining which type of catheter is superior. In this context, we aimed to comparatively analyze two different types of catheters (re-entry malecot catheter and nelaton catheter) in terms of success and complications, which we use for drainage after a PNL operation and which have very different costs. Patients who underwent PNL for kidney stones between January 2018 and October 2022 were included in the study. The data of a total of 148 patients who had a 16-F reentry malecot nephrostomy catheter or a 16-F nelaton catheter were analyzed. In addition to the demographic characteristics of the patients, stone characteristics, operative data, hospitalization time, analgesia requirement, hemoglobin exchange, amount of blood transfusion, and postoperative data (success and complications) were comparatively evaluated. The current unit price for a reentry malecot and a nelaton catheter is 4.7 United States dollars (USD) and 0.11 USD, respectively. There were a total of 148 patients in the study, 63 of whom were nelaton catheters and 85 were reentry malecots, and the mean age was 39.95 ± 13.28 years. There was no statistically significant difference between preoperative stone sizes and residual stone rates according to the groups. In addition, there was no statistically significant difference between the groups in terms of access site and stone localization. There was no significant difference between the groups in terms of complication rates according to the Clavien-Dindo classification, Hb levels, blood transfusion rates, operation times, or hospitalization times. In conclusion, if a second procedure is planned, a reentry malecot catheter may be preferred. Apart from this situation, nelaton catheters should be preferred because they are similar to reentry catheters in terms of effectiveness, and side effects and are more economical than reentry catheters in terms of cost.
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Affiliation(s)
- Remzi Salar
- Department of Urology, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa, Turkey.
| | - Kemal Gümüş
- Department of Urology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Tuncer Bahçeci
- Department of Urology, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
| | - Akif Erbin
- Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey
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Mao YH, Huang CP, Li TC, Li WB, Yang F, Liu BL, Luo Y, Chen XL, Zhan HL. Case selection and implementation of tubeless percutaneous nephrolithotomy. Transl Androl Urol 2021; 10:3415-3422. [PMID: 34532266 PMCID: PMC8421842 DOI: 10.21037/tau-21-559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/27/2021] [Indexed: 11/06/2022] Open
Abstract
Background The tubeless percutaneous nephrolithotomy (PCNL) was proposed to eliminate the side effects of the nephrostomy tube in recent years, such as pain, channel infection, postoperative bleeding, and longer hospital stay. But there is neither clinical guidelines nor consensus about tubeless PCNL in clinical practice. The study is aimed to how to implement the tubeless PCNL step by step, including case selection preoperatively, improving the technique of the surgeon, making the correct decisions at the end of the procedure, which had not been previously examined. Methods From January 2017 to March 2018, 364 consecutive patients requiring PCNL were comprehensively analyzed preoperatively and patients were selected for scheduled tubeless PCNL based on four aspects. The selected patients were divided into two groups according to whether the nephrostomy tube was finally placed. The mean operative time, intraoperative blood loss, stone clearance rate, visual pain score, postoperative hospitalization days and perioperative complications were all evaluated. Results Based on the preoperative evaluation, 42 patients were selected for tubeless PCNL, among which there were finally 37 cases of completed tubeless PCNL. Compared with patients undergoing conventional PCNL, there were not statistical differences in the mean operative time (P=0.207) or intraoperative blood loss (P=0.450) in the tubeless group. Stone clearance rate was 100% in both groups. The visual pain scores in the tubeless PCNL group were lower on operation day (P=0.029), first postoperative day (P<0.001) and the day of discharge (P=0.025). The postoperative hospitalization for the tubeless PCNL group was shorter than that of the control group (P<0.001). No significant difference in grade 1 complications was seen (P=0.424), and no grade 2 or higher complications were observed in either group. Conclusions Postoperative pain was significantly relieved and postoperative hospitalization was significantly shortened in the tubeless PCNL group. Tubeless PCNL is safe if patients are carefully selected using four criteria before operation, attention is paid to four key points and five confirmations are made during operation.
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Affiliation(s)
- Yun-Hua Mao
- Department of Urology, Lingnan Hospital, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chun-Ping Huang
- Department of Respiratory Medicine, The Central Hospital of Panyu, Guangzhou, China
| | - Teng-Cheng Li
- Department of Urology, Lingnan Hospital, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wen-Biao Li
- Department of Urology, Lingnan Hospital, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Fei Yang
- Department of Urology, Lingnan Hospital, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bo-Long Liu
- Department of Urology, Lingnan Hospital, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yun Luo
- Department of Urology, Lingnan Hospital, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xue-Lian Chen
- Department of Urology, Lingnan Hospital, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hai-Lun Zhan
- Department of Urology, Lingnan Hospital, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Melloni ND, Bosco C, Cena G, Putzu MG, Di Vella G. Retained surgical thread and forensic investigation: Malpractice or complication? Leg Med (Tokyo) 2020; 47:101749. [PMID: 32682295 DOI: 10.1016/j.legalmed.2020.101749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/10/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Niccolò D Melloni
- Department of Public Health and Pediatrics, Section of Legal Medicine, Università degli Studi di Torino, Italy.
