Abstract
This study aimed to compare the totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy techniques regarding their rates of success and complications in patients with kidney stones. Patients were randomly assigned to two groups. Forty-four patients (24 men; mean age: 50.40±2.02 years) received totally tubeless percutaneous nephrolithotomy (PCNL; no nephrostomy catheter or ureteral catheter after PCNL) and 40 patients (18 men; mean age: 49.95±13.38 years) underwent standard PCNL (a nephrostomy catheter and ureteral catheter were used after PCNL). All surgeries were performed by one surgeon. Postoperative changes in hemoglobin, the blood transfusion rate, changes in creatinine levels, operation time, analgesic need, hospitalization time, and complication rate were compared between the groups. No significant differences were observed in age, gender, stone size, and surgery side between the groups (P<0.05). The operation time was significantly lower in the totally tubeless PCNL group than in the standard PCNL group (P=0.005). Pethidine requirements were significantly higher in the standard PCNL group than the totally tubeless PCNL group (P=0.007). Hospitalization time was significantly higher in the standard PCNL group than in the totally tubeless PCNL group (P<0.0001). The complication rate was 15% in the standard PCNL group and 9.1% in the totally tubeless PCNL group (P=0.73). The totally tubeless PCNL technique is safe and effective, even for patients with staghorn stones. This technique is associated with decreased pain, analgesic needs, and operative and hospitalization time. We believe that a normal peristaltic ureter is the best drainage tube.
Highlights
Kidney stones are a common disease that affects at least 10% of people
Various non-invasive, minimally invasive, and invasive methods have been reported as a treatment for kidney stones, including medicinal treatment, extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and open renal surgery
The mean preoperative hemoglobin level was significantly higher in the standard PCNL group (13.72±2.07 mg/dL) than in the totally tubeless PCNL group (12.88± 1.45 mg/dL, P=0.038)
Summary
Kidney stones are a common disease that affects at least 10% of people. Various non-invasive, minimally invasive, and invasive methods have been reported as a treatment for kidney stones, including medicinal treatment, extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and open renal surgery. In the past 30 years, PCNL as a minimally invasive method has been an effective treatment for large stones located in the kidney and upper ureter. PCNL is a more effective treatment for stones o2 cm compared with the ESWL method [1]. PCNL includes four steps: access to the kidney, dilatation of the tract (access site), nephroscopy and fragmentation of stones, and inserting a nephrostomy tube.
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