Randomized prospective evaluation of nephrostomy tube configuration: impact on postoperative pain

Weiland, Derek; Anderson, J. Kyle; Best, Sara L.; Lee, Courtney; Hendlin, Kari; Kim, Johnstone; Monga, Manoj

doi:10.1590/s1677-55382007000300003

Cited by 9 publications

(4 citation statements)

References 11 publications

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“…Factors Affecting Post Nephrostomy Removal Urinary Leakage after Percutaneous Nephrolithotomy (PCNL) Karwan Asaad Othman post-surgery pain and morbidity such as urinary leakage and blood loss [9]. The size of the nephrostomy catheter may also be associated with post-operative discomfort [12]. As discussed by Lee et al, PCNL involves many complications such as bleeding may need a blood transfusion, leakage of urine, urinary tract infection (UTI), fever, prolonged leakage of urine from the flank in fifty percent of the patients [10].…”

Section: Discussionmentioning

confidence: 99%

Factors Affecting Post Nephrostomy Removal Urinary Leakage after Percutaneous Nephrolithotomy (PCNL)

Othman¹,

Gazala²,

Jawad³

2020

DJM

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Background: Prolonged urinary leakage after nephrostomy tube removal leads to increased morbidity of PCNL and increased hospitalization. Objective: To evaluate factors affecting post nephrostomy removal urinary leakage after percutaneous nephrolithotomy. Patients and Methods: One hundred eight (108) patients older than 18 years who underwent PCNL were studied prospectively. The reasons that can affect urinary leakage postoperatively were divided into 4 categories according to individual factors including age, gender, and body mass index; Renal factors; including, previous operation, history of ESWL, parenchymal cortical thickness, and grades of hydronephrosis; stone factor (stone burden); and surgical factors including the number of tracts, presence of double J stent, nephrostomy tube diameter and stay duration. These data were compared for postoperative urine leak. Results: Urinary leakage was revealed in 76 of 108 patients (70.3%). There was no statistically significant relationship between individual factors and urinary leakage (P >0.05). Among renal factors, just parenchymal cortical thickness and grade of hydronephrosis were strongly related to the urinary leakage (P <0.001). The renal stone burden did not affect urinary leakage (P >0.05). Among surgical factors, placing of ureteral double-J stent highly minimized the incidence of urinary leakage (P<0.001), and the urinary leakage significantly correlated with the increased diameter of the nephrostomy tube and staying duration (P<0.05). Conclusion: After PCNL surgery, some factors show to influence post-PCNL urinary leakage. however most of the urinary leakage was treated conservatively, but it increases morbidity and hospitalization. Keywords: Percutaneous nephrolithotomy; postsurgical complications; risk-factor; leaking of urine

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Section: Discussionmentioning

confidence: 99%

Factors Affecting Post Nephrostomy Removal Urinary Leakage after Percutaneous Nephrolithotomy (PCNL)

Othman¹,

Gazala²,

Jawad³

2020

DJM

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“…On the other hand, PCNL is highly efficacious in treating patients with stones of >2cms in size, multiple calculi, and staghorn calculi ( 12 ). PCNL can achieve high stone-free rates as compared to shockwave lithotripsy and has significantly lower morbidity as opposed to open surgery ( 13 ). However, it is unclear if PCNL has similar efficacy and safety in obese patients as compared to normal body mass index (BMI) patients.…”

Section: Introductionmentioning

confidence: 99%

Effect of Body Mass Index on Outcomes of Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

Huang

2022

Front. Surg.

