Tubeless PCNL Research Articles

PD16-09 EXTERNALIZED URETERAL CATHETER VERSUS DOUBLE J STENTING IN TUBELESS PERCUTANEOUS NEPHROLITHOTOMY: A PROSPECTIVE, RANDOMIZED STUDY.

You have accessJournal of UrologyStone Disease: Surgical Therapy I1 Apr 2017PD16-09 EXTERNALIZED URETERAL CATHETER VERSUS DOUBLE J STENTING IN TUBELESS PERCUTANEOUS NEPHROLITHOTOMY: A PROSPECTIVE, RANDOMIZED STUDY. Gyanprakash Singh, Datteswar Hota, Sabyasachi Panda, Samir Swain, and Pramod Kumar Mohanty Gyanprakash SinghGyanprakash Singh More articles by this author , Datteswar HotaDatteswar Hota More articles by this author , Sabyasachi PandaSabyasachi Panda More articles by this author , Samir SwainSamir Swain More articles by this author , and Pramod Kumar MohantyPramod Kumar Mohanty More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.843AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Since introduction, tubeless PCNL has undergone various technical modifications to further improve the outcome. Several published literature report that use of an externalized ureteral catheter during tubeless PCNL can obviate the stent related discomfort and the need for a second procedure (i.e. cystoscopic removal of stent). We conducted a prospective, randomized study to compare the outcomes using 2 different techniques (externalized ureteric catheter and double J stent) of internal drainage following tubeless PCNL. METHODS From June 2011 to March 2016, a total of 492 patients underwent tubeless PCNL at our institution. A double J stent was placed in all cases of bilateral simultaneous PCNL, residual stone fragments, PCNL in solitary kidney and in patients with renal failure, so were excluded from study (n=55). Rest 437 patients were randomized into 2 groups: Group A (Tubeless PCNL with externalized ureteral catheter n= 225) and Group B (Tubeless PCNL with double J stent n=212). Study parameters include baseline (age, sex, stone burden, stone location/laterality, anomalous kidneys, past history of stone surgery), intraoperative (operating time, number of punctures, supracostal access, blood loss) and postoperative (analgesia requirement, hospital stay, stent related symptoms, complications, cost of treatment) and appropriate statistical methods were used for analysis. RESULTS Baseline characteristics were comparable in both the groups. No statistical significant difference was observed between the groups with regards to operating time, number of punctures, site of puncture (supracostal or infracostal) and blood loss. Analgesia requirement (P= 0.04), hospital stay (P= 0.02), stent related symptoms (P=0.001) and treatment cost (P=0. 005) were significantly less in group A. CONCLUSIONS Our study demonstrated that tubeless PCNL using a ureteric catheter is a safe, reliable and relatively cost effective technique. It can reduce the complications associated with double J stent without affecting the efficacy of the procedure. However, the surgeon must ensure complete stone clearance in order to avoid ureteric colic. Further prospective, randomized trials are required to substantiate our results. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e351 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Gyanprakash Singh More articles by this author Datteswar Hota More articles by this author Sabyasachi Panda More articles by this author Samir Swain More articles by this author Pramod Kumar Mohanty More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Totally tubeless percutaneous nephrolithotomy: one year single institute prospective study

Background: Urolithiasis forms an important domain in the practice of urology. PCNL is an important armamentarium in the management of urolithiasis, especially for larger and complex stones. The objective of this study was to study the safety and feasibility of totally tubeless (tubeless and stentless) percutaneous nephrolithotomy in selected cases. Methods: The study consisted of 50 cases operated between June 2011 - May 2012 in Department of urology, SMS medical college and hospital, Jaipur. Patients were taken for standard fluoroscopy guided PCNL in prone position with track dilatation up to 24hours. Decision to go for totally tubeless procedure was taken intra-operatively. No weightage was given to the puncture (supra or infra costal) and the calyx selected for access. The exclusion factors were significant intraoperative bleeding, more than one track, residual stones, and injury to pelvicalyceal system. The parameters studied were hospital stay, post-operative pain, analgesia requirements and complication rates. Results: Totally tubeless PCNL constituted 6.2% of the total PCNL during this period. The age ranged from 20 - 70 years with a mean of 43years. Average stone burden was 26.8mm. Mean hospital stay was 1.5 days with 60% of being discharged after 24 hours. Post-operative analgesia was required in 60% and 28% of the patients, with moderate to severe pain on day0 and 1 respectively. No patient required intraoperative blood transfusion. Three patients had mild haematuria on day 0, with one requiring blood transfusion on day 2. No patient developed urinary leakage from skin wound. One patient developed urinoma requiring DJ stenting. No readmission was reported in 1 month follow up. Conclusions: this study demonstrated that totally tubeless PCNL is safe well tolerated procedure, not affected by access track. It significantly decreases post-operative pain, analgesia requirement and hospital stay. The only limitation being its applicability in highly selected cases.

