Study on tubeless mini-percutaneous nephrolithotomy in treatment of the upper ureteral calculi

Abstract

Objective To investigate the feasibility and clinical effect of the tubeless mini-percutaneous nephrolithotomy (PCNL) in treatment of upper ureteral calculi. Methods From March 2014 to March 2015, all the patients with upper ureteral calculi except for those with severe infection, pyonephrosis or renal cortex less than 5 mm were randomized into two groups, the standard PCNL group (24 F nephrostomy tube) and the mini-PCNL group (18 F nephrostomy tube). After PCNL, all the patients received ultrasound examination to check residual stones, perforation and urine leakage. DJ tube was placed and the channel of PCNL was packed with hemostatic sponge without nephrostomy tube. There were 26 patients in standard group and 28 in mini-group. The operation time, postoperative hemoglobin change, postoperative visual analogue pain score (VAS), the time when urine turned clean, postoperative urinary extravasation, hydrothorax, fever and the stone-free rate were compared between two groups. Particularly, these data were compared in those aged>65 years. Results The operation time in the standard PCNL and the mini-PCNL group was (58.3±21.8) and (86.4±23.3) minutes respectively, and had a significant difference (t=10.836, P 0.05). No significant difference were found between two groups (all P>0.05). There was one patient who got fever more than 38.5℃ in the standard group and 2 cases in the mini-group. Each group had 1 slight hydrothorax, and no blood infusion and perinephric urinary extravasation were found. The application of packing hemostatic sponge in the nephrostomy channel was feasible and suitable for both the standard and tubeless mini-PCNL groups. Conclusions The application of packing hemostatic sponge in the nephrostomy channel is feasible and suitable in both the standard and tubeless mini-PCNL. It is safe for the treatment of renal and ureteral calculi, and it can decrease the hemorrhage and urine leakage, which works for the elderly patients too. Key words: Percutaneous nephrolithotomy; Ureteral calculi