Tubeless percutaneous nephrolithotomy: a prospective feasibility study and review of previous reports

Shah, Hemendra N.; Kausik, Vikram B.; Hegde, Sunil S.; Shah, Jignesh; Bansal, Manish

doi:10.1111/j.1464-410x.2005.05730.x

Cited by 107 publications

(63 citation statements)

References 25 publications

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“…While most studies have utilized a ureteral stent in patients undergoing a tubeless PCNL, other investigators have recommended a "totally tubeless" approach (21,22). Tubeless PCNL was proven to be safe in patients with chronic anti-platelet therapy and liver cirrhosis (23), geriatric patients (24), chronic kidney disease (25), patients with solitary kidneys, bilateral procedures and supracostal or multiple renal access (9). However, all these studies have excluded patients with intraoperative bleeding or urinary extravasation.…”

Section: Discussionmentioning

confidence: 99%

“…Tubeless percutaneous nephrolithotomy was introduced in 1997 (7). Subsequently, several groups reported their results with tubeless PCNL in selected patients (8)(9)(10), however all studies excluded patients with concerns regarding bleeding, perforation, or residual stones requiring a second--look nephroscopy. The benefits shown in these select patients included decreased postoperative pain and hospital stay.…”

Section: Introductionmentioning

confidence: 99%

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Tubeless percutaneous nephrolithotomy: outcomes with expanded indications

et al. 2014

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ARTICLE INFO ______________________________________________________________ ______________________Introduction: Tubeless PCNL has been utilized to shorten hospital stay and improve patient postoperative pain control. Prior studies have excluded those patients with significant bleeding or other complications. Our objective was to evaluate the utility of tubeless PCNL in all patients irrespective of intraoperative outcome. Materials and Methods:A retrospective review of the charts of patients who underwent PCNL at our institute was performed. Patients were assigned to one endourologist who routinely performed tubeless PCNL and to a second endourologist who routinely left a small-bore pigtail nephrostomy. Preoperative demographics operative and postoperative outcomes were compared. Results: Out of 159 patients included, 83 patients had tubeless PCNL while 76 patients had standard PCNL. There was no difference between groups regarding age, gender, ASA score, number, maximum diameter of stones, number of calyces involved, stone density (HU), laterality and use of preoperative narcotics. While staghorn stones were more common in patients who underwent standard PCNL (p = 0.008). Tubeless patients had less number of access tracts (p ≤ 0.001), shorter hospital stay (1.7 vs. 3.0 days, p = 0.001) when compared to standard PCNL group. Multivariable analysis controlling for confounding factors including staghorn calculi and number of accesses confirmed that tubeless PCNL was associated with shorter hospital stay and less postoperative pain. There was no significant difference in complication rates between the two groups. Conclusion: Our report confirms the previous reports of shorter hospital stay, less pain and analgesia as compared to standard PCNL, and establishes its safety irrespective of bleeding, perforation, extravasation or other intraoperative issues that have previously been utilized as exclusionary criteria for this approach.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Tubeless percutaneous nephrolithotomy: outcomes with expanded indications

et al. 2014

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“…The four stages of PCNL are: (1) renal access, (2) tract dilatation, (3) nephroscopy and stone disintegration, and (4) nephrostomy tube placement. In uncomplicated PCNL where there is no significant Clinical Urolo�� Clinical Urolo�� doi: 10.1590/S1677-55382010000200006 extravasation, significant bleeding, or any need for a second nephroscopy, the placement of the nephrostomy tube may not be necessary (tubeless PCNL) (1)(2)(3)(4). In specific situations of PCNL, a supracostal renal approach is necessary (5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Supracostal access: does it affect tubeless percutaneous nephrolithotomy efficacy and safety?

Jun-Ou

Lojanapiwat

2010

Int. braz j urol.

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Introduction: Tubeless percutaneous nephrolithotomy (PCNL) in selected patients has been found to be safe and can reduce postoperative discomfort without increasing complications. The challenges of tubeless PCNL via supracostal access are inadequate drainage and postoperative bleeding, conditions that may increase pulmonary complications. We compare the efficacy and safety of the tubeless supracostal versus the standard supracostal PCNL. Materials and Methods: Supracostal PCNL with one percutaneous renal access, no significant bleeding, extravasation and residual stone was performed in 95 patients. Of these, 43 were tubeless PCNL (Group-I) and 52 were PCNL with standard routine postoperative nephrostomy tube (Group-II). In group-I, PCNL was done by the standard supracostal technique with the placement of a postoperative external ureteral catheter for 48 hours. The operative time, success rate, hospital stay and ensuing complications were compared between group-I and group-II. Results: Patients in the tubeless PCNL group (Group-I) were 90.7% stone -free while those with standard routine postoperative nephrostomy tube(Group-II) were 84.6% stone -free. Additionally, stone fragments of less than 4 mm in diameter were found in 9.3% of patients in group-I and 25.4% in group-II. The success rate, hematocrit change and complication were not significantly different between both groups. The analgesic requirement, operative time and hospital stay were all significantly less in the tubeless supracostal group (Group-I). None of group I and only one patient of group II needed intercostal drainage. Conclusion: Tubeless supracostal percutaneous nephrolithotomy in selected patients is effective with acceptable complications. This technique offers the advantage of lower analgesic requirement, shorter operative time and hospital stay. The pulmonary complication is the same as the standard supracostal percutaneous nephrolithotomy.

