Tubeless Percutaneous Nephrolithotomy Research Articles

Tubeless versus standard percutaneous nephrolithotomy: an update meta-analysis

BackgroundTo update a previously published systematic review and meta-analysis on the efficacy and safety of tubeless percutaneous nephrolithotomy (PCNL).MethodsA systematic literature search of EMBASE, PubMed, Web of Science, and the Cochrane Library was performed to confirm relevant studies. The scientific literature was screened in accordance with the predetermined inclusion and exclusion criteria. After quality assessment and data extraction from the eligible studies, a meta-analysis was conducted using Stata SE 12.0.ResultsFourteen randomized controlled trials (RCTs) involving 1148 patients were included. Combined results demonstrated that tubeless PCNL was significantly associated with shorter operative time (weighted mean difference [WMD], −3.79 min; 95% confidence interval [CI], −6.73 to −0.85; P = 0.012; I2 = 53.8%), shorter hospital stay (WMD, −1.27 days; 95% CI, −1.65 to −0.90; P < 0.001; I2 = 98.7%), faster time to return to normal activity (WMD, −4.24 days; 95% CI, −5.76 to −2.71; P < 0.001; I2 = 97.5%), lower postoperative pain scores (WMD, −16.55 mm; 95% CI, −21.60 to −11.50; P < 0.001; I2 = 95.7%), less postoperative analgesia requirements (standard mean difference, −1.09 mg; 95% CI, −1.35 to −0.84; P < 0.001; I2 = 46.8%), and lower urine leakage (Relative risk [RR], 0.30; 95% CI 0.15 to 0.59; P = 0.001; I2 = 41.2%). There were no significant differences in postoperative hemoglobin reduction (WMD, −0.02 g/dL; 95% CI, −0.04 to 0.01; P = 0.172; I2 = 41.5%), stone-free rate (RR, 1.01; 95% CI, 0.97 to 1.05; P = 0.776; I2 = 0.0%), postoperative fever rate (RR, 1.05; 95% CI, 0.57 to 1.93; P = 0.867; I2 = 0.0%), or blood transfusion rate (RR, 0.79; 95% CI, 0.36 to 1.70; P = 0.538; I2 = 0.0%). The results of subgroup analysis were consistent with the overall findings. The sensitivity analysis indicated that most results remained constant when total tubeless or partial tubeless or mini-PCNL studies were excluded respectively.ConclusionsTubeless PCNL is an available and safe option in carefully evaluated and selected patients. It is significantly associated with the advantages of shorter hospital stay, shorter time to return to normal activity, lower postoperative pain scores, less analgesia requirement, and reduced urine leakage.

Management of Colon Perforation During Percutaneous Nephrolithotomy: 12 Years of Experience in a Referral Center

The management protocol for colon perforation during percutaneous nephrolithotomy (PCNL) is controversial because of the scarcity of reported cases and their management diversity. We present our management experience of colon perforation during PCNL. All PCNL operations between April 2004 and September 2016 in our center (N = 11,376) were reviewed for the occurrence and management of colon perforation. We typically performed PCNL with insertion of nephrostomy tube before mid-2007. After mid-2007, we typically performed tubeless PCNL and inspected access tract for evidence of organ injury especially colon perforation during nephroscope removal. Seventeen colon perforations happened during the study period. The first three cases were diagnosed postoperatively and in two patients open surgery was employed for treatment. The next 14 cases were diagnosed intraoperatively (n = 12) or in the early postoperative period (n = 2) and were managed by broad spectrum antibiotics, bowel rest, and urinary Double-J and Foley's catheter insertion. Percutaneous retroperitoneal drain was inserted for only one patient after intraoperative diagnosis of colon perforation. The other 13 patients were managed without insertion of such drains. For one patient, postoperative insertion of retroperitoneal drain was attempted because of collection of urine. In other patients (n = 12), the management was effective with no need for an operation. Complications according to Clavien-Dindo grade in these 17 patients were grades II, IIIa, and IIIb in 13, 1, and 3 patients, respectively. Colon perforation during PCNL that is diagnosed intraoperatively or in the early postoperative period can be managed conservatively. It seems possible not to insert colostomy or retroperitoneal drains in stable patients with early or intraoperative diagnosis. In cases of delayed diagnosis, or deterioration of the patient on tubeless management, the standard protocol should be performed including insertion of colonic or retroperitoneal drain or surgery especially in patients with signs or symptoms of peritonitis or persistent fever.