Super mini-percutaneous nephrolithotomy (SMP) by ultrasound-guided for pediatric kidney stones

Objective To evaluate the safety and efficacy of super mini-percutaneous nephrolithotomy (SMP) by ultrasound-guided renal access in pediatric with renal calculus. Methods From May to August 2015, 20 pediatric patients with upper tract stones underwent the SMP by ultrasound guidance.The patients aged 11-144 months , median age 31.5 months, The stone size ranged 0.8-2.5 cm, mean(1.48±0.59) cm. Among the 20 children, single pelvis stones were in 8, multiple stones in 10 and upper ureter stones in 2. All patients had no previous surgery treatment. The SMP system consists of a F6.0-7.5 nephroscope and a modified F12-14 access sheath with suction-evacuation function. Nephrostomy tract dilation was performed up to F12-14 and lithotripsy procedure was performed by using pneumatic lithotripter. Nephrostomy tube or double J stent was placed only if clinically indicated. Results The stone size was 0.8-2.5 cm, mean(1.48±0.59)cm. Among the 20 children, there were 8 patients with single pelvis stone, 10 with multiple stones and 2 with upper ureter stones. All the patients were completed successfully without surgery conversion. Mean operative time ranged 6-40 minutes , mean( 17.6±11.6) minutes. The stone free rate was 100% after the evaluation in the postoperative day. The hemoglobin drop was 2-16 g/L, mean(7.6±4.1) g/L. No major complications occurred, neither patient required transfusion. The tubeless PCNL without double J stents and nephrostomy tubes placed were achieved in all patients. Only 14 patients had a ureter catheter placement for one day. The average hospital stay ranged 1-4 days, mean (2.4±0.8) days. Conclusions SMP could be a safe and effective treatment for kidney stone up to 2.0 cm in pediatric cases with advantages of short recovery time, high stone free rate and no catheter placement. SMP could be the ideal procedure for children with upper urinary tract calculus. Key words: Pediatric; Upper urinary; Calculus; Super mini-percutaneous nephrolithotomy(SMP)

Hemostatic completion of percutaneous nephrolithotomy using electrocauterization and a clear amplatz renal sheath.

ABSTRACTBackground and Purpose A tubeless PCNL can reduce postoperative pain, the need for analgesics, hospital stay, and postoperative urinary leakage. However, perioperative or delayed bleeding remains the primary postoperative concern. We demonstrate a simple and cost-effective method to develop a clear nephrostomy tract after completion of a tubeless PCNL.Materials and Methods Four consecutive patients with renal calculi >3cm underwent a tubeless PCNL. We used a 24 Fr nephroscope and a 24 Fr transurethral resectoscope. Intraoperative urologist-directed percutaneous renal access was performed under fluoroscopy. After calculi removal, active bleeders were identified via a clear Amplatz renal sheath. The sheath provided excellent visualization of the nephrostomy tract for the detection of bleeders and surrounding structures. Bleeders were electrocauterized using a roller barrel electrode. During extraction of the renal sheath, the surgeon can confirm hemostasis in the tract and apply intermittent suction.Results Bleeding primarily originated from the torn calyeceal mucosa and the parenchyma. Tract electrocauterization was successful. All patients had mild hematuria, which resolved within two days. The average hemoglobin decrease was 1.65g/dL (0.8-2.1) and no patients required a transfusion. No perioperative complications occurred. On postoperative day 2, the patients could ambulate without a Foley catheter. During three months of follow-up, delayed bleeding or percutaneous urine leakage did not occur.Conclusions Electrocauterization with a roller barrel electrode and a clear Amplatz renal sheath is an effective method to obtain hemostasis after completion of a PCNL. Our technique is cost-effective and readily adapted without the need for additional instruments.

Comparison of totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for kidney stones: a randomized, clinical trial.