| | - Caterina Bosco
- Department of Public Health and Pediatrics, Section of Legal Medicine, Università degli Studi di Torino, Italy
| | - Greta Cena
- Department of Public Health and Pediatrics, Section of Legal Medicine, Università degli Studi di Torino, Italy
| | - Maria Grazia Putzu
- University Occupational Medicine and Hospital Occupational Hazards Unit, A.O.U Città della Salute e della Scienza di Torino, Italy
| | - Giancarlo Di Vella
- Department of Public Health and Pediatrics, Section of Legal Medicine, Università degli Studi di Torino, Italy
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Supracostal access tubeless percutaneous nephrolithotomy: minimizing complications. World J Urol 2018; 37:1429-1433. [DOI: 10.1007/s00345-018-2518-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/03/2018] [Indexed: 12/15/2022] Open
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Iqbal N, Assad S, Hussain I, Hassan Y, Khan H, Farooq MA, Akhter S. Comparison of outcomes of tubed versus tubeless percutaneous nephrolithotomy in children: A single center study. Turk J Urol 2018; 44:56-61. [PMID: 29484229 DOI: 10.5152/tud.2018.19616] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 09/22/2017] [Indexed: 11/22/2022]
Abstract
Objective To evaluate and compare the effectiveness of tubeless percutaneous nephrolithotomy (PCNL) and tubed PCNL by using small bore nephrostomy tube (12Fr) in children for the management of nephrolithiasis. Material and methods This study was a retrospective analysis of 35 children where tubed PCNL (Group 1) was done in 18, and tubeless PCNL (group 2) in 17 patients from January 2010 to December 2016. Charts were reviewed for age, mass, stone size, operative time, hospital stay and stone-free rates. These variables were compared between the two groups. SPSS version 21 was used for data analysis. The data were shown as mean±standard deviation for continuous variables. Categorical variables were presented in percentages. Results There is no difference in terms of age, stone sizes, operative times, hospital stays, stone-free rates and post-PCNL complications between the two groups (p>0.05). The mean drop in hemoglobin level was 0.7±0.1 g/dL and 1.3±0.2 g/dL in Groups 1 and 2, respectively (p=0.01). Conclusion Tubeless PCNL in children is a safe option in well selected cases.
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Affiliation(s)
- Nadeem Iqbal
- Department of Urology and Kidney Transplant, Pakistan Kidney Institute, Shifa International Hospital, Islamabad, Pakistan
| | - Salman Assad
- Shifa College of Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Ijaz Hussain
- Department of Urology and Kidney Transplant, Pakistan Kidney Institute, Shifa International Hospital, Islamabad, Pakistan
| | - Yumna Hassan
- Shifa College of Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Hafsa Khan
- Shifa College of Medicine, Shifa International Hospital, Islamabad, Pakistan
| | | | - Saeed Akhter
- Department of Urology and Kidney Transplant, Pakistan Kidney Institute, Shifa International Hospital, Islamabad, Pakistan
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Lee JY, Jeh SU, Kim MD, Kang DH, Kwon JK, Ham WS, Choi YD, Cho KS. Intraoperative and postoperative feasibility and safety of total tubeless, tubeless, small-bore tube, and standard percutaneous nephrolithotomy: a systematic review and network meta-analysis of 16 randomized controlled trials. BMC Urol 2017. [PMID: 28655317 DOI: 10.1186/s12894-017-0239-x.pmid:28655317;pmcid:pmc5488341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Percutaneous nephrolithotomy (PCNL) is performed to treat relatively large renal stones. Recent publications indicate that tubeless and total tubeless (stentless) PCNL is safe in selected patients. We performed a systematic review and network meta-analysis to evaluate the feasibility and safety of different PCNL procedures, including total tubeless, tubeless with stent, small-bore tube, and large-bore tube PCNLs. METHODS PubMed, Cochrane Central Register of Controlled Trials, and EMBASE™ databases were searched to identify randomized controlled trials published before December 30, 2013. One researcher examined all titles and abstracts found by the searches. Two investigators independently evaluated the full-text articles to determine whether those met the inclusion criteria. Qualities of included studies were rated with Cochrane's risk-of-bias assessment tool. RESULTS Sixteen studies were included in the final syntheses including pairwise and network meta-analyses. Operation time, pain scores, and transfusion rates were not significantly different between PCNL procedures. Network meta-analyses demonstrated that for hemoglobin changes, total tubeless PCNL may be superior to standard PCNL (mean difference [MD] 0.65, 95% CI 0.14-1.13) and tubeless PCNLs with stent (MD -1.14, 95% CI -1.65--0.62), and small-bore PCNL may be superior to tubeless PCNL with stent (MD 1.30, 95% CI 0.27-2.26). Network meta-analyses also showed that for length of hospital stay, total tubeless (MD 1.33, 95% CI 0.23-2.43) and tubeless PCNLs with stent (MD 0.99, 95% CI 0.19-1.79) may be superior to standard PCNL. In rank probability tests, small-bore tube and total tubeless PCNLs were superior for operation time, pain scores, and hemoglobin changes. CONCLUSIONS For hemoglobin changes, total tubeless and small-bore PCNLs may be superior to other methods. For hospital stay, total tubeless and tubeless PCNLs with stent may be superior to other procedures.
