Safety and Efficacy of Tubeless Percutaneous Renal Surgery

Abou-Elela, Ashraf; Emran, Ashraf; Mohsen, Mostafa Abdel; Reyad, Ihab; Bedair, Ahmed Samy; Kader, Mongy Abdel

doi:10.1089/end.2006.0229

Cited by 16 publications

(9 citation statements)

References 12 publications

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“…The postoperative retrograde study revealed minor extravasation in 14 patients (12%) and significant extravasation in three (2.3%). 22 Our retrospective evaluation of a consecutive series of 101 PCNLs performed at our institution over a 4-year period illustrates that a 'nephrostomy-free' PCNL is a safe procedure that leads to a decreased length of hospital stay (2.8 days vs 5.1 days; P < 0.001) decreased pain for the patient and, therefore, a reduced need for morphine-based analgesia. Of the 'nephrostomy-free' group, 23% used no morphine-based analgesia at all, compared to only 2.5% of the standard PCNL group (P < 0.001).…”

Section: Discussionmentioning

confidence: 86%

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‘Nephrostomy-Free’ Percutaneous Nephrolithotomy: Experience in a UK District General Hospital

Yates

Safdar

Spencer

et al. 2009

annals

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INTRODUCTION Percutaneous nephrolithotomy (PCNL) is the first-line treatment for large and complex renal calculi. Accepted UK practice is to insert a nephrostomy tube at the end of the procedure to drain the kidney and reduce potential complications. ‘Tubeless’ or ‘nephrostomy-free’ PCNL has been advocated in selected patients as it is thought to reduce length of hospital stay, analgesia requirements and pain experienced. We present our outcomes of a consecutive series (n = 101) of ‘nephrostomy-free’ PCNLs compared to standard PCNL over a 4-year period. PATIENTS AND METHODS Between January 2004 and October 2006, we performed 55 standard (with nephrostomy tube) PCNLs (Group 1). From October 2006 onwards, we changed our technique and have performed 46 consecutive ‘nephrostomy-free’ PCNLs (JJ stent inserted), independent of patient and stone factors (Group 2). We have compared the two groups in terms of length of hospital stay (LOS), analgesia requirements, transfusion rates, haemoglobin (Hb) decrease and immediate, early and late complications. RESULTS ‘Nephrostomy-free’ PCNL significantly reduced the length of hospital stay (2.8 vs 5.1 days; P < 0.001), morphine-based analgesia requirements (23% no morphine required vs 2.8%; P < 0.001), transfusion rate (2.5% vs 7%; P < 0.01) and mean Hb decrease (1.89 g/dl vs 2.25 g/dl; P > 0.05). Overall, no patient experienced a serious complication. All attempted ‘nephrostomy-free’ PCNLs were completed (stone clearance 95%) and no patient needed an unplanned nephrostomy. Only 5% in Group 2 needed their ureteric JJ stent removing earlier than planned secondary to pain. Both groups were comparable in terms of immediate, early and late complications, though three patients in Group 1 developed chronic loin pain and one patient in the ‘nephrostomy-free’ group developed a delayed perirenal haematoma. CONCLUSIONS ‘Nephrostomy-free’ percutaneous nephrolithotomy is a safe, effective and feasible procedure independent of patient and stone factors. It decreases the length of hospital stay, the pain experienced and the need for morphine-based analgesia; we feel it should be the standard of care for patients undergoing a PCNL.

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Section: Discussionmentioning

confidence: 86%

“…The catheters were removed by postoperative day 1 in 91% of patients. 21 Abou-Elela et al 22 performed 128 'tubeless' PCNLs with an external ureteric catheter. They had to convert 18 to 'tubed' PCNLs at the time of surgery.…”

Section: Discussionmentioning

confidence: 99%

‘Nephrostomy-Free’ Percutaneous Nephrolithotomy: Experience in a UK District General Hospital

Yates

Safdar

Spencer

et al. 2009

annals

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“…On the contrary, they observed the advantages of decreased postoperative pain and discomfort, the need for analgesia, and a decrease in hospital stay [6][7][8]10] and cost [16]. However, the drawback was the need for re-cystoscopy, which is more invasive and may need general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…Bellman and associates challenged the requirement for the routine placement of a nephrostomy tube after PNL and were the first to use the term tubeless PNL [5]. Since then there have been increased reports of tubeless PNL utilization [6][7][8][9][10][11]. In this study we present our experience with tubeless PNL, with very limited exclusion criteria as part of the new era of percutaneous renal surgery.…”