This study aimed to compare the totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy techniques regarding their rates of success and complications in patients with kidney stones. Patients were randomly assigned to two groups. Forty-four patients (24 men; mean age: 50.40±2.02 years) received totally tubeless percutaneous nephrolithotomy (PCNL; no nephrostomy catheter or ureteral catheter after PCNL) and 40 patients (18 men; mean age: 49.95±13.38 years) underwent standard PCNL (a nephrostomy catheter and ureteral catheter were used after PCNL). All surgeries were performed by one surgeon. Postoperative changes in hemoglobin, the blood transfusion rate, changes in creatinine levels, operation time, analgesic need, hospitalization time, and complication rate were compared between the groups. No significant differences were observed in age, gender, stone size, and surgery side between the groups (P<0.05). The operation time was significantly lower in the totally tubeless PCNL group than in the standard PCNL group (P=0.005). Pethidine requirements were significantly higher in the standard PCNL group than the totally tubeless PCNL group (P=0.007). Hospitalization time was significantly higher in the standard PCNL group than in the totally tubeless PCNL group (P<0.0001). The complication rate was 15% in the standard PCNL group and 9.1% in the totally tubeless PCNL group (P=0.73). The totally tubeless PCNL technique is safe and effective, even for patients with staghorn stones. This technique is associated with decreased pain, analgesic needs, and operative and hospitalization time. We believe that a normal peristaltic ureter is the best drainage tube.

Tubeless versus standard PCNL in geriatric population

Introduction and objectivesPercutaneous nephrolithotomy (PCNL) is a standard, safe, and efficient method for large-volume renal calculi for all age groups. Nephrostomy tube constitutes an invaluable part of the nephrolithotomy operation. However, the nephrostomy tube has been recently replaced with ureteral catheter or double J-stent thanks to advances in urotechnology and operation equipment. The aim of the current article was to evaluate the safety and reliability of tubeless percutaneous nephrolithotomy in the geriatric population. MethodsBetween January 2009 and September 2013, a total of 52 patients aged 65 years or elder with renal calculi bigger than 2cm underwent PCNL operation. The first group of 25 patients (48%) with a mean age of 70.0 years (std: ±3.8) underwent tubeless PCNL whereas the second group consisting of 27 (52%) patients with a mean age of 71.3 years (std: ±4.0) underwent standard PCNL. The patients were randomly compared retrospectively in terms of burden of calculus, analgesic requirement, creatinine value, renal parenchymal thickness, body-mass index (BMI), clavien score, length of hospitalization, and being calculus-free. ResultsThe groups were found to be similar in age, BMI, and gender (P>0.05). Burden of calculus, duration of operation, and rate of narcotic analgesic use were found to be statistically significantly higher in the group of Standard PCNL group than in the Tubeless PCNL group (P<0.05). Length of hospital stay was 1.7 days in the group of tubeless PCNL and 2.6 days in the standard PCNL group (P<0.05). No significant difference was found between the groups in terms of fall in hemoglobin, creatinine, values of parenchymal thickness, and clavien score, preoperative blood transfusion, previous SWL, location of calculi, number of access, and rate of success (P>0.05). Burden of calculus was 900mm2 (304–4232) in the standard PCNL group and 600mm2 (220–2660) in the tubeless PCNL group with the difference being statistically significant (P=0.014). Overall success was achieved in 96.0 and 96.3% of tubeless PCNL and standard PCNL patients after one session of PCNL, respectively. ConclusionsTubeless percutaneous nephrolithotomy was found to be as safe and effective as standard PCNL in the geriatric population. It is recommended especially in this group of patients because of its advantages such as shorter length of hospitalization, less analgesic requirement, and earlier mobilization.