118 - Is tubeless percutaneous nephrolithotomy safe and effective in treating giant or staghorn stone? – A single medical center experience

118 - Is tubeless percutaneous nephrolithotomy safe and effective in treating giant or staghorn stone? – A single medical center experience

Current trends in percutaneous nephrolithotomy: an internet-based survey.

The aim of this study was to report current practices of percutaneous nephrolithotomy (PCNL) among endourologists. An internet survey was administered to Endourological Society members. Responders were distributed into three groups according to the number of PCNL cases per year (<50, 50-100, >100). PCNL technical details as well as opinions regarding specific clinical case scenarios were evaluated and compared between groups. We received 300 responses from 47 different countries. Prone position was used in 77% of cases, while 16% used supine position and only 7% used modified lateral decubitus. Most endourologists performed their own access. There were no significant differences between the three groups regarding patient position (p = 0.1), puncture acquisition by urologist or radiologist (p = 0.2) and fluoroscopic puncture technique (p = 0.2). Endourologists with high annual PCNL practice (>100) had least probability to utilize nephrostomy tube (p = 0.0005) or use balloon dilator (p = 0.0001). They also had the highest probability of performing mini-PERC (p = 0.0001). The majority of endourologists performing PCNL obtain their own access. Prone positioning is predominant, while totally tubeless PCNL are uncommon. Mini-PERC is gaining more popularity among endourologists. Most endourologists follow the guidelines for their choice of treatment modality in different sizes and locations of upper tract calculi.

Totally Tubeless Percutaneous Nephrolithotomy: A Comparison with Tubeless and Standard Methods

Objectives: The study aimed to compare tubeless, totally tubeless, and standard percutaneous nephrolithotomy (PNL) in a tertiary center with selected patient population. Methods: Between September 2013 and March 2015, percutaneous nephrolithotomy was performed on 216 patients in our center. Patients without massive bleeding, calyceal perforation, and residual fragments smaller than 4 mm were enrolled in this study. The patients were divided into 3 groups. In the first group (n = 68), we placed nephrostomy and kept ureteral catheter for 24 hours (the standard group). In second the group (n = 69), no nephrostomy was inserted and ureteral catheter was removed in the operation room (the totally tubeless group) and in the third group (n = 79), no nephrostomy catheter was placed but antegrade DJ stent was inserted intraoperatively (the tubeless group). Three groups were compared with respect to age, analgesic requirement, BMI, length of stay, pain, and stone size. Results: No significant differences were found in the mean stone size, operation time, transfusion rates, and hemoglobin level change between the groups. However, hospitalization time, the amount of narcotic usage, and pain were significantly lower in the second group compared to the other groups (P < 0.05). Conclusions: In patients with no major intraoperative bleeding and calyceal perforation, the totally tubeless approach is safe with decreased pain, analgesia requirement, and hospital stay.

Primary Report of Totally Tubeless Percutaneous Nephrolithotomy Despite Pelvi-calyceal Perforations.

Nephrostomy tube insertion and/or a ureteral stent placement is advised when pelvi-calyceal perforations are encountered during percutaneous nephrolithotomy (PNL) nevertheless totally tubeless PNL is a possible exit strategy in percutaneous renal surgery therefore case series on the short term clinical outcomes of noninvasive management of iatrogenic pelvicalyceal perforations encountered during PNL is presented. During retrospective analysis of 1271 PNL procedures, 25 incidents of accidental ureteral catheter/ jj stent dislodgement during first 24 post-operative hours were identified in patient who had pelvi calyceal perforations and had no nephrostomy tube (tubeless). Thirteen patients could not be re-stented nor a nephrostomytube could have been placed for them mainly due to patient refusal or comorbid conditions. The main outcome was rate of successful noninvasive management. Eighteen Patients bearing mucosal tears (grade I trauma) or visible peri-pelvic fat (grade II) successfully recovered without need for ureteral stenting or nephrostomy (72.0%). In seven (28.0%) cases of extension of the perforation into the peri-pelvic fat (grade III), either nephrostomy insertion or JJ stenting was needed for resolution of fever and urinoma. The major limitation was the necessity to exclude patients and manage them in the standard fashion according to clinical guidelines. Iatrogenic perforations of the collecting system are quite diverse in terms of severity that result in different natural histories and not all might need urinary diversion via nephrostomy or ureteral stenting.Low grade perforations may be successfully managed in totally tubeless fashion nevertheless further prospective investigations seem warranted.

