Tubeless Percutaneous Nephrolithotomy Research Articles

A study of standard versus tubeless percutaneous nephrolithotomy: Our institutional experience

Background: Percutaneous nephrolithotomy (PCNL) is considered to be the standard procedure in patients with large renal calculus. The purpose of this study is to analyze the evidence-based literature regarding the “nephrostomy-free” or “tubeless” PCNL and to assess the safety, efficacy, possibility, and benefits of tubeless PCNL over standard PCNL. Aims and Objectives: The aim of the study was to review and compare tubeless PCNL with standard PCNL. Materials and Methods: It is a retrospective study done between August 2021 and December 2022. 100 cases of stone disease with stone size more than 2 cm who underwent PCNL in the Department of Urology, Govt hospital, Salem. Patients are divided into two groups (Group A and Group B) of 50 each depending on date of surgery. Results: In our study, we compared tubeless PCNL versus standard PCNL in patients with stone disease. Tubeless PCNL was performed with success in patients of age 13 years–65 years. 36 were female patients, whereas 64 were male patients in this study. All the results were presented in a tabulated form in our study. Conclusion: Tubeless PCNL is a safe and effective technique and is associated with decreased pain, low analgesic requirement, less operating time, and faster recovery. However, it has its own limitation that precludes secondary procedure for the treatment, removal of internal stent, dysuria, and need to visit hospital for subsequent removal of internal stent.

Применение «безнефростомной» перкутанной нефролитотрипсии у детей.

Introduction. Currently, percutaneous renal surgery is a common surgical procedure in urologic practice for the treatment of large and staghorn renal stones. Placement of a nephrostomy tube has been well recognized as a standard procedure to provide hemostasis, adequate drainage, and access for additional endoscopic procedures. At the same time, the use of a nephrostomy tube has negative consequences such as discomfort/pain symptom, longer hospital stay and possible urine extravasation. In view of the above, draining of the access tract raises questions in some cases. The aim of the study was effectiveness of tubeless percutaneous nephrolithotripsy in the treatment of urolithiasis in children. Materials and methods. Between 2013 and 2019, 66 patients (aged 1-17 y/o) underwent tubeless percutaneous nephrolithotomy (PNL) at the Department of Pediatric Urology of N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology. Patients were divided into three groups depending on the size of the instruments and the way the operation was completed. The first group (n=28) underwent surgery using the mini-PNL technique with the closure of the access tract. The second group (n=21) underwent surgery using the mini-PNL technique in the end of the surgery, moderate bleeding along the tract was detected in order to stop bleeding, a hemostatic matrix with thrombin was introduced. The third group (n=17) underwent surgery using the standard PNL technique and moderate bleeding was also determined in this group with the aim of tubeless completion, a hemostatic matrix with thrombin was introduced. Drainage of the upper urinary tract in the postoperative period was carried out by "JJ"-internal and "J"-external ureteral stents, which were held for up to 14 days. Results. The complete removal of the calculus in one surgical session was similar in all three groups. In the first group there were 26 (92.8%) children, in the second group 19 (90.4%) and in the third group 16 patients (94.1%). In the first group it was 26 (92.8%) children, in the second group 19 (90.4%) and in the third group 16 patients (94.1%). The need for additional interventions after surgical treatment was 21.4% in the first group, 23.7% in the second and 17.5% in the third group. Febrile fever (persistent temperature 380 C) most often occurred in the first group – in 10.7% of cases, while in the second and third groups this complication was detected in 4.7% and 5.8% of cases, respectively. Gross hematuria in the postoperative period was noted in the group without the use of a hemostatic matrix, averaging 35 (2-115) hours. Conclusion. The proposed tubeless PNL with the use of a hemostatic matrix is indicated for children without bacteriuria, with complete removal of the calculus, in the absence of trauma of the pelvicalyceal system and intensive bleeding. The duration of gross hematuria decreased with the introduction of the matrix in standard tubeless PNL by 51.4% and in mini-PNL by 25.8% compared with the 1-st group

Comparing Tubeless and Tubed Approaches in Percutaneous Nephrolithotomy for Moderate Renal Calculi: Outcomes on Safety, Efficacy, Pain Management, Recovery Time, and Cost-Effectiveness.

