A Randomized Controlled Trial of Nephrostomy Placement Versus Tubeless Percutaneous Nephrolithotomy

Crook, Tim; Lockyer, C.R.; Keoghane, S.R.; Walmsley, B.H.

doi:10.1016/j.juro.2008.04.020

Cited by 77 publications

(76 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The present novelty in PCNL is "tubeless" which has shown reduced complication rates. [5][6][7][8] But many other studies in the literature have shown that placement of a nephrostomy tube is mandatory. [1,3] Karakose et al [9] have done a study comparing smaller Amplatz sheath versus larger Amplatz sheath and have shown that complications are less with Amplatz sheaths of smaller size.…”

Section: Discussionmentioning

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

View full text Add to dashboard Cite

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...

show abstract

Section: Discussionmentioning

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

View full text Add to dashboard Cite

show abstract

“…15 There have been significant advances in the percutaneous extraction of renal calculi. [2][3][4][5][6][7][8][9][10] Review articles have highlighted the need for minimal intra-operative bleeding, negligible residual stone burden, and one to two attempts at renal access when considering tubeless approaches. Recently, the ability to perform tubeless PCNL as an outpatient procedure has been reported.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7][8] Tubeless PCNL, with ureteral stenting, has been shown to decrease patients' analgesic requirements and hospital length of stay. 9,10 Although hospitalization is standard practice after PCNL, reports have described success with outpatient management. 11,12 This case report is the first to describe successful outpatient PCNL in a renal transplant patient.…”

Section: Introductionmentioning

confidence: 99%

Outpatient percutaneous nephrolithotomy in a renal transplant patient: World’s first case

McAlpine

Leveridge

Beiko

2015

CUAJ

View full text Add to dashboard Cite

Percutaneous nephrolithotomy (PCNL) is an established safe and effective surgical treatment option for renal calculi in renal allografts. The advent of tubeless PCNL has led to reports of ambulatory or outpatient PCNL. This case report describes the successful outpatient management of a 49-year-old female with a symptomatic renal pelvic calculus in her transplanted kidney. Tubeless PCNL successfully removed the stone, free of complication, and the patient was discharged 2 hours and 17 minutes after the procedure in stable condition with minimal pain. This is, to the best of our knowledge, the first successful case of outpatient tubeless PCNL in a transplanted kidney. IntroductionPercutaneous nephrolithotomy (PCNL) is an accepted and widely used approach to extract large renal calculi. Since its description in the 1970s, 1 surgical and technological advances have obviated the need for routine nephrostomy tube placement.2-8 Tubeless PCNL, with ureteral stenting, has been shown to decrease patients' analgesic requirements and hospital length of stay.9,10 Although hospitalization is standard practice after PCNL, reports have described success with outpatient management. 11,12 This case report is the first to describe successful outpatient PCNL in a renal transplant patient. Case reportA 49-year-old female presented to her community hospital with hematuria and lower abdominal pain over the preceding 48 hours. She had received her second cadaveric kidney transplant 6 years previously for end-stage renal disease of unknown etiology. On presentation she was afebrile and hemodynamically stable. Urine was positive for blood, but negative for nitrites or pyuria. Creatinine was 164 μmol/L (estimated glomular filtration rate 29 mL/min/1.73m 2 ), slightly elevated from her baseline of 150 μmol/L. An ultrasound scan showed a large renal stone in the lower pole of the allograft kidney. Intravenous antibiotics were initiated and the patient was transferred to our tertiary care centre.At our institution, a computed tomography scan revealed a 14 × 12 × 11-mm stone located in the renal pelvis (Fig. 1a, Fig. 1b). There was mild hydronephrosis, yet the parenchyma of the graft was preserved. There was no evidence of a urinary tract infection (UTI)/sepsis and the patient's pain responded to oral analgesia. The surgical options were discussed and a decision was made to proceed with the PCNL. Informed consent was obtained and a 1-week course of levofloxacin was prescribed for UTI prophylaxis.On the morning of the procedure, a stress dose of 100 mg intravenous (IV) hydrocortisone was administered. Cefazolin 1 g IV was given prior to induction of general anesthesia. Flexible cystourethroscopy was performed and a 5Fr openended ureteral catheter was passed up the left transplanted ureteral orifice over a 0.035" guidewire. A Foley catheter was placed to straight drainage and the patient was repositioned supine for percutaneous access. Retrograde ureteropyelography outlined the allograft kidney's collecting system, demonstrating renal...

show abstract

“…3 Numerous studies have supported the use of the tubeless method as a viable alternative to standard PCNL. 1,[4][5][6][7] The advantages of tubeless PCNL over the standard procedure include reduced postoperative analgesic requirements, as well as reduced duration of hospitalization without an increase the rate of complications. Surgical advancements have enabled the use of tubeless PCNL in complex cases, including pediatric, geriatric and bilateral simultaneous renal calculi.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies to date have demonstrated that this is a safe and effective method of stone burden clearance in select patients. 1,[3][4][5][6][7] Recently, tubeless PCNL, on an outpatient basis, has been reported. 8,9 This case report is the first to describe a case of outpatient bilateral tubeless PCNL in a patient with bilateral large staghorn calculi.…”

Section: Introductionmentioning

confidence: 99%

Outpatient bilateral supracostal tubeless percutaneous nephrolithotomy for staghorn calculi

Kokorovic

Wilson

Beiko

2014

CUAJ

View full text Add to dashboard Cite

Percutaneous nephrolithotomy (PCNL) is the surgical procedure of choice to treat staghorn calculi. Most centres perform PCNL as the traditional inpatient procedure. However, outpatient PCNL has been successfully attempted and represents a feasible method of reducing hospital costs. We report the case of a 35-year-old female who underwent outpatient simultaneous PCNL for bilateral renal staghorn calculi. The patient was discharged in stable condition less than 3 hours following the procedure with minimal discomfort. To the best of our knowledge, this case report is the first to describe a successfully completed outpatient bilateral supracostal tubeless PCNL for staghorn calculi.

show abstract

A Randomized Controlled Trial of Nephrostomy Placement Versus Tubeless Percutaneous Nephrolithotomy

Cited by 77 publications

References 17 publications

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

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

Outpatient percutaneous nephrolithotomy in a renal transplant patient: World’s first case

Outpatient bilateral supracostal tubeless percutaneous nephrolithotomy for staghorn calculi

Contact Info

Product

Resources

About