Tubeless simultaneous bilateral percutaneous nephrolithotomy: Safety, feasibility and efficacy in an Indian setting

Abstract

Abbreviations & AcronymsObjectives: To study the safety, feasibility and efficacy of tubeless simultaneous bilateral percutaneous nephrolithotomy. Methods: We retrospectively studied 85 patients who underwent tubeless simultaneous bilateral percutaneous nephrolithotomy in the Department of Urology, Kasturba Medical College, Manipal, Karnataka, India, from July 2006 to June 2013. The demographic profile and outcomes were compared with the other existing series reported in the literature. Results: A total of 65 male and 20 female patients with a mean age of 45.7 ± 11.6 years underwent tubeless simultaneous bilateral percutaneous nephrolithotomy. The mean stone burden was 299 mm 2 , with 12 staghorn calculi. Mean operative time was 87.6 ± 35.5 min. A total of 95% of stones were cleared with single access tracts. The success rate of tubeless simultaneous bilateral percutaneous nephrolithotomy (stone clearance) was 95.2%. Mean hemoglobin drop was 1.1 ± 0.9 gm% per patient, with 10.5% of patients requiring blood transfusion. Mean hospital stay was 69.6 ± 28.4 h. Complications included urosepsis (Clavien grade 4), acute kidney injury requiring hemodialysis (grade 3), pneumonia (grade = 2) and hydrothorax requiring intercostal drainage tube insertion (grade 3). On follow up, 4.7% of the renal units required ancillary procedures. Conclusions: Our findings confirm that tubeless simultaneous bilateral percutaneous nephrolithotomy is a safe and effective modality of treatment. It allows obviating a second anesthetic exposure, thus reducing analgesic requirement, hospitalization time and costs. This translates into a significant socioeconomic impact on the outlook of Indian patients presenting with bilateral renal stone disease.

Simultaneous ureteroscopic lithotripsy and contralateral percutaneous nephrolithotomy for ureteral calculi combined with renal staghorn calculi

“…However, it must be that the hospital stay is discrepant in different medical centers and that patients experience different simultaneous procedures. 14,20,21 The present results showed that the costs of patients in the simultaneous group were apparently fewer than that in the staged group, and patients could save approximately CNY 7000. It was amazing that the costs of patients were only closely related to total operation time and total postoperative hospital stay according to the univariate and multivariate analyses, rather than different procedures.…”

“…In contrast, patients had to stay longer in the hospital because of fever. However, it must be that the hospital stay is discrepant in different medical centers and that patients experience different simultaneous procedures …”

Editorial Comment from Dr Karatag et al. to Tubeless simultaneous bilateral percutaneous nephrolithotomy: Safety, feasibility and efficacy in an Indian setting

“…1,2 The authors' study presents a retrospective analysis of tubeless simultaneous bilateral percutaneous nephrolithotomy (SBPCNL) in their institution to determine safety, feasibility and efficacy. 3 Although several reports have been published previously, we should state that the present study consisted of a large number of patients, which could provide a significant contribution to this issue. 4,5 The present study also confirms the safety and feasibility of tubeless management of PNL, even in bilateral cases.…”

Response to Editorial Comments to Tubeless simultaneous bilateral percutaneous nephrolithotomy: Safety, feasibility and efficacy in an Indian setting

“…On initial assessment at the time of surgery, it was assumed that complete stone clearance was achieved, and hence no nephrostomy was left in situ . The detailed information about supracostal interventions is that “ A total of 14 punctures were supracostal, with five in the 10th to 11th ICS and nine in 11th–12th ICS .” The mentioned line has been taken from the manuscript in the Results section, line 12–14 . No more details were available to compare between the two subgroups, as they were a small subset of patients of whom three required intercostal drainage postoperatively.…”