Does Previous Open Nephrolithotomy Affect the Efficacy and Safety of Tubeless Percutaneous Nephrolithotomy?

Abstract

Introduction: Tubeless percutaneous nephrolithotomy (PCNL) in selected patients is effective and results in less postoperative discomfort without increasing complications. The challenges of PCNL in patients who had a history of open nephrolithotomy are decreased kidney mobility due to scarring around the kidney and distortion of the renal collecting system, conditions that may cause difficulty of tract access and increase retained stone and hemorrhagic complications. We compared the efficacy and safety of the tubeless versus the standard PCNL in patients who had undergone previous open nephrolithotomy. Patients and Methods: Percutaneous nephrolithotomy (PCNL) was performed in 104 patients who had a history of previous open nephrolithotomy, of which 45 received tubeless PCNL (group I) and 59 received standard PCNL with routine postoperative nephrostomy tubes (group II). All patients had only one percutaneous renal access and showed no significant bleeding, extravasation or residual stone. Of group I, PCNL was done by the standard technique with only placement of a postoperative external ureteral catheter for 48 h. The success rate, operative time, hospital stay and complications were compared between the two groups. Results: Patient’s demographic data were not different between both groups. Infundibular stenosis and ureteropelvic junction obstruction were found in 2 and 4 cases of groups I and II, respectively. The success rates, operative time and complication rates were not significantly different between both groups. Hospital stay was 3.53 and 5.39 days for groups I and II, respectively, which was significantly different. Average analgesic (meperidine) usage was significantly less in the tubeless group (39 ± 35 mg for group I and 75 ± 32 mg for group II). Conclusion: Tubeless PCNL in selected patients with previous open nephrolithotomy has a safe and effective advantage compared to standard PCNL as indicated by a decrease in length of hospital stay and analgesic usage.

Tubeless vs standard percutaneous nephrolithotomy: a meta‐analysis

“…After further screening of full text, we excluded 13 articles because of lack of basic data or disagreement of outcome measures. Finally, seven studies were included in the meta‐analysis [3–9], published between 2006 and 2010.…”

“…Table 1 [3–9] shows the quality of the included RCT studies as assessed by the Jadad scale. None of the included studies described the randomization method or allocation concealment, only one was a blind study, and descriptions of double‐blind methods were unavailable in four studies.…”

“…Table 2 [1–7] shows the baseline characteristics of the patients in each study group included in our meta‐analysis.…”

Does previous open renal surgery or percutaneous nephrolithotomy affect the outcomes and complications of percutaneous nephrolithotomy

“…Both open surgery and PNL leads to perinephric scar and complicate introduction of needle into desired calyx and adequate tract dilatation [12]. Although, PNL is accepted with lesser scaring in perinephritic area, it should be in mind, in majority case, preferred access location used in second PNL is the same with first PNL.…”

PCNL - a comparative study in nonoperated and in previously operated (open nephrolithotomy/pyelolithotomy) patients - a single-surgeon experience

“…In these cases intraoperative manipulation of nephroscope may torque the kidney and cause laceration with bleeding (14,16). Also, this hampers access to the intrarenal calyces affecting the overall clearance (8).…”