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“…15 There have been significant advances in the percutaneous extraction of renal calculi. [2][3][4][5][6][7][8][9][10] Review articles have highlighted the need for minimal intra-operative bleeding, negligible residual stone burden, and one to two attempts at renal access when considering tubeless approaches. Recently, the ability to perform tubeless PCNL as an outpatient procedure has been reported.…”

Section: Discussionmentioning

confidence: 99%

“…Since its description in the 1970s, 1 surgical and technological advances have obviated the need for routine nephrostomy tube placement. [2][3][4][5][6][7][8] Tubeless PCNL, with ureteral stenting, has been shown to decrease patients' analgesic requirements and hospital length of stay. 9,10 Although hospitalization is standard practice after PCNL, reports have described success with outpatient management.…”

Section: Introductionmentioning

confidence: 99%

Outpatient percutaneous nephrolithotomy in a renal transplant patient: World’s first case

McAlpine

Leveridge

Beiko

2015

CUAJ

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Percutaneous nephrolithotomy (PCNL) is an established safe and effective surgical treatment option for renal calculi in renal allografts. The advent of tubeless PCNL has led to reports of ambulatory or outpatient PCNL. This case report describes the successful outpatient management of a 49-year-old female with a symptomatic renal pelvic calculus in her transplanted kidney. Tubeless PCNL successfully removed the stone, free of complication, and the patient was discharged 2 hours and 17 minutes after the procedure in stable condition with minimal pain. This is, to the best of our knowledge, the first successful case of outpatient tubeless PCNL in a transplanted kidney. IntroductionPercutaneous nephrolithotomy (PCNL) is an accepted and widely used approach to extract large renal calculi. Since its description in the 1970s, 1 surgical and technological advances have obviated the need for routine nephrostomy tube placement.2-8 Tubeless PCNL, with ureteral stenting, has been shown to decrease patients' analgesic requirements and hospital length of stay.9,10 Although hospitalization is standard practice after PCNL, reports have described success with outpatient management. 11,12 This case report is the first to describe successful outpatient PCNL in a renal transplant patient. Case reportA 49-year-old female presented to her community hospital with hematuria and lower abdominal pain over the preceding 48 hours. She had received her second cadaveric kidney transplant 6 years previously for end-stage renal disease of unknown etiology. On presentation she was afebrile and hemodynamically stable. Urine was positive for blood, but negative for nitrites or pyuria. Creatinine was 164 μmol/L (estimated glomular filtration rate 29 mL/min/1.73m 2 ), slightly elevated from her baseline of 150 μmol/L. An ultrasound scan showed a large renal stone in the lower pole of the allograft kidney. Intravenous antibiotics were initiated and the patient was transferred to our tertiary care centre.At our institution, a computed tomography scan revealed a 14 × 12 × 11-mm stone located in the renal pelvis (Fig. 1a, Fig. 1b). There was mild hydronephrosis, yet the parenchyma of the graft was preserved. There was no evidence of a urinary tract infection (UTI)/sepsis and the patient's pain responded to oral analgesia. The surgical options were discussed and a decision was made to proceed with the PCNL. Informed consent was obtained and a 1-week course of levofloxacin was prescribed for UTI prophylaxis.On the morning of the procedure, a stress dose of 100 mg intravenous (IV) hydrocortisone was administered. Cefazolin 1 g IV was given prior to induction of general anesthesia. Flexible cystourethroscopy was performed and a 5Fr openended ureteral catheter was passed up the left transplanted ureteral orifice over a 0.035" guidewire. A Foley catheter was placed to straight drainage and the patient was repositioned supine for percutaneous access. Retrograde ureteropyelography outlined the allograft kidney's collecting system, demonstrating renal...

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Tubeless percutaneous nephrolithotomy: a prospective feasibility study and review of previous reports

Cited by 107 publications

References 25 publications

Tubeless percutaneous nephrolithotomy: outcomes with expanded indications

Tubeless percutaneous nephrolithotomy: outcomes with expanded indications

Supracostal access: does it affect tubeless percutaneous nephrolithotomy efficacy and safety?

Outpatient percutaneous nephrolithotomy in a renal transplant patient: World’s first case

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