NLPC sin catéter versus NLPC estándar en la población geriátrica

Introduction and objectivesPercutaneous nephrolithotomy (PCNL) is a standard, safe, and efficient method for large-volume renal calculi for all age groups. Nephrostomy tube constitutes an invaluable part of the nephrolithotomy operation. However, the nephrostomy tube has been recently replaced with ureteral catheter or double J-stent thanks to advances in urotechnology and operation equipment. The aim of the current article was to evaluate the safety and reliability of tubeless percutaneous nephrolithotomy in the geriatric population. MethodsBetween January 2009 and September 2013, a total of 52 patients aged 65 years or elder with renal calculi bigger than 2cm underwent PCNL operation. The first group of 25 patients (48%) with a mean age of 70.0 years (std:±3,8) underwent tubeless PCNL whereas the second group consisting of 27 (52%) patients with a mean age of 71.3 years (std: ±4,0) underwent standard PCNL. The patients were randomly compared retrospectively in terms of burden of calculus, analgesic requirement, creatinine value, renal parenchymal thickness, Body-mass index (BMI), clavien score, length of hospitalization, and being calculus-free. ResultsThe groups were found to be similar in age, BMI, and gender (P>.05). Burden of calculus, duration of operation, and rate of narcotic analgesic use were found to be statistically significantly higher in the group of Standard PCNL group than in the Tubeless PCNL group (P<.05). Length of hospital stay was 1.7 days in the group of tubeless PCNL and 2.6 days in the standard PCNL group (P<.05). No significant difference was found between the groups in terms of fall in hemoglobin, creatinine, values of parenchymal thickness, and clavien score, preoperative blood transfusion, previous SWL, location of calculi, number of access, and rate of success (P>.05). Burden of calculus was 900 mm2 (304-4232) in the standard PCNL group and 600mm2 (220-2660) in the tubeless PCNL group with the difference being statistically significant (P=.014). Overall success was achieved in 96.0 and 96.3% of tubeless PCNL and standard PCNL patients after one session of PCNL, respectively. ConclusionsTubeless percutaneous nephrolithotomy was found to be as safe and effective as standard PCNL in the geriatric population. It is recommended especially in this group of patients because of its advantages such as shorter length of hospitalization, less analgesic requirement, and earlier mobilization.

Determining standard criteria for tubeless PCNL

selected cases; hence, comparisons based on these parameters would not be meaningful. For instance, if a surgeon placed a PNt in patients whose bleeding during the case was high, then their hemoglobin level would be lower than patients in the tubeless group. So, we cannot make a decision to perform tubeless PCNL in a patient in light of these results. We suggest that a randomized, prospective, singlecenter study should be done to determine the predictive factors for placement of a PNt. Finally, the authors need to state whether they placed a ureteral catheter (totally tubeless PCNL). If so, they need to provide the data regarding its removal.

Tubeless procedure reduces hospitalization and pain after percutaneous nephrolithotomy: results of a multivariable analysis

The objective of the study was to assess the efficacy and safety of tubeless percutaneous nephrolithotomy (t-PCNL) in comparison with standard PCNL (s-PCNL). We retrospectively evaluated 317 consecutive PCNL and compared perioperative results, time of hospitalization and analgesic requirement of t-PCNL (114; 36.0%) to s-PCNL (203; 64.0%). The decision to perform a tubeless PCNL was made at the end of the procedures depending on the surgeon's preference and according to the following inclusion criteria: (a) no serious bleeding or perforation in the collecting system during the procedure; (b) patients with no more than one access; and (c) residual stone burden needing a second-stage nephroscopy. Staghorn stones and anatomic anomalies were not considered as exclusion criteria for t-PCNL. Univariate analyses were conducted with one-way ANOVA, Fisher's exact test, Pearson's Chi-square and linear-by-linear association test as appropriate. Stepwise multivariable regression analyses were used to assess the independent correlation between demographics and clinical variables and the clinical outcomes. There were no significant differences between the two groups in terms of stone-free rate, hemoglobin decrease, blood transfusion and complication rate. Mean hospital stay was significantly shorter in the t-PCNL group (3.3 vs. 4.6days; P<0.001). Tubeless PCNL was associated with less analgesia requirement (68.4 vs. 86.7%; P<0.001) and with lower analgesic dose requirement (1.6 vs. 2.1 mean doses; P=0.010). Multivariable analyses showed that t-PCNL (P<0.001), postoperative fever (P<0.001), transfusions (P<0.001), operative time (P=0.002), postoperative hydronephrosis (P=0.005) and residual fragment dimension (P=0.024) were independently correlated with duration of hospitalization, while analgesic dose requirement was independently influenced by hemoglobin decrease (P<0.001), t-PCNL (P=0.005) and stone number (P=0.044). Our study confirmed that t-PCNL has similar outcomes to s-PCNL in terms of stone-free rate without increasing complications in selected cases. t-PCNL is a factor independently associated with shorter hospitalization and lower analgesic requirement.