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Affiliation(s)
- Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Seong Uk Jeh
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Man Deuk Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Hyuk Kang
- Department of Urology, Inha University School of Medicine, Incheon, South Korea
| | - Jong Kyou Kwon
- Department of Urology, Severance Check-Up, Yonsei University Health System, Seoul, South Korea
| | - Won Sik Ham
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Deuk Choi
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea.
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Lee JY, Jeh SU, Kim MD, Kang DH, Kwon JK, Ham WS, Choi YD, Cho KS. Intraoperative and postoperative feasibility and safety of total tubeless, tubeless, small-bore tube, and standard percutaneous nephrolithotomy: a systematic review and network meta-analysis of 16 randomized controlled trials. BMC Urol 2017; 17:48. [PMID: 28655317 PMCID: PMC5488341 DOI: 10.1186/s12894-017-0239-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 06/21/2017] [Indexed: 01/12/2023] Open
Abstract
Background Percutaneous nephrolithotomy (PCNL) is performed to treat relatively large renal stones. Recent publications indicate that tubeless and total tubeless (stentless) PCNL is safe in selected patients. We performed a systematic review and network meta-analysis to evaluate the feasibility and safety of different PCNL procedures, including total tubeless, tubeless with stent, small-bore tube, and large-bore tube PCNLs. Methods PubMed, Cochrane Central Register of Controlled Trials, and EMBASE™ databases were searched to identify randomized controlled trials published before December 30, 2013. One researcher examined all titles and abstracts found by the searches. Two investigators independently evaluated the full-text articles to determine whether those met the inclusion criteria. Qualities of included studies were rated with Cochrane’s risk-of-bias assessment tool. Results Sixteen studies were included in the final syntheses including pairwise and network meta-analyses. Operation time, pain scores, and transfusion rates were not significantly different between PCNL procedures. Network meta-analyses demonstrated that for hemoglobin changes, total tubeless PCNL may be superior to standard PCNL (mean difference [MD] 0.65, 95% CI 0.14–1.13) and tubeless PCNLs with stent (MD -1.14, 95% CI -1.65–-0.62), and small-bore PCNL may be superior to tubeless PCNL with stent (MD 1.30, 95% CI 0.27–2.26). Network meta-analyses also showed that for length of hospital stay, total tubeless (MD 1.33, 95% CI 0.23–2.43) and tubeless PCNLs with stent (MD 0.99, 95% CI 0.19–1.79) may be superior to standard PCNL. In rank probability tests, small-bore tube and total tubeless PCNLs were superior for operation time, pain scores, and hemoglobin changes. Conclusions For hemoglobin changes, total tubeless and small-bore PCNLs may be superior to other methods. For hospital stay, total tubeless and tubeless PCNLs with stent may be superior to other procedures.
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Affiliation(s)
- Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Seong Uk Jeh
- Department of Urology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, South Korea
| | - Man Deuk Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Dong Hyuk Kang
- Department of Urology, Inha University School of Medicine, Incheon, South Korea
| | - Jong Kyou Kwon
- Department of Urology, Severance Check-Up, Yonsei University Health System, Seoul, South Korea
| | - Won Sik Ham
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Deuk Choi
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea.
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Tubeless versus standard percutaneous nephrolithotomy in pediatric patients: a systematic review and meta-analysis. Urologia 2017; 85:3-9. [DOI: 10.5301/uj.5000270] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: This systematic review and meta-analysis was designed to evaluate the post-operative outcomes between tubeless and standard percutaneous nephrolithotomy (PCNL) among children. Methods: Literature searches were performed following the Cochrane guidelines. We conducted a systematic review and meta-analysis that included three trials investigating the outcomes including the length of hospital stay, operation time, hemoglobin decrease, blood transfusion rate, perirenal fluid presence, post-operative fever, stone clearance rate, and the need for a second operation. Results: The patients who underwent tubeless PCNL had shorter length of hospitalization compared to standard PCNLs (mean difference -1.57, 95% confidence interval -3.2 to 0.07, p = 0.06). No significant decrease was detected in hemoglobin after tubeless PCNL compared to standard PCNL (mean difference 0.05, 95% confidence interval -0.03 to 0.13, p = 0.21). There were no significant differences in operation time (p = 0.7), perirenal fluid presence (p = 0.15), post-operative fever (p = 0.72), stone clearance (p = 0.68), and the need for a second operation (p = 0.90). Conclusions: This study showed no significant difference between tubeless and standard PCNLs in children. However, due to the lack of data, the results should be mentioned prudently. Future randomized trials with more sample sizes and longer follow-ups are warranted.
