Experience and Performance of Tubeless Percutaneous Nephrolitotomy

Abstract

Percutaneous nephrolithotripsy is a standard method in the treatment of nephrolithiasis, in the final stage of which nephrostomy drainage is established, but there are known methods of performing this operation without nephrostomy. This article shows our experience of performing tubeless percutaneous nephrolithotomy, as well as evaluates the safety and efficacy of tubeless PNL with placement of a JJ-stent. The objective: establish opportunities to perform a tubeless mini percutaneous nephrolithotomy and evaluate the safety and effectiveness of its implementation. Materials and methods. For the period 2017–2021. performed more than 500 percutaneous nephrolitotomy. 53 mini-PNL tubeless (II group), the other group (I group) included 58 patients who underwent mini-PNL by standard method. There were no significant differences in age and sex, location and size of stones in the study groups (p>0,05). All operations were performed under regional anesthesia. Results. The average duration of the operation in group I was 57,2±17,9 minutes, in group II 54,9±15,6 minutes (p>0,05). The average drop of hemoglobin in I group was 0,39 g/l compared with 4,1 g/l in II group. The difference between the groups was not statistically significant (p>0,05). The level of pain in this study was assessed using a visual analog scale, in group I the average pain was 3,7 compared with 1,6 in patients of II group (p<0,05). Accordingly, the necessity of analgesia for I group was higher and amounted to 58,4±17,3 mg of dexketoprofen, against 27,3±15,2 mg of dexketoprofen in the second group (p<0,05). Postoperative fever ≥38,0 °С was observed in 5 (8,6%) patients who performing the operation according to the standard method, and 1 (1,9%) of the patient (p>0,05) who performed drainage-free PNL. The stone free rate in I group was achieved in 56 (96,6%), in group II in 53 (100%) (p>0,05). The postoperative hospital stay in I group was 2,92±0,24 days, and in II group – 1,22±0,11 days (p>0,05). Analyzing the results of tubeless percutaneous nephrolithotomy, we can say that its effectiveness is due to careful selection of patients and strict compliance with the rules of PNL. Conclusions. This study demonstrates the advantages of tubeless percutaneous nephrolithotomy over standard methods in the form of reducing the level of postoperative pain, according to the need for analgesics, and reduces the duration of postoperative hospital stay. However, it should be noted that drainage techniques of percutaneous nephrolithotomy should be performed in strictly selected patients.