Section: Introductionmentioning

confidence: 99%

The Era of Tubeless Percutaneous Nephrolithotomy

Al-Ba’adani¹,

Telha²,

Al-Gormozi³

et al. 2012

UIJ

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Objective: To prescribe our experience in performing tubeless percutaneous nephrolithotomy and how we diagnose its indication, safety, and effectiveness. Methods: Two hundred and fifty-three patients with renal stones were enrolled for a tubeless percutaneous nephrolithotomy with an externalized ureteric catheter. Their ages ranged between 4 to 80 years old, and of the sample, 168 were male and 85 were female. The stones ranged from 15 to 80 mm in size and were located in different areas of the pelvicalyceal system. The majority of the procedures were conducted in the prone position while 24 cases were supine. The majority of the patients were treated with a single puncture, 20 patients were treated with double punctures, and 2 patients required 3 punctures. Hemostatic substances were used in only 50 of the patients, with no significant differences when compared to 50 who were treated without. In addition, 40 patients had a history of previous ipsilateral renal surgery, 20 had renal impairments, and 15 had a solitary kidney. Results: The mean operative time was 44.34 minutes, the mean stent time was 1.1 days, and the mean hospital stay was 1.6 days. The mean drop in Hb levels was 1.67gm/dl, with 3.95% of the patients needing blood transfusions and 12.65% needing postoperative analgesia. The stone-free rate was 91.76% while the overall success rate was 97.25%. Complications were encountered in 7.9% of the patients, most of which were minor and were managed conservatively. One patient suffered from a colonic injury and 2 patients suffered from hydrothorax. Conclusion: In the era of tubeless percutaneous nephrolithotomy, nephrostomy tube insertion should only be used for large residuals that need a second look. Tubeless percutaneous nephrolithotomy should be extended to include large stones, multiple numbers, multiple punctures, prone or supine positions, sub-or supracostal approaches, recurrent cases, solitary kidneys, renal impairment, extended time, and bilateral simultaneous cases. It's safe and effective, and it decreases postoperative pain, discomfort, the need for analgesia, and the length of hospital stay.

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“…Similar results were reported by Ashraf Abou-Elela et al . [37] in 128 patients and Gupta et al . [38] in a study of 69 patients [Table 1].…”

Section: Percutaneous Nephrolithotomy With An Externalized Ureteral Cmentioning

confidence: 99%

Tubeless percutaneous nephrolithotomy

Agrawal

2010

Indian J Urol

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Introduction and Objective:Placement of a percutaneous nephrostomy tube for drainage has been an integral part of the standard percutaneous nephrolithotomy (PCNL) procedure. However, in recent years, the procedure has been modified to what has been called ‘tubeless’ PCNL, in which nephrostomy tube is replaced with internal drainage provided by a double-J stent or a ureteral catheter. The objective of this article is to review the evidence-based literature on ‘nephrostomy-free’ or ‘tubeless’ PCNL to compare the safety, effectiveness, feasibility, and advantages of tubeless PCNL over standard PCNL.Materials and Methods: We performed a MEDLINE database search to retrieve all published articles relating to ‘tubeless’ PCNL. Cross-references from retrieved articles as well as articles from urology journals not indexed in MEDLINE, were also retrieved.Results: The majority of the studies have shown ‘tubeless’ PCNL to be a safe and economical procedure, with reduced postoperative pain and morbidity and shorter hospital stay. tubeless PCNL has been found to be safe and effective even in patients with multiple stones, complex staghorn stones, concurrent ureteropelvic junction obstruction, and various degrees of hydronephrosis. The technique has been successful in obese patients, children, and in patients with recurrent stones after open surgery.Conclusion: Tubeless PCNL can be used with a favorable outcome in selected patients (stone burden <3 cm, single tract access, no significant residual stones, no significant perforation, minimal bleeding, and no requirement for a secondary procedure), with the potential advantages of decreased postoperative pain, analgesia requirement, and hospital stay. However, for extended indications, like supine PCNL, multiple, complex and staghorn stones, and concurrent PUJ obstruction, the evidence is insufficient and should come from prospective randomized trials.

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Safety and Efficacy of Tubeless Percutaneous Renal Surgery

Abstract: Tubeless percutaneous renal surgery with an externalized ureteral catheter is a safe procedure that is suitable for any patient who can be rendered stone free with a single procedure regardless of the initial stone burden.

Cited by 16 publications

References 12 publications

‘Nephrostomy-Free’ Percutaneous Nephrolithotomy: Experience in a UK District General Hospital

‘Nephrostomy-Free’ Percutaneous Nephrolithotomy: Experience in a UK District General Hospital

The Era of Tubeless Percutaneous Nephrolithotomy

Tubeless percutaneous nephrolithotomy

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