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Noureldin YA, Diab C, Valenti D, Andonian S. Circle nephrostomy tube revisited. Can Urol Assoc J 2017; 10:E223-E228. [PMID: 28255412 DOI: 10.5489/cuaj.3596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There are few options for patients requiring chronic urinary drainage using nephrostomy tubes. Although circle nephrostomy tube (CNT) was invented in 1954, it is rarely used. Its advantages include longer indwelling time such that it is changed semi-annually when compared with the standard nephrostomy tube (SNT), which is changed monthly. However, there are no studies comparing indwelling times and costs with these two tubes. The aim of the present study was to compare CNT with SNT in terms of frequency of tube changes, reasons for earlier tube changes, and associated costs. METHODS Patients who had CNT inserted between 2009 and 2015 were reviewed. The indications for chronic indwelling nephrostomy tubes were tabulated. The frequency of tube changes was compared between CNT and SNT in the same patients. Furthermore, costs associated with insertion and exchange of CNT and SNT were analyzed. RESULTS Seven patients with mean age of 71.9 ± 7.6 years (range 43-96) had a total of 36 CNT changes. The mean number of CNT changes was four (range 2-5) at a mean interval of 168.3 ± 15.6 days (range 120-231). All patients had SNT prior to converting to CNT. When compared with the mean interval for SNT changes, the mean interval for CNT changes was significantly longer (44.8 ± 19.4 vs. 168.3 ± 41.3 days; p=0.028). Tube blockage and urinary leakage were the most common reasons for earlier than scheduled CNT changes. In our centre, CNT insertion and exchange cost $1965.48 and $923.96 compared with $1450.43 and $803.81 for SNT, respectively. There was an estimated cost savings of $46 861.10 (range $87 414.30 -$40 553.20) for the whole cohort by switching from SNTs to CNTs. CONCLUSIONS Despite the small sample size as the main limitation, this study confirms that CNTs are associated with significantly fewer changes and lower cost when compared with SNTs for poor-surgical-risk patients requiring chronic NTs.
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Affiliation(s)
- Yasser A Noureldin
- Division of Urology, McGill University, Montreal, QC, Canada;; Urology Department, Benha University Hospital, Benha University, Benha, Egypt
| | - Christian Diab
- Division of Urology, McGill University, Montreal, QC, Canada
| | - David Valenti
- Division of Interventional Radiology, McGill University, Montreal, QC, Canada
| | - Sero Andonian
- Division of Urology, McGill University, Montreal, QC, Canada
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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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Álvarez Villarraga JD, Carreño Galeano GL, Hernández García CE, Silva Herrera JM, Patiño Sandoval GA. Nefrolitotomía percutánea convencional vs. tubeless. ¿Es realmente necesaria la derivación urinaria? Rev Urol 2016. [DOI: 10.1016/j.uroco.2015.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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El Tayeb MM, Knoedler JJ, Krambeck AE, Paonessa JE, Mellon MJ, Lingeman JE. Vascular complications after percutaneous nephrolithotomy: 10 years of experience. Urology 2015; 85:777-81. [PMID: 25704996 DOI: 10.1016/j.urology.2014.12.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/29/2014] [Accepted: 12/30/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To provide a contemporary look at vascular complications after percutaneous nephrolithotomy (PNL) with access performed solely by a urologist using fluoroscopic guidance. METHODS A retrospective review of 2792 patients who had 3338 PNLs at Indiana University Health Methodist Hospital and Mayo Clinic Rochester was performed. Patients who experienced significant bleeding requiring diagnostic renal angiography and superselective embolization (SSE) were reviewed and compared with the overall database. RESULTS There were 15 patients (16 renal units) requiring renal angiography and SSE (0.48%). Mean time from PNL to bleeding was 7 days (range, 1-15 days) and to SSE was 9.6 days (range, 2-18 days). Mean drop in hemoglobin was 5.3 g/dL (range, 2-9 g/dL). Transfusion was needed in 9 patients (60%). There were no differences between the vascular complications group and the uneventful PNL group in mean age (55.06 vs 52.2 years; P = .519), UTI history (40% vs 38%; P = .92), mean operative time (125.8 vs 102.47 minutes; P = .192), the need for multiple access (18.75% vs 18%; P = .939), and access location. The vascular complications group had a lower stone burden than the uneventful PNL group (stones > 2 cm; 43.7% vs 74.03%; P = .014). CONCLUSION The incidence of vascular complications in this contemporary series is one of the lowest reported to date. At our centers, vascular bleeding complications appear to be a random and rare event after PNL as we were unable to identify any specific risk factors. Early SSE avoided the need for blood transfusion in many patients.
