Abstract
BackgroundTo assess the morbidities of tubeless percutaneous nephrolithotomy (PCNL) using supra-costal access and re-evaluate traditional concept of increased complications with supra-costal access.MethodsFrom January 2010 to December 2014, a single surgeon performed 118 consecutive one-stage fluoroscopic guided PCNL’s for complex renal and upper ureteral stone. Our definition for complex renal stone is defined as partial or complete staghorn stone, multiple renal stones in more than 2 calyxes, obstructive uretero-pelvic stone > 2 cm, and a renal stone in single functional kidney. Inclusion criteria include: staghorn stones, renal calculi > 2 cm in diameter, upper ureteral stone > 1.5 cm in diameter. Exclusion criteria for tubeless PCNL include: significant bleeding or perforation of the collecting system, large residue stone, multiple PCNL tract and obstructive renal anatomy. Morbidity, operation time, analgesia requirement, length of hospital stay, stone- free rate, were analyzed.ResultsOf the 118 consecutive PCNL, eighty-six patients underwent tubeless PCNL (56 supra-costal and 30 sub-costal) and included in our prospective follow-up period. The mean age, operation side, stone locations were similar. The male to female ratio is higher in supra-costal than sub-costal. Large renal stones and staghorn stones makes up for most patients (supra-costal: 75%, sub-costal: 80%). The stone–free rate of supra-costal group was 59% (33/56) and in sub-costal group was 50% (15/30). The operative times, length of stay, post-op analgesic use, hematocrit change was similar in both groups. The overall complication rate is 6% [supra-costal (1/56), sub-costal (4/30)] with the majority being infectious complications.ConclusionsSupra-costal access above 12th rib during tubeless PCNL is safe and effective procedure and is not associated with higher incidence of post-op complications in experience hands.
Highlights
To assess the morbidities of tubeless percutaneous nephrolithotomy (PCNL) using supra-costal access and re-evaluate traditional concept of increased complications with supra-costal access
Large renal stones and staghorn stones occupied most of the stone cases (Table 1)
Stone location is related to the operative time with upper ureter stone being the shortest and staghorn stone being the longest (Table 3)
Summary
To assess the morbidities of tubeless percutaneous nephrolithotomy (PCNL) using supra-costal access and re-evaluate traditional concept of increased complications with supra-costal access. Since Fernstrom and Johansson performed the first percutaneous nephrolithotomy (PCNL) was performed in 1976, endourological approach has taken an increase role in management of complex urinary calculi [1, 2]. During standard PCNL, the placement of a nephrostomy tube after the operation is a common practice which provides hemostasis, adequate drainage and retaining access for future endoscopic procedures. In selected cases with minimal bleeding and those not needing subsequent percutaneous access, tubeless PCNL has been found to be a safe and effective practice. Tubeless PCNL has been showed to reduce hospital stay and post-operative pain compared to conventional nephrostomy tube placement [3–10]
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