A Randomized Comparison of Totally Tubeless and Standard Percutaneous Nephrolithotomy in Elderly Patients

Kara, Cengiz; Reşorlu, Berkan; Bayindir, Mirze; Ünsal, Ali

doi:10.1016/j.urology.2009.11.077

Cited by 61 publications

(54 citation statements)

References 23 publications

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“…This result is in agreement with that of the study by Istanbulluoglu et al, [2] who reported that the mean operative time for tubeless supine PCNL was 51.79±25.23 minutes, and the mean hospital stay was 2.09±1.75 days. Our results are also in agreement with the findings of Kara et al [10] who found that the mean operative time was (22-50 min). However, in the present study, the mean patient hospital stay (3.4±1.7) may be considered too long in comparison to that reported by Limb and Bellman, [5] who reported a mean of 1.25 days.…”

Section: Discussionsupporting

confidence: 93%

Tubeless PNL in the supine position

Wahab¹,

Sherif²,

El-Karamany³

2012

Turkish Journal of Urology

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Objective: To evaluate the safety, feasibility and efficacy of tubeless percutaneous nephrolithotomy (PNL) in a supine position in selected cases with renal stones. Materials and methods:This descriptive study enrolled 120 patients who presented to the urology department at Benha Faculty of Medicine with renal stones between June 2009 and June 2010. All patients were evaluated based on their history, a physical examination, kidney, ureter, bladder (KUB), pelviabdominal U/S and spiral CT of the abdomen and pelvis without contrast or IVP in selected cases. The patients were followed up for postoperative pain, leakage and fever. Perinephric collection with ultrasound (U/S) was performed, and the Hb% and hematocrit were determined after 12 hours. Results:The access to the stones was achieved through the lower calyx (70.8%) and middle calyx (29.2%) with a stone clearance rate of 100%, and there was no need for a 2nd session. The mean operative time was (67.1±19.2 min.), and the mean length of the hospital stay was (3.4±1.7 days). Three cases had perinephric collections <100 cc, which were managed conservatively and resolved within one week. Prolonged leakage occurred in three cases and also resolved spontaneously within five days. Three cases required a one-unit blood transfusion postoperatively. Stone-free status was achieved in all cases through the use of either the lower or middle calyx in the supine position during the operation. A single dose of non-steroidal antiinflammatory drugs (NSAID) was needed in 30 cases for postoperative analgesia. Conclusion:Tubeless PNL with the patients in the supine position can be used in selected cases with a favorable outcome and minimal morbidity with the potential advantage of deceases in the postoperative pain, analgesia requirement and hospital stay.Key words: Percutaneous nephrolithotomy; percutaneous nephrostomy; renal stones; tubeless PNL. ÖZETAmaç: Böbrek taşları olan seçilmiş olgularda sırt üstü pozisyonda tüpsüz PNL'nin güvenilirliği, uygulanabilirliği ve etkinliğini değerlendirmek. Gereç ve yöntem: Bu tanımlayıcı çalışmaya Haziran 2009-Haziran 2010 tarihleri arasındaki dönemdeBenha Tıp Fakültesi üroloji bölümüne böbrek taşı ile başvuran 120 hasta alındı. Hastaların tamamı öykü, fizik muayene, DÜS grafisi, pelviabdominal USG, abdomen ve pelvisin kontrastsız spiral BT'si veya seçilmiş olgularda IVP ile değerlendirildi. Hastalar ameliyat sonrası ağrı, sızıntı, ateş, USG ile perinefrik birikim açısından izlendi, %Hb ve hematokrit 12 saat sonra yapıldı. Bulgular: Taşa erişim alt kaliks (%70.8) ve orta kaliks (%29.2) yoluyla yapıldı, taş temizlenme oranı %100'dü. İkinci bir seansa gerek duyulmadı. Ortalama işlem süresi 67.1±19.2 ve ortalama hastanede kalış 3.4±1.7 idi. Üç olguda konservatif olarak tedavi edilen ve bir hafta içinde düzelen <100 cc perinefrik birikim vardı. Üç olguda uzamış sızıntı görüldü, bunlar da beş gün içinde kendiliğinden düzeldi. Üç olguda ameliyat sonrası bir ünite kan transfüzyonu gerekti. Bütün olgularda sırt üstü pozisyonunda alt veya orta...

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Section: Discussionsupporting

confidence: 93%

Tubeless PNL in the supine position

Wahab¹,

Sherif²,

El-Karamany³

2012

Turkish Journal of Urology

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“…Ancak multipl, böbrek alt polüne yerleşmiş veya sert yapıya sahip taşlarda (sistin, kalsiyum monohidrat) SWL'nin başarı oranı %50'ye kadar düşmektedir [2,3]. Bu tip taşlarda ve 20 mm'den daha büyük taşlarda PNL ilk tedavi seçeneği olarak önerilmekte ancak SWL ve üreteroskopik girişimlere göre daha yüksek morbiditeye sahiptir [4,5].…”