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Affiliation(s)
- Marawan M El Tayeb
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Jessica E Paonessa
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Matthew J Mellon
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - James E Lingeman
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
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Hartman C, Gupta N, Leavitt D, Hoenig D, Okeke Z, Smith A. Advances in percutaneous stone surgery. Asian J Urol 2015; 2:26-32. [PMID: 29264116 PMCID: PMC5730686 DOI: 10.1016/j.ajur.2015.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/11/2014] [Accepted: 08/18/2014] [Indexed: 11/21/2022] Open
Abstract
Treatment of large renal stones has changed considerably in recent years. The increasing prevalence of nephrolithiasis has mandated that urologists perform more surgeries for large renal calculi than before, and this has been met with improvements in percutaneous stone surgery. In this review paper, we examine recent developments in percutaneous stone surgery, including advances in diagnosis and preoperative planning, renal access, patient position, tract dilation, nephroscopes, lithotripsy, exit strategies, and post-operative antibiotic prophylaxis.
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Hartman C, Gupta N, Leavitt D, Hoenig D, Okeke Z, Smith A. WITHDRWAN: Advances in percutaneous stone surgery. Asian J Urol 2014. [DOI: 10.1016/j.ajur.2014.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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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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Domenech A, Vivaldi B, López J, Pizzi P, Chacón R, Figueroa A, Durruty J, Zambrano N, Coz F. Tubeless percutaneous nephrolithotomy without losing the possibility of second-look nephroscopy: The perfect combination. Actas Urol Esp 2014; 38:334-8. [PMID: 24279984 DOI: 10.1016/j.acuro.2013.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Revised: 10/02/2013] [Accepted: 10/11/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate an alternative approach to tubeless surgery that allows a second percutaneous procedure using the same nephrostomy tract. METHODS Twenty patients underwent percutaneous nephrolithotomy from September 2012 to May 2013 at our institution. Inclusion criteria were: absence of urinary infection, single puncture and operative time less than 2 h. Following the procedure the initially placed ureteral catheter was exteriorized through the working sheath by tying a non-absorbable suture to its end. On postoperative day 1 all patients were studied with non-enhanced CT or X-ray film. If the patient was rendered stone free, the stent was removed along with the urethro-vesical catheter. If a residual stone was present, we recovered the ureteral catheter and used the same nephrostomy tract for a second endoscopic procedure. Patients were assessed for pain, postoperative complications, length of stay, stone free rate, hematocrit and creatinine variations. RESULTS Thirteen patients met the inclusion criteria. No major complications related to the stent placement and its exteriorization were seen. Two patients required a second percutaneous procedure successfully achieved recovering the ureteral catheter through the nephrostomy tract. CONCLUSION We present a safe and simple modification of tubeless percutaneous nephrolithotomy, with its well-known clinical benefits but maintaining a safe path for an eventual second look procedure if necessary.
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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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Advances in Tubeless Percutaneous Nephrolithotomy and Patient Selection: An Update. Curr Urol Rep 2013; 14:130-7. [DOI: 10.1007/s11934-013-0310-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gnessin E, Mandeville JA, Handa SE, Lingeman JE. The Utility of Noncontrast Computed Tomography in the Prompt Diagnosis of Postoperative Complications After Percutaneous Nephrolithotomy. J Endourol 2012; 26:347-50. [DOI: 10.1089/end.2011.0504] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ehud Gnessin
- Department of Urology, Indiana University Health, Methodist Hospital, Indianapolis, Indiana
| | - Jessica A. Mandeville
- Department of Urology, Indiana University Health, Methodist Hospital, Indianapolis, Indiana
| | - Shelly E. Handa
- Department of Urology, Indiana University Health, Methodist Hospital, Indianapolis, Indiana
| | - James E. Lingeman
- Department of Urology, Indiana University Health, Methodist Hospital, Indianapolis, Indiana
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Re: Robert B. Nadler. Words of Wisdom re: A Randomized Comparison of Totally Tubeless and Standard Percutaneous Nephrolithotomy in Elderly Patients. Kara C, Resorlu B, Bayindir M, Unsal A. Urology 2010;76:289–93. Eur Urol 2011;59:1070. Eur Urol 2011; 60:e26. [DOI: 10.1016/j.eururo.2011.05.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 05/31/2011] [Indexed: 11/23/2022]
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Kara C, Resorlu B, Bayindir M, Unsal A. A Randomized Comparison of Totally Tubeless and Standard Percutaneous Nephrolithotomy in Elderly Patients. Urology 2010; 76:289-93. [PMID: 20299077 DOI: 10.1016/j.urology.2009.11.077] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 10/15/2009] [Accepted: 11/21/2009] [Indexed: 10/19/2022]
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Maheshwari PN, Mane DA, Pathak AB. Management of pleural injury after percutaneous renal surgery. J Endourol 2009; 23:1769-72. [PMID: 19785558 DOI: 10.1089/end.2009.1549] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract Pleural injury is a potential complication of supracostal access for percutaneous renal surgery. Vigilant observation by the surgeon for timely identification and prompt treatment of an injury goes a long way toward saving the patient from serious long-term thoracic morbidity.