Introduction This study focuses on investigating the effect of routine nephrostomy tube placement in patients with moderate renal calculi of size 2.5 cm or less who undergo uncomplicated percutaneous nephrolithotomy (PCNL) procedures. Previous studies have not specified whether only uncomplicated cases were included in the analysis, which may affect the results. This study aims to provide a clearer understanding of the effect of routine nephrostomy tube placement on blood loss in a more homogeneous patient population. Materials and methods A prospective randomized controlled trial (RCT) was conducted at our department over 18 months, dividing 60 patients with a single renal or upper ureteric calculus of size ≤2.5 cm into two groups: 30 patients in each group (group 1: tubed PCNL, group 2: tubeless PCNL). The primary outcome was the drop in perioperative hemoglobin leveland the number of packed cell transfusions necessary. The secondary outcome included the mean pain score, analgesic requirement, length of hospital stay, time to return to normal activities, and the total cost of the procedure. Results The two groups were comparable in age, gender, comorbidities, and stone size. The postoperative hemoglobin level was significantly lower in the tubeless PCNL group (9.56 ± 2.13 gm/dL) compared to the tube PCNL group (11.32 ± 2.35 gm/dL) (p = 0.0037), and two patients in the tubeless group required blood transfusion. The duration of surgery, pain scores, and analgesic requirement were comparable between the two groups. The total procedure cost was significantly lower in the tubeless group (p = 0.0019), and the duration of hospital stay and time to return to daily activities were significantly shorter in the tubeless group (p < 0.0001). Conclusions Tubeless PCNL is a safe and effective alternative to conventional tube PCNL, with the advantages of shorter hospital stay, faster recovery, and lower procedure costs. Tube PCNL is associated with less blood loss and the need for transfusions. Patient preferences and bleeding risk should be considered when choosing between the two procedures.

Total tubeless percutaneous nephrolithotomy without artificial hydronephrosis in preschool children: Three case reports.

Indwelling ureteral catheter, double J tube, or nephrostomy tube are routine procedures for percutaneous nephrolithotomy (PCNL) in children. There are a few cases in which PCNL has been performed in children without any additional instruments being left in place. In this study, 3 children were treated for hematuria and complicated with different degrees of urinary tract infection. All of them were diagnosed as upper urinary tract calculi by abdominal computed tomography. Three preschoolers were diagnosed with upper urinary tract calculi before surgery, one with no hydronephrosis and the other 2 with different degrees of hydronephrosis. After preoperative evaluation, all the children successfully completed PCNL without indwelling ureteral catheter, double J tube, or nephrostomy tube. The operation was successful and there were no residual stones observed during postoperative review. The operating times for the children were 33 minutes, 17 minutes, and 20 minutes, and the intraoperative bleeding volumes were 1 mL, 2 mL, and 2 mL. The catheter was removed on the second day after the operation, the postoperative review of the abdominal computed tomography or ultrasound did not indicate any stone residue, and there were no fever, bleeding, and other related complications after the operation. We believe that total tubeless PCNL without artificial hydronephrosis can be achieved in the preschool population.

Comparison between Standard Percutaneous Nephrolithotomy versus Tubeless Percutaneous Nephrolithotomy

