A Prospective Randomized Comparison of Type of Nephrostomy Drainage Following Percutaneous Nephrostolithotomy: Large Bore Versus Small Bore Versus Tubeless

Desai, Mahesh; Kukreja, Rajesh; Desai, Mihir; Mhaskar, Sumeet S.; Wani, Kishore; Patel, S.; Bapat, Sharad

doi:10.1097/01.ju.0000130752.97414.c8

Cited by 220 publications

(142 citation statements)

References 4 publications

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“…Tubeless percutaneous nephrolithotomy was introduced in 1997 (7). Subsequently, several groups reported their results with tubeless PCNL in selected patients (8)(9)(10), however all studies excluded patients with concerns regarding bleeding, perforation, or residual stones requiring a second--look nephroscopy. The benefits shown in these select patients included decreased postoperative pain and hospital stay.…”

Section: Introductionmentioning

confidence: 99%

Tubeless percutaneous nephrolithotomy: outcomes with expanded indications

et al. 2014

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ARTICLE INFO ______________________________________________________________ ______________________Introduction: Tubeless PCNL has been utilized to shorten hospital stay and improve patient postoperative pain control. Prior studies have excluded those patients with significant bleeding or other complications. Our objective was to evaluate the utility of tubeless PCNL in all patients irrespective of intraoperative outcome. Materials and Methods:A retrospective review of the charts of patients who underwent PCNL at our institute was performed. Patients were assigned to one endourologist who routinely performed tubeless PCNL and to a second endourologist who routinely left a small-bore pigtail nephrostomy. Preoperative demographics operative and postoperative outcomes were compared. Results: Out of 159 patients included, 83 patients had tubeless PCNL while 76 patients had standard PCNL. There was no difference between groups regarding age, gender, ASA score, number, maximum diameter of stones, number of calyces involved, stone density (HU), laterality and use of preoperative narcotics. While staghorn stones were more common in patients who underwent standard PCNL (p = 0.008). Tubeless patients had less number of access tracts (p ≤ 0.001), shorter hospital stay (1.7 vs. 3.0 days, p = 0.001) when compared to standard PCNL group. Multivariable analysis controlling for confounding factors including staghorn calculi and number of accesses confirmed that tubeless PCNL was associated with shorter hospital stay and less postoperative pain. There was no significant difference in complication rates between the two groups. Conclusion: Our report confirms the previous reports of shorter hospital stay, less pain and analgesia as compared to standard PCNL, and establishes its safety irrespective of bleeding, perforation, extravasation or other intraoperative issues that have previously been utilized as exclusionary criteria for this approach.

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Section: Introductionmentioning

confidence: 99%

Tubeless percutaneous nephrolithotomy: outcomes with expanded indications

et al. 2014

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“…Desai et al [4] conducted a study comparing tubeless, conventional large bore and small bore nephrostomy drainage and concluded that tubeless technique is associated with less morbidity. But they did not describe the size of the tract and the method of choosing Amplatz sheath.…”

Section: Discussionmentioning

confidence: 99%

“…There have been many studies describing the exit strategies for PCNL to reduce postoperative pain, leak and hospital stay. But there are not many studies regarding entry strategy.Desai et al [4] conducted a study comparing tubeless, conventional large bore and small bore nephrostomy drainage and concluded that tubeless technique is associated with less morbidity. But they did not describe the size of the tract and the method of choosing Amplatz sheath.…”

mentioning

confidence: 99%

Choosing the appropriate size of Amplatz sheath during percutaneous nephrolithotomy-a novel method