Haemostatic sealants unsafe for tubeless PCNL

Haemostatic sealants unsafe for tubeless PCNL

Tubeless &amp; Stentless PCNL in Selected Cases – Our Experience in Bangladesh

Introduction: PCNL is well-accepted method of management of renal stone. In PCNL post operatively usually Nephrostomy tube and JJ stent are used. But Nephrostomy tube and JJ stent has some morbidity. Tubeless and JJ stentless PCNL in selected cases reduces the morbidity. This study will evaluate the results of PCNL with and without Nephrostomy tube and JJ stent in the management of renal stone in selected cases. Methods: From July 2008 to June 2010 total 70 cases of renal stone were managed by PCNL dividing into two groups Group A -PCNL with nephrostomy tube and JJ stent, Group B- Nephrostomy tubeless and JJ stent less PCNL with only ureteric catheter for 24 – 48 hour post operatively. All cases were operated in Urology department of Bangladesh Medical College Hospital, and two other private hospitals located in Dhaka. In all cases initially placed a ureteric catheter and at the end of the procedure compression at renal angle about 10 min in Group –B, in Group A Procedure ended with Nephrostomy tube and JJ stent. Ureteric catheter was removed 24 hour-48 hour after operation. JJ stent was removed 3 weeks after operation. Exclusion criteria for the tubeless and JJ stentless approach were more than one percutaneous access, significant perforation of the collecting system, large residual stone burden, significant postoperative bleeding, ureteral obstruction and renal anomaly. The incidence of complication, length of hospitalization, analgesics requirement and interval to return to normal activities were evaluated. Results: All 70 percutaneous procedures were performed without significant complication, none of the patients demonstrated urinoma in postoperative renal Ultrasound scan. In Group- B length of hospital stay was &lt; 3 days, the average analgesia requirement was 98 mg of Inj.Pethedin, patient return to normal activity earlier then Group -A. Conclusion: Nephrostomy tubeless and JJ stent less Percutaneous Nephrolithotomy with ureteric catheter for 24- 48 hours post operatively is a safe and effective procedure. Hospital stay and analgesia requirements are less and returns to normal activities are faster. DOI: http://dx.doi.org/10.3329/jss.v16i1.14443 Journal of Surgical Sciences (2012) Vol. 16 (1) : 18-25