Totally tubeless percutaneous nephrolithotomy is feasible in morbidly obese patients.

Regarding technical difficulties that obese body habitus might impose to percutaneous nephrolithotomy (PNL) success and higher risk of peri-operative complications in this group of patients, we decided to retrospectively gather data from our patients during past 8 years to determine the stone free and complication rates. Between January 2007-December 2015, seventy-eight obese patients with body mass index over 35 who had indication for PNL including stones larger than 2 cm in pelvi-calyceal system or smaller extracorporeal shock wave lithotripsy (ESWL) resistant stones or who were not a fit candidate for ESWL due to increased skin to target distance, with no contraindication of PNL (including bleeding diathesis, inability to be positioned in prone) were enrolled. They were randomly assigned to group 1 (standard PNL with nephrostomy and ureteral stent) or group 2 (totally tubeless PNL with no ureteral stent and no nephrostomy). The outcomes were compared. The transfusion rate, operation time, and the hemoglobin drop were same across the groups (p>0.05). Total analgesic use was equivalent of 33.8 vs. 14.7 mgs of morphine sulfate (18-77 mg) and was significantly lower in total tubeless group (p=0.001). Return to normal activity was described as total number of in-patient and outpatient days from time of admission to the point which the patients returns to normal life activity such as going to job or school and was 19.4 vs. 9.3 days (6-30 days, p=0.001). Totally tubeless PNL in obese subjects would have lower analgesic use and return to normal activity versus standard PNL. Totally tubeless PNL is recommended for obese patients.

Surgical outcomes of percutaneous nephrolithotomy in 3402 patients and results of stone analysis in 1559 patients.

To report our experience of a series of percutaneous nephrolithotomy (PCNL) procedures in a single centre over 18years in terms of patient and stone characteristics, indications, stone clearance and complications, along with the results of chemical analysis of stones in a subgroup. We retrospectively analysed the outcomes of PCNL in 3402 patients, who underwent the procedure between 1997 and 2014, obtained from a prospectively maintained database. Data analysis included patients' age and sex, laboratory investigations, imaging, punctured calyx, duration of operation, volume of irrigation fluid, radiation exposure time, blood transfusion, complications and stone-free status at 1-month follow-up. For the present analysis, outcomes in relation to complications and success were divided in two eras, 1997-2005 and 2006-2014, to study the differences. Of the 3402 patients, 2501 (73.5%) were male and 901 (26.5%) were female, giving a male:female ratio of 2.8:1. Staghorn (partial or complete) calculi were found in 27.5% of patients, while 72.5% had non-staghorn calculi. Intracorporeal energy sources used for stone fragmentation included ultrasonography in 917 patients (26.9%), pneumatic lithoclast in 1820 (53.5%), holmium laser in 141 (4.1%) and Lithoclast® master in 524 (15.4%). In the majority of patients (97.4%) a 18-22-F nephrostomy tube was placed after the procedure, while 69 patients (2.03%) underwent tubeless PCNL. The volume of the irrigation fluid used ranged from 7 to 37 L, with a mean of 28.4L. The stone-free rate after PCNL in the first era studied was 78%, vs 83.2% in the second era, as assessed by combination of ultrasonography and plain abdominal film of the kidney, ureter and bladder. The complication rate in the first era was 21.3% as compared with 10.3% in the second era, and this difference was statistically significant. Stone analysis showed pure stones in 41% and mixed stones in 58% of patients. The majority of stones consisted of calcium oxalate. This is the largest series of PCNL reported from any single centre in Pakistan, where there is a high prevalence of stone disease associated with infective and obstructive complications, including renal failure. PCNL as a treatment method offers an economic and effective option in the management of renal stone disease with acceptable stone clearance rates in a resource-constrained healthcare system.

