Tubeless per cutaneous nephrolithotomy: is it the present standard of care?

Abstract

INTRODUCTIONRenal calculi are the most common cause for pain in patients with urological problems and their recurrence rate is also very high to the tune of 70%.1 Various options are available for their treatment ranging from open surgery to extracorporeal shock wave lithotripsy (ESWL). For large stone burden, per cutaneous nephrolithotomy (PCNL) is the standard of care.2,3 Per cutaneous nephrolithotomy was first introduced by Fernstrom and Johansson and rapidly gained acceptance as the standard of care for removal of large and complex renal calculi. 4 Since then a lot of modifications have been introduced in the techniques and instrumentation of PCNL.In a standard PCNL, a 30Fr Amplatz sheath is placed after dilatation of the tract and calculi are retrieved after fragmentation. Either a double J (DJ) stent is placed or Ureteric catheter is retained. A nephrostomy tube is placed post procedure for haemostatic tamponade effect and to access the system in case of significant residual ABSTRACT Background: Since the time standard per cutaneous nephrolithotomy (PCNL) was introduced in 1976, it has undergone changes in techniques, instrumentation and post-operative management for better patient care. Standard PCNL involves placement of nephrostomy tube and DJ stent/ureteric catheter after stone retrieval. Now the trend is towards tubeless PCNL and totally tubeless PCNL as to minimize pain, infection and hospital stay. Our objective was to compare the outcome of standard PCNL with tubeless PCNL. Methods: This was a randomized study of patients who underwent standard PCNL and tubeless PCNL in our institute from August 2013 to August 2015 for renal calculi >2 cms. Patients with residual calculi needing further ancillary treatment and patients who had major collecting system tear were excluded from the study. A total of 257 patients who had undergone PCNL during the study period for renal calculi >2 cm were included in the study. 27 patients were excluded due to presence of residual calculi or major collecting system tear. Of these 115 underwent standard PCNL and remaining 115 tubeless PCNL. Post-operative visual analog pain score, need for analgesics, infection rate, post-operative hospital stay were analyzed. Results: No significant differences were noted in patient demographics, age, sex, stone size and stone burden. There were no significant complications seen in tubeless group as compared to standard PCNL group. Post-operative pain and hospital stay was significantly reduced in tubeless PCNL group. Conclusions: Tubeless PCNL is a relatively safe and effective modification of standard PCNL. It increases patient compliance of PCNL by reducing post-operative pain and early recovery.

Порівняльне Дослідження Результатів Лікування Пацієнтів З Сечокам’яною Хворобою: Нефростомний Дренаж Проти Бездренажної Перкутанної Нефролітотомії

“…Female patients in current study were significantly related to tubeless PCNL (p = 0.01). Men were predominant in renal calculi and for PCNL, in spite of that, Zehri et al [10] documented that female gender is risk factor for blood transfusion in PCNL which might influenced surgeons to select tubeless PCNL. Left sided stone was significantly related with tubeless PCNL; a finding that is similar to results of Khan et al [11] study in India.…”