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ObjectiveThe current study aimed to assess the efficacy and safety of percutaneous nephrolithotomy (PCNL) in obese and overweight individuals based on body mass index (BMI).MethodsWe electronically explored the databases of PubMed, CENTRAL, ScienceDirect, Embase, and Google Scholar databases for all types of comparative studies investigating the role of BMI on PCNL outcomes. Only studies defining obesity as >30 kg/m2 were included. Efficacy outcomes were stone-free rates and operating time while safety outcomes were complications and length of hospital stay (LOS).ResultsEighteen studies with 101,363 patients were included. We noted no difference in the stone-free rates after PCNL for morbid obese vs normal BMI patients (OR: 0.78 95% CI, 0.57, 1.08 I2 = 7% p = 0.13), overweight vs normal (OR: 1.01 95% CI, 0.89, 1.15 I2 = 1% p = 0.83) and obese vs normal patients (OR: 1.00 95% CI, 0.87, 1.16 I2 = 0% p = 0.95). PCNL operative time was significantly increased in morbid obese (MD: 9.36 95% CI, 2.85, 15.88 I2 = 76% p = 0.005) and obese patients as compared with normal patients (MD: 2.15 95% CI, 1.20, 3.10 I2 = 0% p < 0.00001), but not for overweight patients. There was no difference in the odds of complications between morbid obese vs normal (OR: 1.26 95% CI, 0.93, 1.72 I2 = 0% p = 0.13), overweight vs normal (OR: 1.11 95% CI, 0.96, 1.28 I2 = 0% p = 0.15), and obese vs normal patients (OR: 1.07 95% CI, 0.91, 1.27 I2 = 0% p = 0.40). LOS was significantly reduced in obese patients (MD: −0.12 95% CI, −0.20, −0.04 I2 = 0% p = 0.004) as compared to normal patients, but not for morbid obese or overweight patients.ConclusionPCNL has similar efficacy and safety in morbidly obese, obese, and overweight patients as compared to normal BMI patients with no difference in the stone-free and complication rates. Evidence suggests that operating time is increased in morbidly obese and obese patients and the latter may have shorter LOS.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier: CRD42022313599.

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“…Percutaneous nephrolithotomy (PCNL) is a minimally invasive endourological procedure used to manage patients with large, multiple, and staghorn renal calculi (1). The procedure has a higher stone clearance rate as compared to extracorporeal shockwave lithotripsy, with significantly less morbidity as opposed to open surgery (2). However, significant post-operative pain can occur with PCNL in the first 24 h along the nephrostomy tract or due to dilatation of the renal capsule and parenchyma.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Intercostal Nerve Block for Pain Control After Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

Chen

Zhu

2021

Front. Surg.

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Background: We aimed to assess the efficacy of intercostal nerve block (ICNB) for pain relief after percutaneous nephrolithotomy (PCNL).Methods: An electronic search of the databases of PubMed, Science Direct, BioMed Central, CENTRAL, Embase, and Google Scholar was conducted. All types of studies conducted on adult patients undergoing PCNL, comparing ICNB with control or any other anesthetic method, and reporting postoperative pain outcomes were included.Results: Six studies were included. Studies compared ICNB with peritubal (PT) infiltration and with control. Pooled analysis of ICNB vs. PT infiltration indicated no difference between the two groups for pain scores at 6–8 h (MD −0.44; 95% CI −3.41, 2.53; I2 = 99%; p = 0.77), 12 h (MD −0.98; 95% CI −4.90, 2.94; I2 = 99%; p = 0.62) and 24 h (MD 0.16; 95% CI −0.90, 1.21; I2 = 88%; p = 0.77). Time for first analgesic demand was also not significantly different between the two groups. Meta-analysis of ICNB vs. control indicated statistical significant difference in pain scores between the two groups at 8 h (MD −1.55; 95% CI −2.60, −0.50; I2 = 47%; p = 0.04), 12 h (SMD −2.49; 95% CI −4.84, −0.13; I2 = 96%; p = 0.04) and 24 h (SMD −1.22; 95% CI −2.12, −0.32; I2 = 88%; p = 0.008). The total analgesic requirement in morphine equivalents was not significantly different between the two groups.Conclusions: ICNB may be effective in reducing postoperative pain after PCNL. However, its efficacy may not be greater than PT infiltration. Current evidence is from a limited number of studies. Further, high-quality randomized controlled trials are needed to provide robust evidence.

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Randomized prospective evaluation of nephrostomy tube configuration: impact on postoperative pain

Cited by 9 publications

References 11 publications

Factors Affecting Post Nephrostomy Removal Urinary Leakage after Percutaneous Nephrolithotomy (PCNL)

Factors Affecting Post Nephrostomy Removal Urinary Leakage after Percutaneous Nephrolithotomy (PCNL)

Effect of Body Mass Index on Outcomes of Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

Efficacy of Intercostal Nerve Block for Pain Control After Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

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