Tubeless versus standard percutaneous nephrolithotomy in pediatric patients: a systematic review and meta-analysis

This systematic review and meta-analysis was designed to evaluate the post-operative outcomes between tubeless and standard percutaneous nephrolithotomy (PCNL) among children. Literature searches were performed following the Cochrane guidelines. We conducted a systematic review and meta-analysis that included three trials investigating the outcomes including the length of hospital stay, operation time, hemoglobin decrease, blood transfusion rate, perirenal fluid presence, post-operative fever, stone clearance rate, and the need for a second operation. The patients who underwent tubeless PCNL had shorter length of hospitalization compared to standard PCNLs (mean difference -1.57, 95% confidence interval -3.2 to 0.07, p = 0.06). No significant decrease was detected in hemoglobin after tubeless PCNL compared to standard PCNL (mean difference 0.05, 95% confidence interval -0.03 to 0.13, p = 0.21). There were no significant differences in operation time (p = 0.7), perirenal fluid presence (p = 0.15), post-operative fever (p = 0.72), stone clearance (p = 0.68), and the need for a second operation (p = 0.90). This study showed no significant difference between tubeless and standard PCNLs in children. However, due to the lack of data, the results should be mentioned prudently. Future randomized trials with more sample sizes and longer follow-ups are warranted.

MP75-16 SUPRACOSTAL ACCESS TUBELESS PERCUTANEOUS NEPHROLITHOTOMY: MINIMIZING COMPLICATIONS

You have accessJournal of UrologyStone Disease: Surgical Therapy VII1 Apr 2017MP75-16 SUPRACOSTAL ACCESS TUBELESS PERCUTANEOUS NEPHROLITHOTOMY: MINIMIZING COMPLICATIONS Michael Sourial, Nathaly Francois, Hiroko Miyagi, Geoffrey Box, and Bodo Knudsen Michael SourialMichael Sourial More articles by this author , Nathaly FrancoisNathaly Francois More articles by this author , Hiroko MiyagiHiroko Miyagi More articles by this author , Geoffrey BoxGeoffrey Box More articles by this author , and Bodo KnudsenBodo Knudsen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2164AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Supracostal access in percutaneous nephrolithotomy (PCNL) may be avoided due to concern for thoracic complications. The objective of the study is to report the safety and efficacy of supracostal access utilizing a tubeless (stent only) PCNL technique. METHODS From July 2010 to Oct 2016, 70 patients (76 renal units) underwent a supracostal access tubeless PCNL. The study is a retrospective review of their perioperative and postoperative outcomes. All patients underwent a non-contrast CT prior to the surgery. No nephrostomy tubes were left and all patients had a 7F ureteral stent and Foley catheter placed. The nephrostomy sheath was removed with the patient held in expiration, similar to a chest tube, and the incision closed. RESULTS Median patient age was 62 years. Median BMI and ASA score was 32.9 kg/m2 and 3, respectively. The median stone size was 20 x 21 mm, and 13 patients had complete staghorn stones. The upper calyx was the site of access in 50 cases. The access was above the 12th and 11th rib in 57 and 12 cases, respectively. The median length of hospital stay was 30 hours. Postoperatively, 48 (63%) patients had no residual fragments (<2 mm) on postoperative imaging. 8 patients underwent an ancillary procedure to clear residual stones (7 URS and 1 ESWL), with an additional 6 patients becoming stone-free after this procedure. Thoracic complications occurred in 2 (2.6%) patients: 1 small pneumothorax that resolved with conservative management, and 1 symptomatic ipsilateral pleural effusion requiring thoracocentesis. Other complications occurred in 9 patients (11.8%) which included bleeding requiring transfusion (1), fever (4), urinary retention (2), and syncope (2). CONCLUSIONS Compared to historical controls, our approach to upper tract PCNL utilizing a nephrostomy tube free approach resulted in an overall low thoracic complication rate and facilitated hospital discharge. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1009-e1010 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Michael Sourial More articles by this author Nathaly Francois More articles by this author Hiroko Miyagi More articles by this author Geoffrey Box More articles by this author Bodo Knudsen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

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 ...