Background: Percutaneous nephrolithotomy (PCNL) technique has become a routine treatment for upper urinary calculi. Objectives: To describe the socio-demographic characteristics of the patients and to compare the outcome of operated patients. Materials And Methods: This was a retrospective study, of patients underwent PCNL in our Urology Center, between January 2020 and December 2022. Data of age, side, location of stone, size of stone, operating time, hospital stay, post operation pain, residual stones, fever, fistula, blood transfusion, and postoperative infection were recorded and compared between the two groups. Data were analyzed by using the SPSS version 22. Independent t-tests were used to analyze continuous variables, while for categorical variables chi-square test was used to compare two groups and a p value of less than 0.05 was determined as statistically significant. Results: 51.1% of the patients were females and 48.9% were males, (P = 0.000). The mean age was 38.1 ± 11.1 years. The highest number of patients were in the age group 30 – 39 years (40.0%), (P = 0.000). The location of stones was in pelvic (48.9%), lower calyces (30.0%) and pelvic + lower calyces (21.1%), (P = 0.000). Pain was more common as moderate in both groups PCNL (42.2%). Residual stones were (23.4%) only in standard PCNL group, (P = 0.000). Fever was in (7.8%) standard PCNL and in tubeless PCNL was in (2.2%), (p = 0.045). Blood transfusion was provided to (5%) for the standard PCNL patients and (3.3%) for tubeless PCNL patients. Patients who had standard PCNL had postoperative infectious (2.2%) was found in standard PCNL patients. Mean operation-time and mean hospital stay of standard PCNL was predominant. Conclusion: Tubeless PCNL proved to be the safest and most effective. Keywords: Comparison, standard, tubeless percutaneous, nephrolithotomy.

The modified technique of totally tubeless percutaneous nephrolithotomy with a safety suture thread

The modified technique of totally tubeless percutaneous nephrolithotomy with a safety suture thread

Retrospective evaluation of outcome of percutaneous nephrolithotomy at a tertiary care center in eastern Nepal

Background: Percutaneous nephrolithotomy (PCNL) is considered as the standard treatment for renal tract stones. It is a successful procedure with low complication rate. Objective was to evaluate the outcome measures in large renal stone including stone free rates and complications in patients underwent PCNL. Methods: A retrospective study was conducted in 120 patients who underwent PCNL for renal stone size 2 to 2.5 cm, between 2019 and 2021. Ethical clearance was obtained from the institutional review committee (IRC/2430/022). The data were collected from the records available in the medical record section. The data were analyzed for patient demographics, investigations, site of puncture, stone-free rates (SFRs), type of nephroscope, use of nephrostomy tube, blood transfusion, hospital stay and complications. Results: Out of 120 cases, 64 (53.3%) were males and 67 (55.8%) presented with renal stone on the right kidney. Renal stone was in pelvis in 47 (39.2%) patients. In 47 (39.2%) cases puncture was made in the lower pole. Stone free clearance rate was 92.5% and 4.2% patients required blood transfusion. There was no statistical difference in intraoperative complication like bleeding in supracostal puncture group and subcostal puncture group [25% vs 13.2%; p=0.13] and in tube group and tubeless group (43.9% vs 3.8%; p&lt;0.001). There was significant difference in length of hospital stay and duration of Foley’s catheter removal between supracostal group vs subcostal group and tube group vs tubeless group (p&lt;0.05). Postoperative complications like fever were seen in 14 (23.0%) and four (6.8%) patients with standard nephroscope group and mini nephroscope group respectively and it was statistically significant (p&lt;0.05). Conclusions: Mini and tubeless PCNL had a good success rate with minimal complication. The total stone clearance rate in our study was 92.5%.

Tubeless versus conventional minimally invasive percutaneous Nephrolithotomy: A comparative study