Thirugnanasambandam

David

Kone

et al. 2018

Turkish Journal of Urology

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Objective: To choose appropriate size Amplatz sheath during percutaneous nephrolithotomy (PCNL) based on retrograde pyelogram. Material and methods:We performed standard PCNL in prone position in 20 patients. All these patients had placement of appropriate size of Amplatz sheath based on retrograde pyelogram images. All patients had nephrostomy tubes postoperatively. The preoperative and postoperative renal parameters, hemoglobin, mean operating time and mean hospitalisation stay were measured. Results:There was no significant difference between the pre-operative and postoperative hemoglobin and creatinine levels. Median operating time was 60.5 mins (45 to 98 mins). The median hospitalisation stay was 4.6 days (3 to 7 days). There was no intraoperative pelvic wall or infundibular injury. Conclusion:Choosing correct size of Amplatz sheath lowers the incidence of kidney hemorrhage and renal function impairment. Choosing the appropriate size of Amplatz sheath during percutaneous nephrolithotomy-a novel method IntroductionThe art of percutaneous nephrolithotomy (PCNL) has evolved over years in terms of technique and technology to improve the outcome, tide over the difficulties during the procedure and prevent complications. [1][2][3] The procedure has seen many advances in terms of miniaturisation, reducing radiation exposure and positioning. But, still it is not devoid of complications. In recent years, PCNL is performed with smaller sized Amplatz sheaths to avoid complications, and reduce morbidities. There is little evidence in the literature as to the selection of appropriate size Amplatz sheath to be used during PCNL.The present study discusses a technique which helps in determining the correct size Amplatz sheath to be used during the PCNL procedure. Material and methodsThis study was conducted between April 2015 and August 2015 in a tertiary care hospital where multiple number of patients with stone disease attend our department. We included 20 patients with pure renal pelvic calculi in our protocol, as this was our preliminary study. The mean stone size, preoperative blood and urine parameters and other patient demographics are given in Table 1. All patients underwent standard prone PCNL with stent and nephrostomy placement under general anaesthesia.During placement of ureteric catheter, a retrograde pyelogram (RGP) was done by instilling 10-15 mL of contrast material through catheter slowly under low pressure. The size of the desired calyceal infundibulum was noted. The infundibular diameter is the shortest distance between the edges of the fluoroscopic infundibular image nearer to the pelvis (Figure 1). Then serially starting from smaller to bigger size, Amplatz sheaths were placed over the back of the patient and fluoroscopic match was obtained between the infundibular diameter and appropriate Amplatz sheath. The size of the correct size Amplatz sheath was noted ( Figure 2).Initial access to the desired calyx was performed under the guidance of fluoroscopy. The access tract was serially dilated ov...

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“…Desai et al (12) did comparative study of type of nephrostomy drainage following PCNL, i.e., large bore (20 Fr) versus small bore (9 Fr) versus tubeless PCNL. Large bore nephrostomy tube patients had significantly higher analgesic requirement (218 mg of diclofenac sodium) than small bore and tubeless patients (140 and 88 mg of diclofenac sodium, respectively).…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study of Peritubal Infiltration of Bupivacaine, Ropivacaine and Placebo in Percutaneous Nephrolithotomy for Post-Operative Analgesia

Vaddineni¹,

K²,

P³

et al. 2014

jemds

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BACKGROUND AND AIMS: Percutaneous nephrolithotomy (PCNL) is a safe and effective endourologic procedure in patients with renal calculi. Though it is less painful than open surgery, effective postoperative analgesia is required to reduce the pain around the nephrostomy site. Objectives of this study are to compare and evaluate the peritubal infiltration of bupivacaine, ropivacaine, and placebo from renal capsule to skin along the nephrostomy tract for postoperative analgesia in percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: A randomized controlled double blinded study was designed in 60 American Society of Anesthesiologists (ASA) grade I and II patients to assess & compare the impact of peritubal infiltration of bupivacaine, ropivacaine, saline with 23-gauge spinal needle along the nephrostomy tract after PCNL under fluoroscopic guidance. Patients were randomized into 3 groups B (bupivacaine), R (ropivacaine), S (saline/control). Each group containing 20 patients were given 20mL of respective drug at the conclusion of the procedure. Postoperative pain score and analgesic requirement for the first 24 hours were assessed by visual analog scale second hourly. Rescue analgesia with inj. Tramadol 2mg/kg was given intravenously to a maximum total dose of 400mg when pain score exceeded 4. RESULTS: Pain scores and analgesic requirement for the first 24 hours postoperatively were lesser in the B (bupivacaine) & R(ropivacaine) groups than in the S(saline/control) group of patients at all points of time and were statistically significant (p<0.005). CONCLUSION: In this study a significant difference in the pain scores and analgesic requirement was noted in saline and drug groups. Peritubal infiltration of 0.25% bupivacaine or 0.375% ropivacaine solutions is equally efficient in alleviating postoperative pain after PCNL.

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A Prospective Randomized Comparison of Type of Nephrostomy Drainage Following Percutaneous Nephrostolithotomy: Large Bore Versus Small Bore Versus Tubeless

Abstract: Tubeless PCNL is associated with the least postoperative pain, urinary leakage and hospital stay. Small bore nephrostomy drainage may be a reasonable option in patients in whom the incidence of stent dysuria is likely to be higher.

Cited by 220 publications

References 4 publications

Tubeless percutaneous nephrolithotomy: outcomes with expanded indications

Tubeless percutaneous nephrolithotomy: outcomes with expanded indications

Choosing the appropriate size of Amplatz sheath during percutaneous nephrolithotomy-a novel method

A Comparative Study of Peritubal Infiltration of Bupivacaine, Ropivacaine and Placebo in Percutaneous Nephrolithotomy for Post-Operative Analgesia

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