The effect of nephrostomy tract infiltration of ketamine on postoperative pain and peak expiratory flow rate in patients undergoing tubeless percutaneous nephrolithotomy: a prospective randomized clinical trial.

Ketamine, as a systemic and local analgesic, has been used to reduce postoperative pain in many studies. The present study was designed to assess the analgesic efficacy of nephrostomy tract infiltration of ketamine in postoperative pain after tubeless percutaneous nephrolithotomy (PCNL). Sixty-six patients with renal stone who were candidates for PCNL were randomized to two groups with 33 patients in each group. In group K, 20mL saline solution containing 1.5mg/kg ketamine was infiltrated into the nephrostomy tract and in group C, 20mL saline solution was infiltrated into the nephrostomy tract at the end of surgery. The postoperative pain scores, sedation scores, time to first rescue analgesia, rescue analgesic requirement, peak expiratory flow rate (PEF), and hemodynamic parameters were compared between two groups. Sixty-six patients with a mean age of 45.29 ± 15years and an age range of 18-60years participated in this study. There was no significant difference in the demographic data and duration of surgery between the two groups. The mean VAS scores were significantly lower in the intervention group compared with the control group at the recovery, and 4 and 6h postoperatively (p = 0.001). The mean time to first rescue analgesia in the postoperative period was significantly lower in the control group (64.5 ± 8.1min) compared with the intervention group (122 ± 18.4min). The trend of first opioid administration was significantly lower in the ketamine group p < 0.009. There was no significant differences in PEF between the two groups in the postoperative period (p = 0.622). In conclusion infiltration of ketamine into the nephrostomy tract provides superior analgesic and sedative effects in PCNL surgery without significant changes in PEF.

557 - A prospective, randomized trial evaluating the efficacy of two different hemostatic sealant in tubeless percutaneous nephrolithotomy

557 - A prospective, randomized trial evaluating the efficacy of two different hemostatic sealant in tubeless percutaneous nephrolithotomy

558 - A prospective randomized controlled study of instantly phase-II tubeless percutaneous nephrolithotomy

558 - A prospective randomized controlled study of instantly phase-II tubeless percutaneous nephrolithotomy

Use of hemostatic sealant in tubeless percutaneous nephrolithotomy: Experience of a single institution from Taiwan

ObjectiveTubeless percutaneous nephrolithotomy (PCNL) offers several advantages over standard PCNL, including a shorter hospital stay, less analgesic requirement, and less postoperative pain. Using a fibrin sealant to seal the nephrostomy tract had become a widely accepted technique at the conclusion of tubeless PCNL. Our objective is to evaluate the efficacy and safety of tubeless PCNL using hemostatic matrix. Materials and methodsThis is a retrospective review of PCNL database at our hospital between June 2014 and March 2016. During this period, a total of 139 PCNLs were performed, including 41 with tubeless technique with adjunct of hemostatic matrix (Floseal; Baxter, Deerfield, IL, USA) at the conclusion of the PCNL procedure. The standard PCNL group and the tubeless PCNL group were compared in terms of demographic characteristics, perioperative data, stone characteristics, and complication rate. ResultsOf all 123 patients included in this study, 41 underwent tubeless PCNL. Demographic data of the two groups were comparable except for a higher proportion of male patients in the tubeless PCNL group (73.2% vs. 53.7%). Stone characteristics were also comparable in the two groups. Perioperative variables, including operative time, drop of serum hemoglobin level, and perioperative complication rate, revealed no statistical difference between the two groups. Tubeless PCNL was associated with less postoperative pain, less analgesic requirement, and a shorter hospital stay (p < 0.01). ConclusionTubeless PCNL with adjunct use of a hemostatic sealant can be considered as a safe treatment option for renal calculi with favorable outcome, without an increase in complications. Compared with standard PCNL, tubeless PCNL with hemostatic sealant use is associated with less pain, use of fewer narcotic agents, and a shorter hospital stay.

Tubeless per cutaneous nephrolithotomy: is it the present standard of care?