1539 TUBELESS PERCUTANEOUS NEPHROLITHOTOMY FOR COMPLEX RENAL CALCULI AND COMPLICATED PROCEDURES

INTRODUCTION AND OBJECTIVES: Tubeless PCNL is underutilized, usually as an option in nonbleeding, uncomplicated monotracts with complete stone clearance & decided intraoperatively. In this study we evaluated its feasibility, safety and efficacy in a tertiary teaching institute. METHODS: Forty (40) patients were alternately randomized (1:1) into tube (T) and tubeless (TL) PCNL groups. Tract dilatations were done using Alken metal dilators, no sealant or electrocautery was used for hemostasis and a 6 Fr JJ stent was kept. In T group 24 Fr nephrostomy tubes were placed. In TL group JJ stent was removed at 48 hours after operation and in tube group it was removed 1 week after drying of nephrostomy site. In TL group deep skin stitched were applied. Analgesic (intravenous tramadol) requirement and Visual Analogue Scores (noted every 3 hours) were recorded in first 48 hours (hrs). Postoperative X-ray KUB (on Day1) and ultrasound scans (on postoperative days 1, 2, 3 and 3 weeks) were done in all to see stone clearance and perinephric/puncture tract/intrarenal collection or hematoma. RESULTS: Demographic data and outcomes are shown in table 1. One procedure in TL required conversion to tube because of intraoperatively diagnosed pleural violation. Despite complicated calculi (55%) and high risk situations (50%), none in TL group had any significant perinephric collection or severe postoperative bleeding requiring any intervention. Patient age, size and type of stones, punctures, stone clearance rate, hematuria clearance time, mean haemoglobin drop, transfusion requirements, and complication rate were similar in both groups. TL-PCNL is superior (p values 0.05) to T-PCNL in terms of VAS pain scores and analgesic requirement in first 48 hrs, leak from tract site and hospital stay. CONCLUSIONS: In TL PCNL, deep skin stitches with JJ stenting for 48 hrs ensure a good local bleeding control and a dry tract site. TL-PCNL may be considered a new standard for PCNL. Nephrostomy should only be used for specific purposes like intraoperative pleural violation, major pelvicalyceal injury, balloon tamponading or relook. Parameter Tube group Tubeless group Number of patients(Right/left side) 20(13/7) 20(11/9) Age in years(mean/range) 33.2(15-55) 36.7(17-52) Sex(M:F) 2.3:1 3:1 Stone burden(maximum diameter in cms) (mean/range) 2.72(1.8-3.8) 2.56(1.9-4.2) No. of patients with Simple Calculi(Pelvis/ Calyceal) 8(6/2) 9(7/2) No. of patients with Complex Calculi(Multiple pole calculi/ Staghorns) 12(7/5) 11(7/4) No.of punctures(mean/range) 1.4(1-3) 1.3(1-3) Tracts: single/multiple(No.of pts.) 14/6 15/5 High risk situations : Infundibular tear/ Extravasation & tract loss/ Obvious bleeding/ Stone guided punctures (No.of pts.) 2/1/4/1 2/1/5/2 Operative time in minutes (mean/range) 106(60-170) 108(80-130) Hemoglobin drop in gm/dl (mean/range) 1.36(0-4.1) 1.21(0-3.1) VAS score in 0-24 hrs & 25-48 hrs(mean/range) 3.5(2.1-4.6) & 2.5(1-3.5) 2.4(0-3.8) & 1.9(0.5-2.5) Analgesic (tramadol in mg)requirement in 0-48 hrs (mean/range) 165(100-250) 85(50-100) Hematuria settling time in hrs(mean/range) 29.1(6-192) 36(3-160) Nephrostomy removal time in hrs(mean/range) 42.6(30-72) Not applicable(NA) Tract site leak duration in hrs(mean/range) 13.8(0-72) 0 Hospital stay in hrs(mean/range) 121.4(50-168) 88.3(52-210) Blood transfusion(No.of pts.) 4 3 Complications:Hydro-pneumothorax/ UTI/Late hematuria(No.of pts.) 1/3/0 1/2/1 Complete stone clearance rate : after first procedure/ after relook/ At 3 weeks follow up(in %) 70/80/90 70/NA/85

Feasibility, safety and efficacy of tubeless percutaneous nephrolithotomy: a randomized controlled trial

Objective To evaluate the feasibility,safety and efficacy of tubeless percutaneous nephrolithotomy ( PCNL).Methods Patients who underwent PCNL were randomized into 2 groups by extracting a random number generated from random number table,tubeless PCNL group and traditional PCNL group when the stones were cleared.Each patient in tubeless PCNL group was treated with insertion of a F5 ureteral double pigtail stent without placement of nephrostomy tube,while both double pigtail stent and F16 nephrostomy tube were placed in patients in traditional PCNL group.Exclusion criteria were severe bleeding requiring blood transfusion,stone residual requring a second PCNL,severe hydronephrosis with the thickness of renal parenchyma less than 5 mm,pyonephrosis,stricture of ureter or ureteropelvic junction,and severe perforation of the collecting system.A total of 50 patients were enrolled in this study.Tubeless PCNL and traditional PNCL were performed in 25 patients,including 27 kidney units,respectively.The two groups had comparable demographic data.All the operations were performed by the same surgeon.Evaluation factors included postoperative pain,decreased hemoglobin,blood transfusion rate,incidence of fever and perirenal hematoma,and duration of hospitalization.Results The average visual analogue scale (VAS) score on postoperative day 1 in tubeless PCNL group was 2.24 compared with 5.04 in traditional PCNL group (P ＜ 0.01 ).The average hospital stay in tubeless PC NL group (3.04 d) was significantly shorter than that in traditioal PCNL group (6.88 d) (P ＜0.01 ).The differences in average hemoglobin drop and stone clearance in the 2 groups were not significant.The differences between the 2 groups in blood transfusion ( 1/25 in tubeless PCNL group vs 3/25 in traditional PCNL group,P ＞0.05),renal hematomas rate (6/27 in tubeless PCNL group vs 7/27 in traditional PCNL group,P ＞ 0.05) and fever rate (3/25 in tubeless PCNL group vs 4/25 in traditional PCNL group,P ＞0.05 ) were not significant.There was no incidence of urinary leakage from the nephrostomy site in the 2 groups.Conclusions Tubeless PCNL can significantly decrease postoperative pain and discomfort and shorten the duration of hospitalization without increase of complications.Tubeless PCNL is safe,effective and performable,but the contraindications such as massive haemorrhage,pyonephrosis,ureteral obstruction,severe perforation of the collecting system,residual stone requring a second PCNL,should be kept in mind. Key words: Nephrostomy, percutaneous; Randomized controlled trials; Kidney calculi; Ureteral calculi; Tubeless percutaneous nephrolithotomy

