Abstract
Objective:To evaluate the impact of nephrostomy tube type on postoperative pain and blood loss following percutaneous nephrolithotomy (PCNL).Methods:This is a prospective non-randomized study performed at Aga Khan University Hospital from July 2017 to June 2018. In this study we prospectively studied adult patients (16 to 65 years) who underwent unilateral PCNL. Patients who had nephrostomy with balloon (12Fr Foley’s catheter) were compared with patients who had nephrostomy without balloon (12Fr Nelaton™ catheter). STONE Nephrolithometry score was used to assess the stone complexity. Mean pain score at six and 24 hours and mean hemoglobin drop at 24 hours was compared between two groups using independent sample t-test, p-value of <0.05 was considered significant.Results:Over one year, 198 PCNL were performed out of which 119 were included for analysis. Sixty-six had nephrostomy tube with balloon and 53 had nephrostomy tube without balloon. Mean STONE score (9.66±1.4 vs. 9.64±1.24) and operative time (72.84±28.34 vs. 86.05±32.1 minutes) was comparable. Mean postoperative pain score at 6 hours and 24 hours postoperative was significantly lower in balloon group as compared to without balloon group. Mean Hemoglobin drop was similar in both groups (p=0.60).Conclusion:The use of nephrostomy tube with balloon after PCNL as this is associated with less pain and comparable hemoglobin drop as compare to nephrostomy tube without balloon.
Highlights
percutaneous nephrolithotomy (PCNL) is the standard of care for patients with moderate to large upper tract urinary stones
In order to improve hospital stay, total tubeless and tubeless PCNLs with stent may be superior to other procedures
In the current work we have attempted to assess the impact of type of nephrostomy placed post PCNL have influence on postoperative pain and hemoglobin drop
Summary
PCNL is the standard of care for patients with moderate to large upper tract urinary stones. Su H et al in 20154 compared the effect of nephrostomy tubes with and without balloon after percutaneous nephrolithotomy They observed significantly less hemoglobin drop in nephrostomy tube with balloon as compared to those without balloon at 72 hours postoperatively, noted no difference in postoperative pain. Jiang and colleagues[5] noted that the drainage types after PCNL using a nephrostomy tube, a double J stent or an openended ureteral catheter were safe and efficacious. They observed that compared to a nephrostomy tube or an open-ended ureteral catheter double J stent adversely affect HRQoL. In the current work we have attempted to assess the impact of type of nephrostomy placed post PCNL have influence on postoperative pain and hemoglobin drop
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