Background: Since the time standard per cutaneous nephrolithotomy (PCNL) was introduced in 1976, it has undergone changes in techniques, instrumentation and post-operative management for better patient care. Standard PCNL involves placement of nephrostomy tube and DJ stent/ureteric catheter after stone retrieval. Now the trend is towards tubeless PCNL and totally tubeless PCNL as to minimize pain, infection and hospital stay. Our objective was to compare the outcome of standard PCNL with tubeless PCNL. Methods: This was a randomized study of patients who underwent standard PCNL and tubeless PCNL in our institute from August 2013 to August 2015 for renal calculi >2 cms. Patients with residual calculi needing further ancillary treatment and patients who had major collecting system tear were excluded from the study. A total of 257 patients who had undergone PCNL during the study period for renal calculi >2 cm were included in the study. 27 patients were excluded due to presence of residual calculi or major collecting system tear. Of these 115 underwent standard PCNL and remaining 115 tubeless PCNL. Post-operative visual analog pain score, need for analgesics, infection rate, post-operative hospital stay were analyzed. Results: No significant differences were noted in patient demographics, age, sex, stone size and stone burden. There were no significant complications seen in tubeless group as compared to standard PCNL group. Post-operative pain and hospital stay was significantly reduced in tubeless PCNL group. Conclusions: Tubeless PCNL is a relatively safe and effective modification of standard PCNL. It increases patient compliance of PCNL by reducing post-operative pain and early recovery.

Prophylactic antibiotics for tubeless percutaneous nephrolithotomy

Objective: The objective of this study was to investigate the efficacy of second-line versus first-line antibiotics in the prevention of postoperative fever after tubeless percutaneous nephrolithotomy (PCNL). Methods: Three hundred consecutive tubeless PCNL procedures performed at our hospital between August 2010 and December 2013 were enrolled in this study. The efficacy of second-line antibiotics in the prevention PCNL-related urinary traction was reviewed by retrospective chart review. Results: The overall postoperative fever rate was 12% (36 of 300 procedures). The second-line antibiotic prophylaxis was provided in 32 procedures according to preoperative urine culture data or physician's judgment. The first-line prophylactic antibiotic was used in 268 procedures with postoperative fever in 29 procedures (10.8%). The second-line prophylactic antibiotic was used in 32 procedures with postoperative fever in seven procedures (21.9%). No significance difference of postoperative fever rate between first-line or second-line prophylactic antibiotic was found (P = 0.069). Conclusions: The second-line prophylactic antibiotic use for tubeless PCNL does not offer additional benefit over the first-line prophylactic antibiotic in the prevention of postoperative fever or shortening of the postoperative hospital stay.

A randomized controlled study comparing the standard, tubeless, and totally tubeless percutaneous nephrolithotomy procedures for renal stones from a tertiary care hospital.

Introduction:Percutaneous nephrolithotomy (PCNL) is an effective treatment for renal stones. Due to the significant pain and morbidity after standard PCNL because of nephrostomy tubes, various modifications of PCNL are being performed. We report a randomized trial comparing these modalities.Materials and Methods:A total of 75 patients were randomized into three groups of 25 each: standard PCNL with nephrostomy tubes (Group 1), tubeless PCNL with ureteric stent and no nephrostomy (Group 2), and totally tubeless PCNL without ureteric catheter or nephrostomy (Group 3). Randomization was done at the end of the procedure for those patients satisfying the inclusion criteria based on duration of surgery, single puncture tract, intraoperative bleeding, stone burden, intact pelvicalyceal system, and no residual stones at the end of procedure. The outcomes measured were hemoglobin (Hb) drop, hemorrhage, need for blood transfusion, pyrexia, urine leak, pain score, analgesic requirement, and duration of hospital stay.Results:There was no significant difference in hemorrhage, Hb drop, need for blood transfusion, and postoperative pyrexia among the groups. All patients except one in the standard group only had variable amount of urinary leak. The analgesic requirement and duration of hospital stay attained statistical significance in favor of tubeless and totally tubeless groups compared to the standard.Conclusions:Tubeless and totally tubeless PCNL are safe and effective method of renal stone management. Totally tubeless PCNL significantly reduced postoperative pain and morbidity compared to the tubeless method.

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.

Does Intra-Operative Administration of Tranexamic Acid Increases the Chance of Tubeless Percutaneous Nephrolithotomy

Does Intra-Operative Administration of Tranexamic Acid Increases the Chance of Tubeless Percutaneous Nephrolithotomy