Nephrostomy Tube after Percutaneous Nephrolithotomy: Large-Bore or Pigtail Catheter?

Maheshwari, Pankaj N; Andankar, Mukund; Bansal, Manish

doi:10.1089/end.2000.14.735

Cited by 95 publications

(39 citation statements)

References 6 publications

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“…[18,19] In contrast, in a prospective study, Maheshwari and coworkers demonstrated no significant increase in the postoperative bleeding in 20 patients who underwent a one-stage tubeless PCNL. [20] In the present study, 3 of 120 cases (2.5%) developed perinephric collection ranging from 50-100 cc. These cases were managed conservatively, and the collections resolved spontaneously within one week.…”

Section: Discussionsupporting

confidence: 42%

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: 42%

Tubeless PNL in the supine position

Wahab¹,

Sherif²,

El-Karamany³

2012

Turkish Journal of Urology

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“…In our patients we didn't see any child needing renal arterial embolisation or nephrectomy for postoperative bleeding. Maheshwari et al [22] performed a prospective study on 40 patients who had undergone either 28 F nephrostomy tube or 9 Fr pigtail catheter insertions at the end of the PCNLs. They reported relatively shorter duration of the urinary leakage and hospital stay, with reduced pain and lesser need for analgesia in pigtail nephrostomy group.…”

Section: Discussionmentioning

confidence: 99%

Comparison of outcomes of tubed versus tubeless percutaneous nephrolithotomy in children: A single center study

Iqbal¹,

Assad²,

Hussain³

et al. 2018

Turkish Journal of Urology

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Objective: To evaluate and compare the effectiveness of tubeless percutaneous nephrolithotomy (PCNL) and tubed PCNL by using small bore nephrostomy tube (12Fr) in children for the management of nephrolithiasis. Material and methods:This study was a retrospective analysis of 35 children where tubed PCNL (Group 1) was done in 18, and tubeless PCNL (group 2) in 17 patients from January 2010 to December 2016. Charts were reviewed for age, mass, stone size, operative time, hospital stay and stone-free rates.These variables were compared between the two groups. SPSS version 21 was used for data analysis. The data were shown as mean±standard deviation for continuous variables.Categorical variables were presented in percentages.Results: There is no difference in terms of age, stone sizes, operative times, hospital stays, stone-free rates and post-PCNL complications between the two groups (p>0.05). The mean drop in hemoglobin level was 0.7±0.1 g/dL and 1.3±0.2 g/dL in Groups 1 and 2, respectively (p= 0.01). Conclusion:Tubeless PCNL in children is a safe option in well selected cases.

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“…On the other hand, a nephrostomy tube was associated with patients' discomfort and prolonged hospital stay. These were the main reasons to use a small nephrostomy tube or to omit the placement of it in the so called ''tubeless'' PCNL [6,7]. We think that the term ''tubeless'' is misleading because in many series the kidney was drained with either internalized or externalized ureteral stents [7,17].…”

Section: Discussionmentioning

confidence: 99%

“…However, the nephrostomy tube was associated with patients' discomfort and prolonged hospital stay. Therefore, the large sized tube of 16-22 French (F) was replaced with smaller tubes (8-9 F) [5,6].…”

Section: Introductionmentioning

confidence: 99%

Percutaneous nephrolithotomy: keeping the bridge for one night

El-Nahas

Shokeir

2011

Urol Res

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This study was conducted to compare nephrostomy-free percutaneous nephrolithotomy (PCNL) with early nephrostomy tube removal (after 1 day). A prospective study started from January 2008 through December 2009 and included patients who underwent non-complicated PCNL through a single tract without intra-operative residual stones. Nephrostomy-free technique was performed during 2008 (nephrostomy-free group). During 2009, a nephrostomy tube was placed for 1 day (1-day nephrostomy group). Both groups were compared for post-operative events, dose of analgesia, hemoglobin deficit and hospital stay. The study included 55 patients (27 in nephrostomy-free group and 28 in 1-day nephrostomy group). There were no statistically significant differences between patients, renal and stone characteristics of both groups. Post-operative events were significantly more in nephrostomy-free group (26 vs. 14.3%, p = 0.039). They include hematuria in three (11.1%) of nephrostomy-free patients and one (3.6%) of 1-day nephrostomy patient, severe renal colic in four patients of nephrostomy-free group (14.8%), and temporary urinary leakage via the nephrostomy site in three patients of 1-day nephrostomy group (10.7%). Mean dose of post-operative analgesia, mean hemoglobin deficit and hospital days were comparable for both groups (p = 0.946, 0.541, 0.807, respectively). A second look PCNL was performed through the already present tract to retrieve residual stones in two patients with nephrostomy. In conclusion, 1-day nephrostomy technique after PCNL showed significantly better post-operative course. It was comparable to nephrostomy-free technique in analgesic requirements and hospital stay. The nephrostomy tube provided a bridge for second look nephroscopy.

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Nephrostomy Tube after Percutaneous Nephrolithotomy: Large-Bore or Pigtail Catheter?

Cited by 95 publications

References 6 publications

Tubeless PNL in the supine position

Tubeless PNL in the supine position

Comparison of outcomes of tubed versus tubeless percutaneous nephrolithotomy in children: A single center study

Percutaneous nephrolithotomy: keeping the bridge for one night

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