One-Step Percutaneous Nephrostomy in Patients with a History of Open Nephrolithotomy: Comparison with the Fascial Dilator System

Abstract

A percutaneous nephrostomy (PCN) done on the same side as a previous open nephrolithotomy is always technically challenging. A novel one-step PCN tube that allows the puncture and placement of a drainage tube to be done in a single step has been developed. The hydrophilic coating on the tube's surface significantly reduces friction and allows easier insertion. We evaluated the tube's efficiency and safety compared with the traditional fascial dilator system. Sixty-five patients with a history of open nephrolithotomy were randomly allocated (with the aid of a computer-derived assignment number) into two groups to have PCN performed in one step or multiple steps. In the one-step group, a new type of PCN tube was used. In the multistep group, fascial dilators were used serially prior to tube insertion. The two groups were similar in terms of mean age, width of target calix, and baseline serum creatinine and hemoglobin concentrations. The operating times, intubation rates, and complications in the two groups were compared. The mean number of attempts required to access the collecting system was 1.1 +/- 0.6 in the one-step group v 2.3 +/- 1.2 in the multistep group (P = 0.002), the successful intubation rate was 96.9% v 78.8% (P = 0.012), the mean operating time was 10.2 +/- 2.4 minutes v 25.6 +/- 2.8 minutes (P = 0.029), and the rate of intraoperative and postoperative complications was 3.1% v 15.2%, respectively (P = 0.019). No major complications occurred in the one-step group. The one-step PCN tube is a convenient and efficacious method for accessing an anatomic region where open nephrolithotomy was done previously and is a simple method for nephrostomy tube placement.