PCNL (Percutaneous Nephrolithotomy) and MPCNL (Miniaturized Percutaneous Nephrolithotomy) are minimally invasive surgical procedures used to treat kidney stones. Both PCNL and MPCNL are effective treatments for kidney stones, but the choice of procedure depends on the size, location, and number of stones, as well as the patient&#39;s medical history and overall health. The present study was aimed to assess the safety and efficacy of tubeless PCNL compared to conventional PCNL in terms of Postoperative pain, hospital stay, Drop in Haemoglobin levels, Operative time, Stone free rate, Post operative fever. Methodology: A Prospective comparative interventional study has been done in Department of Urology, Mamata Super Specialty Hospital, Khammam with a total of 50 patients who were randomized into two groups of 25 each undergoing tubeless mini PCNL and conventional mPCNL respectively. Results: The mean age was 43.76 years and 41.92 years for mini PCNL and conventional mPCNL groups respectively, the mean calculus size in the tubeless PCNL group was 2.028 cm, while in the conventional PCNL group, it was 2.452 cm. There was significantly lesser operative time taken in conventional PCNL group when compared with Tubeless PCNL group. Stone free clearance rate 97% in tubeless PCNL. The mean hospital stay in tubeless PCNL group was significantly more than that in conventional PCNL. Conclusion: Both tubeless mPCNL and conventional mPCNL had similar surgical outcomes, but tubeless mPCNL had reduced surgery time, stone clearance, and hospital stay, indicating its potential for wider use.

Self-Removing Antegrade Tethered Ureteric Stents After Tubeless Percutaneous Nephrolithotomy in the COVID-19 Era

Purpose: To assess the safety and efficacy of self-removing antegrade tethered stents after percutaneous nephrolithotomy (PNL) during the COVID-19 pandemic. Materials and Methods: Instead of routine placement of double-J stent which requires endoscopic removal, a tethered antegrade stent after tubeless PNL as an exit strategy followed by self-removal can obviate the need of early postoperative revisit. A prospective observational study in a university teaching hospital was conducted during the lockdown period from May 2021–June 2021 with the use of antegrade tethered stent in 30 patients and we studied the complications associated with it. Results: The average stone size among the patients was 2.4 cm (1.2–4.9). Postoperative visual analog scale (VAS) till the time of stent removal was 30.8 + 4.4 mm while the VAS at stent removal was 26.6 + 3.8 mm. None of the patients had urine leak or hemorrhage from the site of percutaneous access after self-removal of stent. Two (6.66 percent) patients had grade I and grade II modified Clavien–Dindo complication. The mean score of satisfaction with life scale (SWLS) Questionnaire was 31 (34–27). The present study demonstrates that tubeless PNL with antegrade tethered stent has the advantages of avoiding hospital visits for stent removal during COVID-19. Conclusion: The use of an antegrade threaded stent is safe, culminating in minimal morbidity and patient distress, and greater overall patient satisfaction.

The feasibility and safety of one-shot dilatation compared to conventional sequential dilatation in tubeless percutaneous nephrolithotomy: a prospective randomized controlled study

To study the feasibility and safety of One-Shot Dilatation (OSD), versus serial sequential dilatation in tubeless Percutaneous Nephrolithotomy (PCNL). One Hundred and Fifty patients were randomised into two groups; Group A (One-Shot Dilatation), Group B (Serial Dilatation). Twenty-one patients were excluded from the study. Detailed history was taken and full physical examination was performed. Pre-operative routine laboratory investigations were done. Also, non-contrast Computed Tomography of the Urinary Tract (CTUT) and plain urinary tract x-ray were done. Intra-operative assessments of dilatation, total operative, total fluoroscopy and fluoroscopy during dilatation durations were recorded, as well as estimated blood loss. Post-operatively haemoglobin, creatinine levels and CTUT were performed for all patients. Complications, as urinary leakage time, analgesic requirements and hospitalization time were measured. There were statistically significant differences in the intraoperative durations, where Group A had shorter dilatation time, fluoroscopy time during dilatation and total operative time. Group B had a higher complications rate than Group A; 37.9%, 11.3%, respectively. Also, Group B showed haemoglobin drop by 0.44 mg/dl higher than Group A. More doses of analgesia were required for Group B. Hospitalization time and rate of urinary leakage were both in favour of Group A. For patients undergoing Tubeless PCNL, we have concluded that one-shot dilatation seems to be a safer and more feasible technique than Serial dilatation.

