Tubeless procedure reduces hospitalization and pain after percutaneous nephrolithotomy: results of a multivariable analysis

Abstract

The objective of the study was to assess the efficacy and safety of tubeless percutaneous nephrolithotomy (t-PCNL) in comparison with standard PCNL (s-PCNL). We retrospectively evaluated 317 consecutive PCNL and compared perioperative results, time of hospitalization and analgesic requirement of t-PCNL (114; 36.0 %) to s-PCNL (203; 64.0 %). The decision to perform a tubeless PCNL was made at the end of the procedures depending on the surgeon's preference and according to the following inclusion criteria: (a) no serious bleeding or perforation in the collecting system during the procedure; (b) patients with no more than one access; and (c) residual stone burden needing a second-stage nephroscopy. Staghorn stones and anatomic anomalies were not considered as exclusion criteria for t-PCNL. Univariate analyses were conducted with one-way ANOVA, Fisher's exact test, Pearson's Chi-square and linear-by-linear association test as appropriate. Stepwise multivariable regression analyses were used to assess the independent correlation between demographics and clinical variables and the clinical outcomes. There were no significant differences between the two groups in terms of stone-free rate, hemoglobin decrease, blood transfusion and complication rate. Mean hospital stay was significantly shorter in the t-PCNL group (3.3 vs. 4.6 days; P < 0.001). Tubeless PCNL was associated with less analgesia requirement (68.4 vs. 86.7 %; P < 0.001) and with lower analgesic dose requirement (1.6 vs. 2.1 mean doses; P = 0.010). Multivariable analyses showed that t-PCNL (P < 0.001), postoperative fever (P < 0.001), transfusions (P < 0.001), operative time (P = 0.002), postoperative hydronephrosis (P = 0.005) and residual fragment dimension (P = 0.024) were independently correlated with duration of hospitalization, while analgesic dose requirement was independently influenced by hemoglobin decrease (P < 0.001), t-PCNL (P = 0.005) and stone number (P = 0.044). Our study confirmed that t-PCNL has similar outcomes to s-PCNL in terms of stone-free rate without increasing complications in selected cases. t-PCNL is a factor independently associated with shorter hospitalization and lower analgesic requirement.

Minimally invasive surgical treatment for large impacted upper ureteral stones: Ureteroscopic lithotripsy or percutaneous nephrolithotomy?

“…16 In our study, we performed tubeless PCNL in 17 patients. Of these patients, 4 had a double-J stent insertion, 7 a ureteral catheter insertaion and the remaining 6 were totally tubeless.…”

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

“…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.…”

“…[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.…”

Outpatient bilateral supracostal tubeless percutaneous nephrolithotomy for staghorn calculi

“…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.…”

“…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.…”