Case selection and implementation of tubeless percutaneous nephrolithotomy

Mao, Yun-Hua; Huang, C. H.; Li, Tengcheng; Li, Wen-Biao; Liu, Bolong; Luo, Yun; Chen, Xuelian; Zhan, Hong

doi:10.21037/tau-21-559

Cited by 5 publications

(4 citation statements)

References 24 publications

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“…Numerous studies have demonstrated that the tubeless PCNL (ureteral stent only) technique is being employed with increasing frequency. It has been reported to be both safe and effective, as well as associated with a shorter hospital stay and a reduced incidence of postoperative pain [ 6 , 22 , 23 ]. Nevertheless, completely tubeless PCNL technique (neither ureteral stent nor nephrostomy tube) is still challenging and must also be performed by experienced surgeons [ 7 , 24 – 26 ].…”

Section: Discussionmentioning

confidence: 99%

A randomized controlled study of ureteral stent extraction string on patient’s quality of life and stent-related complications after percutaneous nephrolithotomy in the prone position

Kong

Xing

et al. 2023

Urolithiasis

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To demonstrate the Tianjin Institute of Urology (TJIU) technique to place and remove the ureteral stent with extraction string after percutaneous nephrolithotomy (PCNL). Additionally, we aim to compare the pain experienced during stent removal, quality of life during stent retention, and stent-related complications between patients with and without extraction string. 65 patients were included in the final analysis in the string group constructed by the TJIU technique and 66 patients in the conventional double-J ureteral stent (non-string) group. All patients underwent the surgery in a prone position under general anesthesia. They completed the Ureteral Stent Symptom Questionnaire (USSQ) on postoperative days (POD) 7, as well as before their ureteral stent was removed. The visual analogue scale (VAS) pain score (0–10) was completed immediately after the removal of the ureteral stent. Moreover, a specialized person was responsible for recording stent-related complications. All patients completed the USSQ on POD 7, and we did not find a difference in scores in each field. However, there was a significant difference in the “sex” domain before removing the ureteral stent (4.34 vs 3.23; p = 0.01). Notably, the use of extraction string after PCNL could decrease the pain associated with stent removal significantly (mean VAS scores 1.45 vs 2.76; p < 0.01). Extraction string did not increase the incidence of stent-related complications. We concluded that placing a ureteral stent with an extraction string after PCNL reduces the pain of ureteral stent removal without increasing complications such as accidental removal of the stent, febrile urinary tract infection (UTI).

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Section: Discussionmentioning

confidence: 99%

A randomized controlled study of ureteral stent extraction string on patient’s quality of life and stent-related complications after percutaneous nephrolithotomy in the prone position

Kong

Xing

et al. 2023

Urolithiasis

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“…Related studies have shown that tubeless PCNL has been proven to be the safest and most effective compared to standard and totally tubeless PCNL [ 25 ]. Due to the absence of an indwelling nephrostomy tube, the VAS pain score in tubeless PCNL group was significantly lower than that in PCNL group [ 26 ]. It is also consistent with the results of this study.…”

Section: Discussionmentioning

confidence: 99%

Tubeless PCNL versus standard PCNL for the treatment of upper urinary tract stones: a propensity score matching analysis

Hao,

Shen,

Han

et al. 2023

Int Urol Nephrol

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Purpose In this study, the feasibility of tubeless percutaneous nephrolithotomy (PCNL) for the treatment of upper urinary tract stones was investigated. Methods From January 2021 to December 2022, the clinical data of 273 patients who received tubeless PCNL (Group A) were studied. The control group includes clinical data from 302 patients (from January 2019 to October 2022) who received standard PCNL (Group B). The baseline characteristics were consistent between the two groups after using the propensity score matching (PSM) method. Compare the preoperative clinical characteristics, postoperative complications, residual stones, catheterization time, and hospital stay between the two groups. Results 146 pairs of patients were successfully paired through PSM. There was no statistically significant difference in operative time, blood leukocyte counts, haemoglobin decrease, fever, urinary extravasation, sepsis, bleeding, blood transfusion rates, embolism, and residual stones after surgery between the two groups; Postoperative day 1 and discharge day, the VAS pain score in Group A was significantly lower than that in Group B. The catheterization time and hospitalization time of patients in Group A were significantly lower than those in Group B. Conclusion According to the inclusion and exclusion criteria, selecting suitable patients for tubeless PCNL is safe and effective, while significantly alleviating pain and reducing catheterization time and hospital stay.

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“…A study conducted by Xun et al [ 27 ] has demonstrated that tubeless PCNL was a feasible and effective choice for strictly selected patients, and its advantages include low postoperative pain, short postoperative hospitalization, and quick recovery. [ 28 ] For patients undergoing LIA, tubeless PCNL is suitable because of these advantages; however, these patients must be selected strictly. The criteria for tubeless PCNL under LIA in our study were similar to those used under general anesthesia, [ 7 ] and 10 patients underwent tubeless MPCNL in our study.…”

Section: Discussionmentioning

confidence: 99%

Chinese mini percutaneous nephrolithotomy for upper urinary calculi under local infiltration anesthesia

Zhang,

Li,

Xie

et al. 2023

Medicine

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Percutaneous nephrolithotomy is generally performed under general or regional anesthesia; however, it is rarely performed under local infiltration anesthesia (LIA). This study aimed to assess the safety and effectiveness of Chinese mini percutaneous nephrolithotomy (MPCNL) for upper urinary calculi under LIA. A retrospective analysis of 52 patients with upper urinary stones who underwent MPCNL under LIA from April 2019 to May 2022 was performed. Pethidine and Phenergan were intramuscularly injected 30 minutes preoperatively. Oxybuprocaine hydrochloride gel was applied to the urethra for lubricating and mucosal anesthesia. Ropivacaine hydrochloride and lidocaine were injected into the whole percutaneous channel for local anesthesia. An 8/9.8F ureteroscope and an 18F vacuum-assisted access sheath were applied in MPCNL. All 52 patients tolerated procedures and underwent operations successfully; none of them converted the anesthesia method or required additional analgesia. The mean visual analogue scale scores intraoperatively and at 6 hours, 24 hours, and 48 hours after surgery were 3.25 ± 0.52, 3.13 ± 0.69, 2.25 ± 0.56, and 1.58 ± 0.50, respectively. The stone free rate was 84.6%. Complications were seen in 6 (11.5%) patients, including fever in 2 patients (Clavien I), renal colic in 1 patient (Clavien I), clinically insignificant bleeding in 2 patients (Clavien I), and urinary tract infection in 1 patient (Clavien II). No severe complications were observed in any patients. Chinese MPCNL under LIA was a feasible option and achieved good outcomes in appropriately selected patients, and it may become the routine procedure for general patients.

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Case selection and implementation of tubeless percutaneous nephrolithotomy

Cited by 5 publications

References 24 publications

A randomized controlled study of ureteral stent extraction string on patient’s quality of life and stent-related complications after percutaneous nephrolithotomy in the prone position

A randomized controlled study of ureteral stent extraction string on patient’s quality of life and stent-related complications after percutaneous nephrolithotomy in the prone position

Tubeless PCNL versus standard PCNL for the treatment of upper urinary tract stones: a propensity score matching analysis

Chinese mini percutaneous nephrolithotomy for upper urinary calculi under local infiltration anesthesia

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