Section: Introductionunclassified

Our experiences on retrograde intrarenal surgery

Hatipoğlu¹

2014

Diclemedj

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Objective: To evaluate outcomes of the cases who had undergone retrograde intrarenal surgery (RIRS) in our clinics. Methods:Outcomes of 100 cases who had undergone RIRS because of renal stones between February 2012, and May 2013 were retrospectively evaluated.Results: Study population consisted of 35 female and 65 male patients with a mean age of 36.81(1-76) years. RIRS was performed with the indication of rest double J (D-J) stent (n=1), and renal stone (n=99). Mean stone size was 15.26 (5-27) mm. Preoperatively, 61 cases (61%) had preexisting D-J stents, while 39 (39%) cases were stentless. Access sheaths were used in 86 (86%) cases, while in 14 (14%) cases the procedure was applied without using an access sheath. Mean operative, and fluoroscopy times were 52.72 (10-120) minus, and 57.32 (10-180) seconds, respectively. Postoperatively D-J stents were implanted in 88 (88%) cases, and 12 (12%) cases were stent-free. Mean hospital time was 1.3 (1-7) days. After one month postoperatively, stone-free rate was achieved in 87 (87%) patients. Clinically insignificant residual stone fragments (CIRF) 6 (6%), and residual stones 7 (7%) were also detected. The latter group consisted of cases with horseshoe kidney (n=1), pelvic kidney (n=1), and kyphoscoliosis (n=1). Also in two case procedure was terminated prematurely, because of blurring of the vision secondary to bleeding. Apart from these patients, any preoperative complication did not develop. During follow-up period, urinary tract infection developed in 3 patients with resultant renal parenchymal damage in one patient. In one patient, D-J stent migrated into ureter. Conclusion:Retrograde intrarenal surgery is an effective and safe technique in the management of renal stones. İşlemlerin 86'sında (%86) üretral giriş kılıfı kullanılırken, 14'ünde (%14) ise işlem kılıfsız uygulandı. Ortalama operasyon süresi 52,72 (10-120) dakika, floroskopi süresi ise 57,32 (10-180) saniye olan işlemlerin, 88'inde (%88) operasyon sonrası D-J stent takılırken, 12 (%12)'sine ise takılmadı. Hastanede kalış süresi ortalama 1,3 (1-7) gün olan olguların, 1. ay kontrolerinde, 87 (%87)'inde taşsız-lık sağlanırken, 6'sında (%6) klinik önemsiz rezidüel taş (CIRF) ve 7'sinde (%7) de rest taş saptandı. Rest taş kalan olgulardan biri atnalı, biri pelvik böbrek, bir tanesi kifoskolyozlu, iki tanesi ise işlem sırasında kanama nedeniyle görüntünün bozulmasından dolayı işleme son verilen olgulardı. Bu hastalar dışında perop hiçbir hastada komplilkasyon gelişmedi. Takiplerde üç hastada üriner sistem infeksiyonu ve bir hastada ise D-J üretere migre olmuştu. Sonuç:Retrograd intrarenal cerrahi böbrek taşı tedavisinde etkili ve güvenli bir cerrahi tekniktir. Anahtar kelimeler:Böbrek taşı, retrograd intrarenal cerrahi, fleksibl üreteroskopi

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“…These authors claim that post-operative pain and hospital stay would be decreased with this technique, while blood loss would not change significantly (4). Safety and feasibility of this technique has been proved for elderly patients without major intraoperative bleeding (5,6). To the best of the author's knowledge, there is no controlled blind study comparing standard PCNL with tubeless PCNL.…”

Section: Introductionmentioning

confidence: 99%

Gradenigo’s Syndrome Without Facial Nerve Involvement in a Fourteen-Month-Old Girl

Nikkhah

2014

Jentashapir J Health Res

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Background: Percutaneous nephrolithotomy (PCNL) has been established as a minimally invasive treatment option for removal of kidney stones. The aim of this research was to compare complications and surgical outcomes of standard PCNL with tubeless PCNL. Methods: In this double-blind randomized controlled trial, 50 consecutive patients with kidney stone were randomly assigned to intervention and control groups. In the control group, a nephrostomy was placed at the end of PCNL and in the intervention group, nephrostomy was omitted. Incidence of fever, hospital stay, analgesic requirement, blood transfusion, urinary leakage, and patient's satisfaction were compared between the 2 groups. Results: Pain score was significantly lower in the tubeless group in comparison with the control group (P < 0.001). Analgesic use among patients of the tubeless PCNL group was significantly lower than the control group (P value < 0.02). Eight percent of the control group and 20% of the intervention group had a transient fever (P value < 0.05). Hemoglobin levels did not show any significant difference between the 2 groups (P value > 0.78). The number of patients with "low urine leakage" was significantly higher in the tubeless group than in the control group (P < 0.002). Hospital stay was significantly lower while patient satisfaction was significantly higher in patients, who underwent tubeless PCNL in comparison with the control group (P < 0.02). Conclusions:The evidence from this study provides some support for application of tubeless percutaneous nephrolithotomy for patients with renal stone, regardless of the stone size and type.

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A Randomized Comparison of Totally Tubeless and Standard Percutaneous Nephrolithotomy in Elderly Patients

Cited by 61 publications

References 23 publications

Tubeless PNL in the supine position

Tubeless PNL in the supine position

Our experiences on retrograde intrarenal surgery

Gradenigo’s Syndrome Without Facial Nerve Involvement in a Fourteen-Month-Old Girl

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