Standard Versus Tubeless Percutaneous Nephrolithotomy in Children: A Comparative Study at Tertiary Care Centre

Background: Percutaneous nephrolithotomy is a urological technique advocated to extract kidney and proximal ureter calculi. Various strategies evolved throughout time as a result of experiences and new instruments. Tubeless PCNL is chosen over traditional PCNL due to fewer post-operative problems, a shorter patient hospital stay, and shorter procedure duration. This is the first of its kind study, to our knowledge in paediatric population in our setup. Objective: To compare the outcomes of standard versus tubeless percutaneous nephrolithotomy in children. Material and Methods: This prospective descriptive comparative study conducted at Department of Paediatric Urology, Institute of Kidney Disease, Peshawar; from October 2021 to September 2022 consisting of 100 patients. Patients in the age range of 4 to 14 years with renal or ureteric stones were arbitrarily assigned to two groups. Group A underwent through standard PCNL and group B underwent through tubeless PCNL. Outcomes of both groups were compared in terms of operative time, post-op pain and post-op complications. All the data was analyzed through SPSS version 24. Results: Mean age of the patients in group A and B was 9.12±2.07 years and 8.68±1.82 years respectively. The mean operation time, hospital stay in group A (standard PCNL) and B (tubeless PCNL) were 86.06 ±7.20 minutes, 6.46±.97 days and 83.68 ±3.81 minutes and 3.42±.81days respectively. The mean VAS pain scores in group A and group B were 6.24 ± .71 and 3.70 ± .81 respectively. Post operative complications were less seen in the tubeless PCNL. Conclusions: Tubeless PCNL is a safe technique having shorter operative time while post-operatively associated with shorter hospital stay and fewer complications as compared to standard PCNL. Keywords: Renal Stones, Standard PCNL, Tubeless PCNL, Outcomes Abbreviations: PCNL=Percutaneous Nephrolithotomy, VAS=Visual Analogue Scale

A prospective, observational study to assess the feasibility and safety of supine percutaneous nephrolithotomy under regional anesthesia for obese patients with a body mass index ≥30.

Besides being a risk factor for urolithiasis, obesity is a challenge in the treatment of urolithiasis from the perspective of both the surgeon and the anesthetist. In this study, we tried to assess the feasibility and safety of supine percutaneous nephrolithotomy (PCNL) under regional anesthesia in obese patients with a body mass index (BMI) ≥30. This was a prospective observational study and included 51 obese patients (BMI ≥30 kg/m2) with renal stones planned for PCNL. All patients underwent supine PCNL under regional anesthesia with the standard technique. A decision for totally tubeless or a tubeless PCNL was made at the end of the procedure and the intraoperative and postoperative data were recorded. All patients underwent computed tomography (CT) imaging at 1 month after surgery to assess the stone-free status and the need for additional treatment. The mean age of the patients was 53.2 ± 8.09 years, and the mean BMI was 34.4 ± 2.369 kg/m2. The mean operative time was 73.3 ± 26.2 min, the mean hospital stay was 58.3 ± 22.1 h, and the mean postoperative Visual Analog Score (VAS) for pain was 3.8 ± 1.4. The stone-free rate was 68.6% on the follow-up CT performed after 1 month, and 31.4% of the patients had significant residual fragments which required re-treatment either by retrograde intrarenal surgery (RIRS) in 19.6% (either as primary RIRS for the residual calculi in one patient [1.9%] or as RIRS for post shock wave lithotripsy (SWL) or alkalinization failure in 9 patients), SWL in 21.6%, or urine alkalinization in 7.8%. Supine PCNL under regional anesthesia, in this subgroup of obese patients, was found to be feasible and safe with satisfactory stone-free rates and minimal postoperative pain.