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Shah HN, Sodha HS, Khandkar AA, Kharodawala S, Hegde SS, Bansal MB. A randomized trial evaluating type of nephrostomy drainage after percutaneous nephrolithotomy: small bore v tubeless. J Endourol 2008; 22:1433-9. [PMID: 18690809 DOI: 10.1089/end.2007.0350] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To compare the outcome of tubeless percutaneous nephrolithotomy (PCNL) with small-bore nephrostomy drainage after PCNL. PATIENTS AND METHODS We tested the hypothesis that tubeless PCNL is superior to small-bore nephrostomy drainage after PCNL in terms of postoperative pain, analgesic requirement, and hospital stay. To show a 10% difference in these parameters, a sample size of 30 persons per group would be needed. All patients undergoing PCNL from September 2005 to May 2006 were included in the study. Patients meeting the inclusion and exclusion criteria were then randomized to either a tubeless approach with insertion of a ureteral stent or placement of an 8F nephrostomy tube without insertion of a ureteral stent. The perioperative outcomes of patients in the two groups were compared. RESULTS Tubeless PCNL was performed in 33 patients, and an 8F nephrostomy tube was placed in 32 patients. The two groups had comparable demographic data. The hemoglobin drop and complication rate between the two groups were comparable. Patients undergoing tubeless PCNL experienced less postoperative pain (P = 0.001), needed less analgesia (P = 0.006), and were discharged 9 hours earlier than patients in the other group. Complete stone clearance was achieved in 87.87% patients in the tubeless group and 87.5% patients in the nephrostomy group. In the tubeless group, 39.4% of patients had bothersome stent-related symptoms, of whom 61.5% needed analgesics and/or antispasmodic agents. CONCLUSIONS Tubeless PCNL offers the potential advantages of decreased postoperative pain, analgesic requirement, and hospital stay without increasing the complications. It was associated with stent-related discomfort in 39% of patients.
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Affiliation(s)
- Hemendra N Shah
- Department of Urology, R. G. Stone Urological Research Institute, Mumbai, India.
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Saussine C, Lechevallier E, Traxer O. [PCNL: technique, results and complications]. Prog Urol 2008; 18:886-90. [PMID: 19033048 DOI: 10.1016/j.purol.2008.09.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 09/02/2008] [Indexed: 11/19/2022]
Abstract
Recent technological changes of percutaneous nephrolithotomy are reviewed. Results and complications of the most recent publications are presented.
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Affiliation(s)
- C Saussine
- Service d'urologie, hôpital Civil, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
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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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Die Verwendung von Gelatine-Thrombin-Matrix zum Verschluss des Arbeitskanals bei der nephrostomielosen minimal-invasiven perkutanen Nephrolitholapaxie. Urologe A 2008; 47:601-7. [DOI: 10.1007/s00120-008-1673-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Abstract
Percutaneous nephrolithotomy was first performed in 1976. In the past 30 years, many refinements to the procedure have been made and it has become the gold standard for the management of large and complex renal calculi. This article reviews advances made in the field and highlights the nuances of the technique. The large published series are reviewed and their results discussed.
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Affiliation(s)
- Leslie A Deane
- Department of Urology, University of California Irvine, UCI Medical Center, Orange, CA 92868, USA
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Khairy Salem H, Morsi HA, Omran A, Daw MA. Tubeless percutaneous nephrolithotomy in children. J Pediatr Urol 2007; 3:235-8. [PMID: 18947742 DOI: 10.1016/j.jpurol.2006.06.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Accepted: 06/30/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the effectiveness of tubeless percutaneous nephrolithotomy (PCNL) as an alternative to extracorporeal shock-wave lithotripsy (ESWL) in the management of urolithiasis in children. MATERIALS AND METHODS In 2003-2005 we operated on 20 cases that met the inclusion criteria. Extensive follow-up tests were performed in all patients; stone clearance was defined as the absence of residual fragments on plain abdominal X-ray and renal ultrasound. Pain-scale ruler (0-10) was used to evaluate pain postoperatively. Comparison was made with a group of 10 patients with very similar criteria operated upon with PCN tube. RESULTS Mean follow-up period was 9 months (3-18 months) and mean age 7.5 years (4-15 years). Mean operative time was 115 min (45-180) with no significant bleeding intra- or postoperatively. Conversion to open surgery was necessary in one case. There were no major perioperative complications. In the tubeless group the pain score was 3-6 (mean 4.6), there was no need for IV analgesia, and median hospital stay was 1.7 days (1-4 days); urine leakage occurred in one patient. In the group with PCN tube the pain score was 5-8 (mean 5.5), IV analgesia was mandatory in four patients, and median hospital stay was 2.8 days (3-4 days); urine leakage occurred in five patients and a small residual stone was detected in one child. CONCLUSION Tubeless PCNL in children has the advantages of being less painful, less troublesome and shortening the hospital stay of the child. The decision to use this procedure is best made intraoperatively and depends on the experience of the surgeon.
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Affiliation(s)
- H Khairy Salem
- Department of Pediatric Urology, Cairo University Specialized Pediatric Hospital, Urosurgery, Kasr el Einy Hospital, PO Box 247, Giza, Cairo 12515, Egypt.
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Canales BK, Karlovsky ME, Monga M, Seidmon EJ. How small can we go? Percutaneous nephrolithotomy using 6F nephroureteral catheter. Urology 2007; 69:629-32. [PMID: 17445638 DOI: 10.1016/j.urology.2007.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2006] [Revised: 09/27/2006] [Accepted: 01/03/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To retrospectively examine our percutaneous nephrolithotomy pathway to determine the efficacy of a 6F antegrade nephroureteral catheter (NUC). METHODS The records of 99 consecutive patients who underwent percutaneous nephrolithotomy from 1998 to 2000 were reviewed. All patients were admitted the day before percutaneous nephrolithotomy and underwent placement of a nephrostomy tube. The following day, after balloon dilation of the access tract and performance of the procedure through a 30F sheath, an internal-external 6F NUC was left in place. Nephrostograms were performed on postoperative day 1, and, if negative for extravasation or residual stones, the stent was removed. The postoperative parameters included the length of stay, intravenous narcotic use, complications, and time to removal of the indwelling stent. RESULTS The average procedure time was 103 minutes (range 30 to 300), with a mean stone size of 1.7 cm. The average length of stay was 2.5 days, with postoperative intravenous narcotic use lasting 1.7 days. Of the 99 NUCs placed, 82% were removed by postoperative day 2. Eleven patients had either renal (n = 8) or ureteral (n = 3) extravasation requiring prolonged stenting, and nine had residual stones requiring a second-look procedure. Multivariate analysis demonstrated that prolonged narcotic use, days with an indwelling stent, and longer procedure times correlated significantly with a longer length of stay (P <0.001). The proportion of minor and major complications was 18% and 5%, respectively. CONCLUSIONS The results of our study have indicated that the 6F NUC minimizes postoperative intravenous narcotic use and expedites both recovery and discharge. Because it is the smallest nephroureteral catheter reported to date for this use, we recommend it be incorporated into prospective studies with validated pain questionnaires.
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Affiliation(s)
- Benjamin K Canales
- Department of Urology, University of Minnesota School of Medicine, Minneapolis, Minnesota 55455-0392, USA
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Shah HN, Shah H, Hegde SS, Hegde S, Shah JN, Shah J, Bansal MB, Bansal M. Safety and efficacy of supracostal access in tubeless percutaneous nephrolithotomy. J Endourol 2007; 20:1016-21. [PMID: 17206894 DOI: 10.1089/end.2006.20.1016] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To evaluate the feasibility and safety of supracostal access in tubeless percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS From September 2004 to November 2005, tubeless PCNL using supracostal access was done for 72 patients at our institute. Patients requiring more than two percutaneous tracts or with significant intraoperative bleeding or residual stone burden were excluded from the study. The outcome of these patients was compared with that of a historic cohort of similar patients having supracostal access with routine placement of a nephrostomy tube. The two groups had comparable demographic data. RESULTS The differences in the mean drop in hemoglobin concentration, transfusion requirement, and complication rate in the two groups were not statistically significant, with three patients in the study group and four patients in the control group requiring blood transfusion. Patients undergoing tubeless PCNL required less analgesia (P = 0.000) and were discharged a mean of 19 hours earlier (P = 0.000) than those in the control group. Complete stone clearance was achieved in 90.27% of the renal units in the study group and 86.11% of the renal units in the control group. Two patients in the study group and three patients in the control group had postoperative hydrothorax, all of whom, except for one in the control group, were managed conservatively. CONCLUSION Supracostal access in tubeless PCNL appears to be feasible, safe, and effective, offering the advantages of a lower analgesic requirement and shorter hospital stay without increasing thoracic complications. Studies with larger numbers of patients are needed to confirm these initial findings.
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Affiliation(s)
- Hemendra N Shah
- Department of Urology, R.G. Stone Urological Research Institute, Mumbai, India.
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Tefekli A, Altunrende F, Tepeler K, Tas A, Aydin S, Muslumanoglu AY. Tubeless percutaneous nephrolithotomy in selected patients: a prospective randomized comparison. Int Urol Nephrol 2006; 39:57-63. [PMID: 17171416 DOI: 10.1007/s11255-006-9040-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2006] [Accepted: 05/09/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To prospectively compare the outcome of standard and tubeless percutaneous nephrolithotomy (PNL) in a selected group of patients with renal stones. METHODS Patients with simple, isolated renal pelvis or lower pole caliceal stones and no significant hydronephrosis were randomly enrolled to undergo either standard PNL, in which routine nephrostomy tube was placed at the end of operation, or tubeless PNL. Occurrence of intraoperative complications, total operative time exceeding 2 h, indication for additional access or second-look PNL due to residual stones were exclusion criteria. RESULTS There were 11 isolated lower pole caliceal stones (mean stone burden: 3.1 cm(2)) and 6 isolated renal pelvis stones (mean stone burden: 2.8 cm(2)) in the tubeless PNL group (n: 17), and 9 isolated lower pole caliceal stones (mean stone burden: 3.4 cm(2)) and 9 isolated renal pelvis stones (mean stone burden: 3.1 cm(2)) in the standard PNL group (n: 18). Mean operation time was 59.6 +/- 9.1 (range: 50-90) min in the tubeless group, and 67.3 +/- 10.1 (range: 60-115) min in the standard PNL group (P > 0.05). Successful stone removal was achieved in all patients, and no significant complication was observed in any case. The mean postoperative analgesic requirement was significantly less in the tubeless group (P < 0.05). Mean hospital stay was 1.6 +/- 0.4 (range: 1-3) days in the tubeless group, and 2.8 +/- 0.9 (range: 2-4) days in the former group (P < 0.05). CONCLUSION Our results indicate that tubeless PNL is safe in the management of selected patients and that mean analgesic requirement as well as hospitalization time is diminished with this modification.