Nephrostomy Tube Placement After Percutaneous Nephrolithotomy: Critical Evaluation Through a Prospective Randomized Study

To evaluate the hemostatic and drainage functions of the nephrostomy tube after percutaneous nephrolithotomy through a prospective randomized study. Additionally, the effect of nephrostomy tube placement on postoperative pain, hospital stay, and the success and complication rates was assessed. The present study was designed to include 100 patients with upper urinary tract calculi who were prospectively randomized to tubeless (group 1) and standard (group 2) PCNL using closed envelopes. The hemoglobin and hematocrit deficits, development of hematuria and hematoma, and blood transfusion rate were compared to assess the hemostatic effect. The drainage effect was evaluated by comparing the incidence of postoperative urinary leakage, urinoma, and/or hydrothorax development. A total of 123 patients were assessed for eligibility, and 100 fulfilled the study requirements. The hemoglobin and hematocrit deficits were comparable. Significant hematuria and/or hematoma were recorded in 5 and 4 patients in groups 1 and 2, respectively. Blood transfusion was required in 5 and 6 patients in groups 1 and 2, respectively. One patient with chronic kidney disease in the tubeless group required abdominal exploration because of respiratory embarrassment and a large hematoma. Transient urinary leakage was recorded in 2 and 31 patients in groups 1 and 2, respectively (P < .05). No urinoma developed. Hemothorax developed in 1 patient in the tubeless group with supracostal puncture. Postoperative pain was significantly less in the tubeless group. No statistically significant difference was found in the success rate, morbidity, or hospital stay between the 2 groups. The hemostatic and drainage functions of the nephrostomy tube were modest. However, the tubeless approach might be not suitable for the patients with chronic kidney disease or a supracostal approach.

A comparative nursing study of tubeless and standard percutaneous nephrolithotomy

Objective To compare the post operative nursing between tubeless and standard percutaneous nephrolithotomy. Methods The retrospective study was done on both 35 cases with standard percutaneous nephrolithotomy and 12 cases with tubeless percutaneous nephrolithotomy. The following variables were statistically analyzed: the operation time, postoperative pain, analgesia requirement, blood loss, postoperative morbidity and postoperative hospital stay, etc. Results All patients had an uneventful postoperative recovery. The average visual analogue scale pain score on postoperative day 1 for the standard PCNL group patients was (5.9 ±0.51 )compared with (3.1 ± 0.48 ) in the tubeless group (t =2. 72, P ＜ 0. 01 ). The mean analgesia requirement for the standard PCNL group (meperidine 126.5 ± 33.3 mg) was significantly more than the tubeless group (meperidine 81.7 ± 24.5 mg) (t =3. 31, P ＜ 0. 01 ). Conclusions Tubeless PCNL reduces postoperative urinary leakage and local pain related to the drainage tube. It also minimizes hospital stay; the majority of patients were discharged from the hospital in less than 24 hour. With the hypothesis of same therapy effect, it may reduce the pains of patients and the difficulty of nursing, which may improve the working efficiency of medical treatment and nursing. Key words: Renal calculi; Nephrolithotomy,percutaneous; Nursing

MP-01.02 Nephrostomy Tubeless and JJ Stentless PCNL: Experience of 113 Cases

PCNL is well accepted method of renal stone management. In PCNL postoperatively usually nephrostomy tube and D-J stent are used. But nephrostomy tube and D-J stent has some morbidity. Tubeless and JJ stentless PCNL in selected cases reduces morbidity. This study will evaluate the results of nephrostomy tubeless and JJ stentless PCNL in the management of renal stones in selected cases.