The effectiveness and safety of tubed and tubeless percutaneous nephrolithotomy types in the treatment of preschool-age pediatric kidney stones

The incidence of kidney stones in children has increased in recent years. Unlike adults, the treatment of pediatric kidney stones is more difficult because of the size of the stones and the high risk of recurrence.&#x0D; The present study aimed to evaluate the management of pediatric kidney stones with percutaneous nephrolithotomy in general and with both types of percutaneous nephrolithotomy (PCNL).&#x0D; Methods. This retrospective cross-sectional study was conducted at Al-Safeer Al-Imam Al-Hussein Hospital from November 1, 2019 to October 31, 2021. A total of 90 children with kidney stones were divided into 45 with tubular PCNL and 45 with tubeless PCNL. The children were followed up for at least six months postoperatively. &#x0D; Results. After PCNL, only 4 children were not stone-free and no injury was noted, whereas sepsis was noted in only one child. Renal status after PCNL was stable renal function in 97.8% of children and improved renal function in 2.2% of children, while no deterioration of renal function was noted. The characteristics of the children, the characteristics of the surgical procedure (except access), and the results of PCNL were not significantly different among the different types of PCNL&#x0D; Conclusion. PCNL in both variants (with and without tubing) is a safe and effective surgical option in the treatment of children with renal stones.

STANDARD VERSUS TUBELESS PCNL: A COMPARATIVE AND PROSPECTIVE STUDY

Introduction: PCNL is considered to be the standard procedure in patients with large renal calculus. The essential step in standard percutaneous nephrolithotomy (PCNL) procedure is placement of a percutaneous nephrostomy tube for drainage. On the other hand, in recent years, the procedure has been reformed to one called as 'tubeless' PCNL in which a double-J stent without nephrostomy tube is placed for internal drainage. This was aMaterials And Methods: prospective comparative study, conducted in the department of Urology,Vardhman hospital and research centre Meerut and NCR medical college, Meerut between a period of 24 months from Jan. 2020 to Dec. 2021. Sample size estimated based on prevalence of the operable renal calculi. Results of study group were compared with other group of traditional PCNL. We evaluated the data of 100 cases undergoing PCNL in our hospital. We divided total cases in to 2Results: groups. There are 48 cases in group 1 who underwent traditional PCNL and 52 patients in group B of totally tubeless PCNL. Both groups have similar demographics according to age sex and comorbidities. Among these 48 cases (group 1) 30 were male and 18 female patients. Male to female ratio is 1.66:1. The average age was 52 years with arrange of 20 to 65 years. Where as in group 2 male to female ratio is 1.42:1 and average age is 49 years. Out of48 cases 31.2 %( 15) have hypertension, 12.5% (6) have diabetes mellitus, 4 patients have COPDs, and 7 patients was known CKD. Conclusion: Our findings demonstrated that tubeless PCNLs can be safely and effectively performed by an experienced endourologist. Tubeless PCNL has an obvious advantage of significantly reduced postoperative pain, less analgesic requirement and shorter hospital stays. Complications rate are less with tubeless PCNL and blood transfusion is less when compared with traditional PCNL.

Comparison of Tubeless Percutaneous Nephrolithotomy and Ordinary Minimally Invasive Percutaneous Nephrolithotomy in the Treatment of Renal Calculi

Comparison of Tubeless Percutaneous Nephrolithotomy and Ordinary Minimally Invasive Percutaneous Nephrolithotomy in the Treatment of Renal Calculi

Outcome of Standard Percutaneous Nephrolithotomy and Totally Tubeless Percutaneous Nephrolithotomy for Renal Calculi: A Comparative Study

