La néphrolithotomie percutanée “tubeless” : à propos de 37 cas

Abstract

To assess the value and feasibility of "tubeless" percutaneous nephrolithotomy (without postoperative nephrostomy tube). Prospective study of 37 consecutive patients operated by "tubeless" percutaneous nephrolithotomy (PCNL) between 1998 and 2007 for renal stones. Inclusion criteria for this technique were: a single puncture tract, a procedure lasting less than 2 hours, <3 stones with a diameter <25 mm, complete extraction of all stones and no significant bleeding in the renal cavities at the end of the operation. A 7 Fr ureteric stent was inserted at the beginning of the operation in 33 patients and a double J stent was already present in the last four patients. All these stents were not remowed at the end of the procedure and the nephrostomy tract was electrocoagulated by a blunt electrocautery loop mounted on a 26 F resectoscope. No nephrostomy tube was left in place and no haemostatic product was used. Complications, length of hospital stay, operating time, blood loss, transfusions and intensity of pain were recorded. The mean stone diameter was 172 mm. The mean percutaneous operating time was 72 min. The mean length of hospital stay was 1.9 days (range: 1 to 7 days). The success rate was 95% and the complication rate was 13.5%. Complications were: two cases of pyelonephritis, one case of prolonged haematuria, one case of renal colic and one case of urinary extravasation. The mean decrease in haemoglobin was 0.95 g/dl (range: 0 to 2 g/dl). The mean intensity of pain evaluated by visual analogue scale (VAS) was 1.9. No blood transfusion was required. The ureteric stent was removed on postoperative D1 in 91% of patients with a stent. "Tubeless" percutaneous nephrolithotomy is an effective and reproducible procedure with low morbidity that provides satisfactory results in selected cases.