One-stage tubeless percutaneous nephrolithotomy for asymptomatic calculous pyonephrosis

Abstract

Background In recent years, the safety and effectiveness of one-stage percutaneous nephrolithotomy (PCNL) for the treatment of calculous pyonephrosis have been proven. In order to further reduce postoperative pain and hospital stay, we first proposed and practiced the idea of one-stage tubeless percutaneous nephrolithotomy for calculous pyonephrosis. Methods A retrospective analysis was performed of case data of 30 patients with asymptomatic calculous pyonephrosis treated in our center with one-stage PCNL from January 2016 to January 2021. Patients were routinely given 20 mg of furosemide and 10 mg of dexamethasone sodium phosphate injection intravenously at the beginning of anesthesia. Among them, 27 patients successfully underwent one-stage tubeless percutaneous nephrolithotomy, while 3 cases were given indwelling nephrostomy tubes because of proposed second-stage surgery or the number of channels was greater than or equal to 3. All patients were operated on by the same surgeon. Results Preoperatively, 11 of 30 patients (8 men and 22 women) had positive urine bacterial cultures, and all were given appropriate antibiotics based on drug sensitivity tests. All patients completed the surgery successfully. The mean operative time was 66.6 ± 34.7 min, the mean estimated blood loss was 16.67 ± 14.34 mL and the mean postoperative hospital stay was 5.0 ± 3.1 days. The mean postoperative hospital stay was 4.6 ± 2.5 days among the 27 patients with one-stage tubeless percutaneous nephrolithotomy. Of the 3 patients with postoperative fever, 2 had the tubeless technique applied. One patient with 3 channels was given renal artery interventional embolization for control of postoperative bleeding. None of the 30 patients included in the study developed sepsis. The final stone-free rate was 93.3% (28/30) on repeat computed tomography at 1 month postoperatively. The final stone-free rate was 92.6% in the 27 patients undergoing one-stage tubeless percutaneous nephrolithotomy (25/27). Conclusions One-stage tubeless PCNL is an available and safe option in carefully evaluated and selected calculous pyonephrosis patients.

Construction of an alignment diagram model for predicting calculous obstructive pyonephrosis before PNL

“…Usually, patients with asymptomatic pyonephrosis do not present with fever, low back pain, or blood leucocytosis [ 9 ] until they are identified during the creation of a skin-to-renal channel during a PNL, at which point sepsis or even infectious shock may result if the PNL is continued [ 8 ]. Although it has been suggested that one-stage PNL is safe and effective in the treatment of calculous obstructive pyonephrosis after careful evaluation and screening [ 10 ], early prediction and diagnosis of pyonephrosis is the key to successful treatment, and drainage of pus through one-stage nephron puncture can improve the safety of two-stage PNL [ 11 , 12 ].…”

Percutaneous nephrolithotomy in patients with incidental encountered purulent urine at initial puncture

“…On the other hand, studies have challenged the practice of stopping PCNL for patients with purulent uid in the PCS, since not all are infected and fewer than half have organisms on the uid. Continuing PCNL may be an option (5,(12)(13)(14)(15)(16).…”

“…In some circumstances, however, surgeons could need second though about some patients who need to undergo PCNL and have some inexplicit risk factors, such as incidentally detected purulent uid during surgery while having sterile urine culture and no signs of infection. This is not an uncommon condition, and growing evidence shows that not all patients with purulent uid in the pelvicalyceal system are infected; fewer than half of the patients had organisms on purulent uid, and proceeding with PCNL in these patients is a feasible option (5,(12)(13)(14)(15)(16).…”