Objective: In standard PCNL usually placement of a double J stent and a nephrostomy tube is required.Several recent studies have reported the benefits of tubeless percutaneous nephrolithotomy (PCNL). Postoperatively,In standard PCNL patients have an indwelling ureteric stent placed, which is often associated with stent-related morbidity. We performed totally tubeless(without any stent or nephrostomy tube) PCNL.This study was conducted in the urology centre of Combined military Hospital,Dhaka, to evaluate the safety, effectiveness, and feasibility of totally tubeless PCNL and to compare with standard PCNL where both nephrostomy tube and double J stent were placed. Materials and Methods: From January 2018 to June 2019 , total 57 selected patients underwent standard or totally tubeless PCNL.In standard PCNL group, both D-J stent and nephrostomy tube were placed and Neither a nephrostomy tube nor a ureteral stent was placed in the totally tubeless PCNL group. We compared patient demographics and stone characteristics, operation time, length of hospital stay, analgesia requirements, stonefree rate, blood loss, change in creatinine, and postoperative complications between the standard and totally tubeless PCNL groups. Results: There were no significant differences in preoperative patient characteristics, postoperative complications, and the stone-free rate between the two groups, but the totally tubeless PCNL group showed a shorter hospital stay and a lesser analgesic requirement compared with the standard PCNL group. Blood loss and change in serum creatinine level were not significantly different between the two groups. Conclusions: Totally tubeless PCNL appears to be a safe and effective alternative for the management of renal stone in selected patients and is associated with a shorter length of hospital stay and less analgesic requirement. Bangladesh J. Urol. 2021; 24(1): 53-57

A prospective, single-centered, cohort study comparing the treatment of renal stones by following PCNL types: Standard, tubeless & totally tubeless

IntroductionRenal stones are a frequent cause of morbidity globally. The number of lumbotomies performed for benign lithiasis has been greatly decreased with the usage of Percutaneous Nephrolithotomy (PCNL). Further development is aimed at reducing tract size, leading to numerous advanced minimally invasive PCNL procedures like mini-PERC, ultra-mini-PERC, and micro-PERC. The aim of this study was to evaluate whether tubeless or totally tubeless PCNL is the safest and most efficient, less morbid management technique for renal stones compared to the standard PCNL with a nephrostomy tube. MethodologyThis is a comparative, prospective, single-centered, cohort study that took place between August 2015 and January 2018 in the Urology department of Benazir Bhutto Hospital in Rawalpindi, Pakistan. 218 patients having single/multiple stones of variable sizes were enrolled in the study. Participants were stratified into three groups; Group A: Standard PCNL treatment; Group B: Tubeless PCNL treatment; Group C Totally Tubeless treatment. Mean operation time (±SD) and stone-free rates were our primary outcomes. The rate of complications during and post-operative complications were our secondary outcomes. ResultsA total of 181 patients were included in our study. A decreasing trend can be seen in mean operation time as we move from Group A to Group C (p = 0.000). The rate of problems during operation in each group was highest (45.8%) in Group A, much lesser problems in Group C (13.3%), and least problems in Group B (8.1%) (p = 0.000). The postoperative complication rate was again the highest in Group A (30.5%), low in Group C (8.3%), and extremely low in Group B (1.6%) ConclusionTubeless PCNL proved to be the safest and most effective when compared to standard and totally tubeless PCNL procedures. It also showed the highest stone-free rates and least ‘unsatisfactory’ results amongst all the groups. Conclusively, it should be performed in routine preferably.

The safety and efficiency of a 1470 nm laser in obtaining tract hemostasis in tubeless percutaneous nephrolithotomy: a retrospective cross-sectional study

ObjectiveIt is challenging to perform a tubeless percutaneous nephrolithotomy (PNL) in patients with tract bleeding. The present study was designed to study the safety and efficacy of the 1470 nm laser for hemostatic completion in tubeless PNL patients with tract bleeding.Patients and MethodsBetween January 2020 and October 2021, 120 patients were retrospectively included and divided into two groups. The hemostasis group included 60 patients receiving tubeless PNL, in which a 1470 nm laser was used to manage tract bleeding. The other group included 60 patients receiving tubeless PNL in which the hemostasis procedure was not performed, serving as the control group. The differences in the patients’ demographic characteristics, procedural information, and posttreatment outcomes between the two groups were statistically compared.ResultsThe differences associated with sex, age, weight, body mass index, urine culture, stone burden, calyx of puncture, degree of hydronephrosis and comorbidities between the two groups were not statistically significant. Compared with the control group, the hemostasis group showed greatly reduced blood loss (0.61 ± 0.31 vs. 0.85 ± 0.46 g/dL) and decreased postoperative hospitalization duration (2.83 ± 0.81 vs. 4.45 ± 0.91 days). The differences in operative time, stone-free rate, Visual Analogue Score and postoperative complications between the two groups were not statistically significant. In the subgroup analysis, the obese patients and patients with moderate to severe hydronephrosis in the hemostasis group also showed a significantly less blood loss (0.51 ± 0.22 vs. 0.83 ± 0.48 g/dL; 0.54 ± 0.27 vs. 0.85 ± 0.47 g/dL, respectively) and shorter length of postoperative hospitalization (2.62 ± 0.51 vs. 4.47 ± 1.19 days; 2.97 ± 0.63 vs. 4.41 ± 0.91 days, respectively) than those in the control group.ConclusionsOur results demonstrated that 1470 nm laser is a safe, feasible and effective method to obtain tract hemostasis in tubeless PNL.

