[Choosing a method of draining the upper urinary tract following percutaneous nephrolithotripsy]

PURPOSE

to compare various methods of upper urinary tract drainage in patients with urolithiasis.

PATIENTS AND METHODS

60 patients were included into a prospective study which ran from March 2013 through December 2014. All patients underwent PCNL with a nephrostomy tract diameter of (28-30 Ch.) at the I.M. Sechenov First Moscow State Medical University urology clinic. Patients were divided into 2 groups. Group 1 30 (patients) underwent nephrostomy after PCNL with nephrostomy tract placement, in group 2 (29 patients) internal drainage was performed. One patient withdrew from the study due to residual stone. Adequacy of urinary tract draining was assessed by operative time and blood loss. A comparative analysis was performed to outline difference in both groups by length of hospital stay, severity of flank pain in early postoperative period and 5 days after the procedure, day of drain removal.

RESULTS

the average operative time in group No1 was 104 minutes (+/-17 min.), and 71 minutes (+/- 19 minutes) in group No2 . The average hemoglobin level before surgery in both groups was roughly comparable and amounted to: 141.5g / l (+/-13) in group No1, in group No 2 143.6 g / l (+/-18). At the same time, hemoglobin level in the early postoperative period varied in both groups and was as follows: 121g / l (+/-13) in group No1, and 128g / l (+/-14) in group 2. Evaluation of pain severity by VAS score showed that severity of pain in an early postoperative period was roughly comparable in both groups and amounted to 6.29 and 6.05 points, respectively, but from the second day, and since the activation of the patients, the values of the intensity of pain in both groups became differ. Group No1: - 5.33 (+/-1.5) on day 2, 3.25 (+/-1.8) on day 3, - 2.5 (+/-1.6) on day 5. A more thorough elucidation of the cause of pain showed that in 56 (88%) patients the pain was due to the nephrostomy and pain in the nephrostomy stroke while driving and only 7 (11%) patients complained of a pain in the operated kidney. Group No2: - 3.5 (+/-1.2) on day 2, - 2.9 (+/-1.4) on day 3, 1.22 (+/-0.8) on day 5.

CONCLUSION

A detailed and thorough history, taking together with multislice computed tomography and multiplanar 3D modeling allows for better preoperative assessment regarding a size, a number and location of stones, vascular architecture of the kidney. This enebles an experienced endoscopic surgeon to plan an operation, and avoid the possible difficulties associated with lithotripsy and choose a more suitable method of pyelocaliceal system draining after the operation. In turn, tubeless PCNL, with proper intraoperative managamant and careful selection of patients appears to be safe and effective. Drainage of the upper urinary tract with internal drainage reduces intensity of postoperative pain, which improves the quality of life of patients in the postoperative period, and reduces the length of postoperative stay.