Results of a Modified Technique of Tubeless PCNL

Results of a Modified Technique of Tubeless PCNL

Totally tubeless percutaneous nephrolithotomy: a prospective randomized controlled study

The purpose of this study was to perform a randomized controlled trial to evaluate the role, safety, and effectiveness of totally tubeless PCNL and whether this procedure is less morbid in terms of analgesia requirement, related complications and convalescence. A total of 131 patients, with impacted ureteropelvic junction stone or single renal pelvic stone larger than 20 mm, were prospectively randomized (using random numbers table) into two groups, and underwent conventional (63 patients) or totally tubeless (68 patients) PCNL. Preoperative data included urinalysis, urine culture, complete blood count, biochemistry study, renal ultrasonography, intravenous urography and Tc 99m DTPA clearance for determination of selective glomerular filtration rate. Intraoperative findings, operative time, and outcome were also recorded. All patients were followed regularly at clinic every 3 months during year 1 and every 6 months, thereafter, and Tc 99m DTPA clearance for the determination of selective glomerular filtration rate, renal ultrasonography and intravenous urography was performed to assess the kidney function 6 months later. There was no difference between the groups with regard to serum creatinine change, hemoglobin decrease, morphology improvement, resumption of normal activity and complication grading. The length of stay, pain visual analog scale and analgesic requirements favored the tubeless group with statistical significance. There was significant statistical difference in relative perfusion rate between preoperative and postoperative in both groups. This trial demonstrates that totally tubeless PCNL is safe and well tolerated in selected patients and associated with decreases in length of stay, postoperative pain and analgesia requirement. Most importantly, patients undergoing uncomplicated PCNL are not mandated to have a nephrostomy or ureteral stent placed for specific indications.

Simultaneous bilateral tubeless percutaneous nephrolithotomy of staghorn stones: a prospective randomized controlled study

A randomized controlled study was performed to evaluate the feasibility and outcome of staged versus simultaneous bilateral tubeless PCNL for bilateral renal staghorn stones. A total of 99 patients, with bilateral renal staghorn stones, were prospectively randomized into two groups, and underwent staged tubeless PCNL (49 patients) or simultaneous bilateral tubeless PCNL (50 patients). Preoperative data included urinalysis, urine culture, complete blood count, biochemistry study, renal ultrasonography, intravenous urography, and Tc 99m DTPA clearance for the determination of selective glomerular filtration rate. Intraoperative findings, operative time, and outcome were also recorded. All patients were followed regularly at clinic every 3months during year 1 and every 6months thereafter, and Tc 99m DTPA clearance for determination of selective glomerular filtration rate was performed to assess the kidney function 6months later. There was no difference between the groups with regard to serum creatinine change, hemoglobin decrease, and complication grading. The length of stay, convalescence period, pain visual analog scale, analgesic requirements, and direct cost favored the simultaneous bilateral tubeless group with statistical significance. There was no significant statistical difference in relative perfusion rate between preoperative and postoperative in both groups. This study demonstrates that simultaneous bilateral tubeless PCNL is a safe, efficacious, and cost-effective option in bilateral renal staghorn calculi, which is associated with low morbidity, short hospital stay, high stone-free rate, and early return-to-normal activity.

Percutaneous nephrolithotomy: tubeless or not tubeless?

The objective of this study is to evaluate the safety and outcomes of tubeless PCNL in comparison with standard PCNL. Since June 2002, we have performed 99 tubeless PCNL. Tubeless technique involves antegrade placement of a 6Fr double-J stent without nephrostomy tube at the end of the procedure. This series has been compared with a total of 110 patients in which revision of operative reports ruled out the presence of intraoperative conditions necessary to candidate a patient to tubeless procedure but standard PCNL was performed because prior to its introduction or because of surgeon's attitude afterward. Mean stone burden was 5.4 for standard group and 4.9 cm(2) for tubeless group, respectively. Mean BMI was 24.1 in the first group and 23.6 in the second one. In this retrospective study, complications rate, postoperative pain, length of hospitalization and convalescence were evaluated by chart review. Hematocrit drop did not differ significantly between tubeless PCNL and standard PCNL (5.5 vs. 5.9%). Conversely, there was statistically significant difference between tubeless and standard PCNL in terms of the amount of analgesics (49.5 vs. 84.2 mg), immediate postoperative patients' discomfort, hospitalization (2.2 vs. 5.3 days) and time to resume normal activities (11.0 vs. 16.5 days). In conclusion, in our series, tubeless approach did not determine increase in complication rate. Conversely, tubeless PCNL reduced analgesics' requirement, patients' discomfort, hospitalization and time to recovery. As such, at our institution, tubeless PCNL has become routine procedure that actually is feasible in almost two-third of renal calculi suitable for percutaneous treatment.