Worldwide practice patterns of percutaneous nephrolithotomy.

To evaluate the current practice of percutaneous nephrolithotomy (PCNL), conducting a worldwide survey among urologists with a special interest in endo-urology. A 22-question survey was specifically developed by the European Association of Urology (EAU) young academic urologists (YAU) and uro-technology (ESUT) groups and globally distributed via SurveyMonkey to almost 2000 members of Endourology Society. The questionnaire included questions dedicated to the demographics and general practice of the participating urologists. In total, 441 responses (male/female ratio - 418/23) were received. A comparatively higher percentage of specialists (56.2%) practiced in academic institutions and had specific endo-urological fellowship training (56.7%). The classical prone PCNL remained the most practiced approach among the surveyed specialists, 47.7% stated to always do prone PCNLs, while 51.8% of respondents used multiple positioning options as required. The PCNL tract was mostly performed by urologists (84.3%) and fluoroscopic guidance was still predominantly used by 74.5% of respondents. The most practiced tract dilation method was balloon dilator used by 42% of respondents. Most of the surveyed urologists had ultrasonic, pneumatic or laser lithotripsy devices in their armamentarium. The use of some form of post-procedural drainage was reported in 85.1% of respondents, whereas tubeless PCNL remained a fairly uncommon practice. The majority of urologists still use prone positioning, get their own access under fluoroscopy guidance and use a balloon for tract dilation. However, we also identified that when necessary, urologists will deviate from routine practice and change strategy, adopting other approaches for PCNL.

Infectious complications of endourological treatment of kidney stones: A meta-analysis of randomized clinical trials.

Endourological treatment is associated with a risk of postoperative febrile urinary tract infections and sepsis. The aim of this study was to review the reported rate of infectious complications in relation to the type and modality of the endourologic procedure. This systematic review was conducted in accordance with the PRISMA guidelines. Two electronic databases (PubMed and EMBASE) were searched. Out of 243 articles retrieved we included 49 studies after full-text evaluation. Random-effects meta-analysis demonstrated that retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) were associated with not significantly different odds of getting fever (OR = 1.54, 95% CI: 0.99 to 2.39; p = 0.06) or sepsis (OR = 1.52, 95% CI: 0.37 to 6.20, p = 0.56). The odds of getting fever were not significantly different for mini PCNL compared to standard PCNL (OR = 1.11, 95% CI: 0.85 to 1.44; p = 0.45) and for tubeless PCNL compared to standard PCNL (OR = 1.34 95% CI: 0.61 to 2.91, p = 0.47). However, the odds for fever after PCNL with suctioning sheath were lower than the corresponding odds for standard PCNL (OR = 0.37, 95% CI: 0.20 to 0.70, p = 0.002). The odds of getting fever after PCNL with perioperative prophylaxis were not different from the corresponding odds after PCNL with perioperative prophylaxis plus a short oral antibiotic course (before or after the procedure) (OR = 1.31, 95% CI: 0.71 to 2.39, p = 0.38). The type of endourological procedure does not appear to be decisive in the onset of infectious complications, although the prevention of high intrarenal pressure during the procedure could be crucial in defining the risk of infectious complications. on behalf of U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai.