Systematic Review and Meta-Analysis of Nephrostomy Placement Versus Tubeless Percutaneous Nephrolithotomy

Borges, Carlos Nazareno Ferreira; Fregonesi, Adriano; Silva, Daniel Carlos; Sasse, André Deeke

doi:10.1089/end.2010.0231

Cited by 44 publications

(31 citation statements)

References 26 publications

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“…Borges CF et al performed a systematic review with meta-analysis to compare tubeless versus conventional PCNL. Meta-analysis of data showed a benefit of shorter hospitalization time in tubeless PCNL group than conventional group (Mean difference: −1.11; CI 95% = −1.55 to −0.68; P<0.00001) [35]. However, tubeless PCNL was indicated in patients with mild-to-moderate stone burden, no perioperative complication, no residual stones needing auxiliary procedures, or depending on surgeon’s experience [31].…”

Section: Discussionmentioning

confidence: 99%

Chinese Minimally Invasive Percutaneous Nephrolithotomy for Intrarenal Stones in Patients with Solitary Kidney: A Single-Center Experience

Huang

Zhong

et al. 2012

PLoS ONE

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ObjectiveTo report our experience with Chinese minimally invasive percutaneous nephrolithotomy (Chinese MPCNL) to manage patients with intrarenal stones in solitary kidney, and evaluate the safety, efficiency and feasibility of this technique.MethodsForty-one patients with intrarenal stones in solitary kidney underwent Chinese MPCNL in our department from March 2009 to February 2011. Demographic characteristics, operative parameters, number of tracts, stone-free rates (SFRs), stone analyses, hemoglobin levels, nephrostomy tube removal time, hospitalization time, and complications were evaluated. Serum creatinine (Scr) and glomerular filtration rate (GFR) were measured preoperatively, postoperatively at 1 month, and each follow-up visit. The 5-stage classification of chronic kidney disease (CKD) was used according to the National Kidney Foundation guidelines.ResultsThe initial stone-free status was achieved in 35 (85.4%) patients after Chinese MPCNL. The mean follow-up time was 16.9±4.7 months (range: 12–24), and the final SFR improved to 97.6% after auxiliary procedures. Among all patients, complex stones were detected in 26 (63.4%) patients, and 9 (22.0%) required multiple tracts. The mean operative time and mean hospitalization time were 71.3±23.5 min (range: 40–139) and 6.1±0.5 days (range: 5–11), respectively. During preoperative period and postoperative period (1 month), Scr were 132.1±41.3 umol/L (range: 78.2–231.4) and 108.9±30.7 umol/L (range: 71.6–136.9), respectively (P<0.05), while GFR were 74.9±24.2 ml/min (range: 35–110) and 83.9±27.4 ml/min (range: 65–110), respectively (P<0.05). According to CKD classification, the renal function was stable, improved, and worse in 29 (70.7%), 11 (26.8%), and 1 (2.5%) patients, compared with the preoperative levels. No patient progressed to end-stage renal disease requiring dialysis.ConclusionsOur experience with Chinese MPCNL demonstrates that it is safe, feasible and efficient for managing the intrarenal calculi in solitary kidney with a low complication rate. At long-term follow-up, renal function stabilized or even improved in the majority of patients with solitary kidney.

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Section: Discussionmentioning

confidence: 99%

Chinese Minimally Invasive Percutaneous Nephrolithotomy for Intrarenal Stones in Patients with Solitary Kidney: A Single-Center Experience

Huang

Zhong

et al. 2012

PLoS ONE

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“…In order to minimize postoperative complications, placement of a nephrostomy tube (NT) has historically Nephrostomy Tube-Free versus Nephrostomy Tube for Renal Drainage Urol Int 2012;88: [298][299][300][301][302][303][304][305][306] 299 been adopted as the standard of care [2,3] . In PNL, whether to perform the standard placement of a NT, 'tubeless' (placement of a double-J stent without renal drainage) or totally tubeless (no NT, no double-J stent) is an ongoing matter of debate [4] . Recently, the need of NT after PNL has come into question and some investigators suggested that in selected cases performing tubeless PNL (with placement of JJ ureteric stent only) is safe and feasible [5][6][7][8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

Nephrostomy Tube-Free versus Nephrostomy Tube for Renal Drainage after Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