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Affiliation(s)
- Ahmet Tefekli
- Department of Urology, Haseki Teaching and Research Hospital, 34096 Haseki, Istanbul, Turkey.
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Shah HN, Hegde S, Shah JN, Mohile PD, Yuvaraja TB, Bansal MB. A Prospective, Randomized Trial Evaluating the Safety and Efficacy of Fibrin Sealant in Tubeless Percutaneous Nephrolithotomy. J Urol 2006; 176:2488-92; discussion 2492-3. [PMID: 17085137 DOI: 10.1016/j.juro.2006.07.148] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE We performed a prospective, randomized trial to assess the safety and efficacy of fibrin sealant in tubeless percutaneous nephrolithotomy. MATERIALS AND METHODS A total of 63 patients undergoing tubeless percutaneous nephrolithotomy were randomized to receive Tisseel vapor heated sealant at the end of the procedure. Fibrin sealant was instilled under direct vision in the nephrostomy tract at the end of the procedure. Patients younger than 14 years and those undergoing staged percutaneous nephrolithotomy or bilateral simultaneous percutaneous nephrolithotomy were excluded from study. Patients needing greater than 2 percutaneous tracts, those with significant bleeding or associated pyonephrosis and those with a residual stone burden were also excluded from study. The perioperative outcome in these patients (experimental group) was compared with the outcome in those undergoing tubeless percutaneous nephrolithotomy without fibrin sealant (control group). RESULTS Fibrin sealant was instilled in 32 patients. There was no difference in the hematocrit decrease and blood transfusion requirement in the 2 groups. Patients in the experimental group experienced less postoperative pain and required less analgesia. They were discharged home 5 hours earlier than patients in the control group. However, this difference was not statistically significant. Complete stone clearance was achieved in 87.5% of patients in the experimental group and in 90.32% of controls. CONCLUSIONS The instillation of Tisseel fibrin glue is safe for tubeless percutaneous nephrolithotomy. It is associated with less postoperative pain and a lower analgesic requirement. Additional prospective, randomized studies are required to better define its clinical role in the future.
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Affiliation(s)
- Hemendra N Shah
- R. G. Stone Urological Research Institute, Khar (W), and Tata Memorial Hospital, 21-A, 14-A Road, Ahimsa Marg, Mumbai 400052, India.
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Shah HN, Kausik V, Hedge S, Shah JN, Bansal MB. Initial experience with hemostatic fibrin glue as adjuvant during tubeless percutaneous nephrolithotomy. J Endourol 2006; 20:194-8. [PMID: 16548728 DOI: 10.1089/end.2006.20.194] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To report our initial experience with hemostatic fibrin glue as an adjuvant during tubeless percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS Seventeen consecutive patients underwent tubeless PCNL with injection of 2 mL of Tisseel Vapor Heated Sealant (Baxter AG, Vienna, Austria) into the percutaneous tracts at the conclusion of the procedure. The perioperative outcomes of these patients were compared retrospectively with those of a control group of 25 consecutive patients who underwent tubeless PCNL without the use of fibrin glue. The safety and efficacy of the new approach was evaluated by comparing operative time, hemoglobin drop, transfusion requirement, length of hospitalization, postoperative pain, analgesic use, and postoperative complications in the two groups. RESULTS There was no difference in the mean drop in hemoglobin, transfusion requirement, or complications in the two groups. However, patients undergoing Tisseel tubeless PCNL required less analgesia postoperatively (P=0.05), and they were discharged an average of 7 hours earlier than the patients in the control group. There were no major postoperative complications. CONCLUSIONS Use of fibrin glue was safe and was associated with less analgesic requirement and a shorter hospital stay. Randomized studies are needed to evaluate its clinical role in the future.
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Bibliography. Current world literature. Minimally invasive surgery in urology. Curr Opin Urol 2006; 16:112-7. [PMID: 16479214 DOI: 10.1097/01.mou.0000193398.85092.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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LiteratureWatch. J Endourol 2005; 19:1045-62. [PMID: 16253079 DOI: 10.1089/end.2005.19.1045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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