Comparison one-step procedure with two-step procedure in percutaneous nephrolithotomy

Abstract

The aim of this study was to compare the effects of one-step percutaneous nephrolithotomy (PCNL) by the urologist alone and two-step PCNL by cooperating with the radiologist. We included 168 patients who underwent surgery by the same surgeon, 83 who underwent two-step PCNL, in which percutaneous nephrostomy insertion was performed by the radiologists on the day before endo-surgery, and 85 who underwent one-step PCNL, which involved the creation of a nephrostomy tract and performing the PCNL at the same time in the operating room, by a urologist. We compared the perioperative and postoperative parameters between these two groups. The result revealed that there were no significant differences between one-step and two-step PCNL in the decreases in haemoglobin level and blood transfusion volume, and the hospital stay was shorter in the one-step PCNL group. In addition, the one-step PCNL group was associated with significantly lower visual analogue score (VAS), which were 2.3, 1.1, and 0.4 on the post-operative days 1, 2, and 3, respectively, compared with 3.2, 1.7, and 1.0 in the two-step PCNL group. The number of parenteral analgesic prescriptions was fewer in the one-step PCNL group (0.8 ± 1.1 amps/vials) than in the two-step PCNL group (4.1 ± 2.4 amps/vials). Furthermore, different stone locations barely affected VAS and analgesic administrations. The results indicate that the one-step PCNL by the urologist alone, compared to two-step PCNL with the radiologist, has better wound pain outcome and shorter hospital stay with comparable successful rate and complication grade.

Emergency Placed Percutaneous Nephrostomy Catheter Provides Safe and Effective Access for Future Percutaneous Nephrolithotomy Operation

“…The authors interpreted this as the use of antibiotics appropriate to the culture obtained from the preoperative nephrostomy (5). In contrast, in the study by Chen et al, the presence of preoperative PCN did not significantly contribute to a reduction in operative time (6).…”

“…There are studies in the literature comparing data from patients who had a PCN catheter placed prior to PNL surgery with patients who had renal access during surgery. The availability of a PCN catheter preoperatively may have some advantages, but it may not always be possible to use this tract for renal access (4)(5)(6). A limited number of studies have investigated the availability of renal access in patients with previous PCN catheter placement in emergency situations (7)(8)(9).…”

Application of Machine-Learning Models in Predicting Transfusion Among Complex Renal Stones Patients Receiving Percutaneous Nephrolithotomy：A Retrospective Study

“…It is recommended that a standard channel for PCNL is established through the "two-step method", but there are disadvantages to this strategy [31].To overcome these shortcomings and reduce complications, urological surgeons frequently use a modi ed method, such as one-shot dilation and serial dilation [32].Moreover, Manuel et al reported that ultrasonography-guided dilatation can be safely performed with a high puncture accuracy and low bleeding risk [33]. In our previous study, we found that MARS signi cantly reduce bleeding compared to ultrasound-guided direct puncture, and here we also found that the accuracy of puncture method was a signi cant independent predictor of bleed during or following PCNL as previous studies mentioned [34].…”