Shen

Liu²,

Wang³

2012

Urol Int

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Background: Historically, percutaneous nephrostomy drainage following percutaneous nephrolithotomy (PNL) has been considered the standard of care. More recently, however, an increasing number of centers are performing tubeless (with insertion of JJ ureteric stent) or totally tubeless (with no internal or external drainage) PNL with impressive outcome data. Objective: This systematic review is to compare the clinical therapeutic efficacy and safety of nephrostomy tube-free (NT-free) and standard PNL. Materials and Methods: We searched PubMed (1966 to April 2011), Embase (1966 to April 2011), and the Cochrane Library without language restriction. All randomized controlled trials that compared NT-free PNL (using a double-J stent) with standard PNL were enrolled in this review. The Cochrane Collaboration’s RevMan5.0.2 software was used for statistical analysis. Results: Nine studies involving 547 patients were included. Patients were divided into 4 groups: NT-free group, small tube group (8–9 Fr), middle tube group (16–18 Fr), and large tube group (20–24 Fr). Meta-analysis showed that: (1) with regard to hospital stay (h) and visual analog scale scores for postoperative pain on day 1, there was no significant difference between the NT-free group and the small tube group, but there were differences between the NT-free group versus the middle and large tube groups; (2) for puncture site urinary leakage, no significant difference was found between the NT-free group and the small and middle tube groups; (3) no significant difference was found with regard to transfusion, fever or infection, operative time between the NT-free group and the 3 tube groups. Conclusions: The clinical efficacy and safety of NT-free and small tube are similar in all measurements. Compared with the middle and large tubes, NT-free PNL could reduce hospital stay and postoperative analgesia requirement without increasing other complications.

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“…Several RCTs and their meta-analyses [3, 4] have shown that tubeless PCNL provides less postoperative pain, less postoperative urinary leakage and shorter hospital stay than NT placement. A report by Cormio et al on the use of TachoSil ® has been published recently [14].…”

Section: Discussionmentioning

confidence: 99%

“…Several randomized controlled trials (RCTs) and their meta-analyses [3, 4] suggest that the tubeless approach reduces postoperative pain and hospital stay and that substituting double-J stents with external ureteral catheters or no drainage at all [totally tubeless (TTL)] further improves patients’ compliance by eliminating stent-related symptoms and need for cystoscopic removal [5, 6]. On the other hand, other well-designed RCTs demonstrate advantages of early NT removal [7] or placement of small-bore NTs [8] over the tubeless approach.…”

Section: Introductionmentioning

confidence: 99%

Exit strategies following percutaneous nephrolithotomy (PCNL): a comparison of surgical outcomes in the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study

et al. 2012

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PurposeTo compare the characteristics and outcomes of exit strategies following percutaneous nephrolithotomy (PCNL) using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database.Materials and methodsTwo matched data sets were prepared in order to compare stent only versus NT only and TTL versus NT only. Patients were matched on the exit strategy using the following variables: case volume of the center where they underwent PCNL, stone burden, the presence of staghorn stone, size of sheath used at percutaneous access, the presence of bleeding during surgery, and treatment success status. For categorical variables, percentages were calculated and differences between the four groups were tested by the chi-square test.ResultsThe only significant difference reported between the matched pairs was between NT and stent only groups. NT only PCNL was associated with significantly longer operating times (p = 0.029) and longer hospital stay (p < 0.001) than stent only PCNL.ConclusionsPatients who undergo PCNL with less invasive exit strategy involving a stent only have shorter hospital stay than those who have postoperative NT. The intraoperative course is the primary driver of complications in PCNL and not necessarily the exit strategy.

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Systematic Review and Meta-Analysis of Nephrostomy Placement Versus Tubeless Percutaneous Nephrolithotomy

Cited by 44 publications

References 26 publications

Chinese Minimally Invasive Percutaneous Nephrolithotomy for Intrarenal Stones in Patients with Solitary Kidney: A Single-Center Experience

Chinese Minimally Invasive Percutaneous Nephrolithotomy for Intrarenal Stones in Patients with Solitary Kidney: A Single-Center Experience

Nephrostomy Tube-Free versus Nephrostomy Tube for Renal Drainage after Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

Exit strategies following percutaneous nephrolithotomy (PCNL): a comparison of surgical outcomes in the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study

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