Tubeless Percutaneous Nephrolithotomy: Is it Really Less Morbid?

Singh, Iqbal; Singh, Arvind; Mittal, Gyanendra S

doi:10.1089/end.2007.0269

Cited by 69 publications

(69 citation statements)

References 24 publications

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“…12 Several studies since then have demonstrated that tubeless and totally tubeless PCNL have equivalent outcomes in the properly selected patient group when compared to PCNL performed with the presence of a nephrostomy tube (with/without stent). 2,3,5,6,10,11 Our study also demonstrated that totally tubeless PCNL have equivalent outcomes in the properly selected patients. In our study perioperative blood loss, transfusion, and the complication rate in the totally tubeless group were comparable to the standard group.…”

Section: Discussionsupporting

confidence: 51%

“…Despite this, tubeless PCNL retains its role in selected patients with renal stones who are undergoing uncomplicated PCNL. 3,6,[21][22][23] However, a nephrostomy tube should be placed if serious disruption or significant laceration of the collecting system is noted. Also, if significant intrarenal bleeding is found and endoscopic visualization is impossible, a nephrostomy tube should be inserted.…”

Section: Discussionmentioning

confidence: 99%

“…Then came the concept that the best available drainage of the kidney is the normal peristaltic ureter and this resulted in totally tubeless PCNL, which questions the need for any type of drainage following PCNL. [3][4][5][6][7] But it is still considered by many as adventurous and risky. Hence, in a prospective study, we tried to assess the efficacy, safety & morbidity of totally tubeless PCNL and compare with tubeless and standard PCNL.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prospective study comparing the safety and efficacy of totally tubeless percutaneous nephrolithotomy vs standard percutaneous nephrolithotomy

Vig

Nagi

et al. 2016

Int J Res Med Sci

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Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prospective study comparing the safety and efficacy of totally tubeless percutaneous nephrolithotomy vs standard percutaneous nephrolithotomy

Vig

Nagi

et al. 2016

Int J Res Med Sci

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“…Since this report, several other investigators have confirmed that tubeless PCNL leads to shorter hospital stays and less postoperative pain (16,18,19) and decreased cost as compared to nephrostomy tube drainage (7,20). While most studies have utilized a ureteral stent in patients undergoing a tubeless PCNL, other investigators have recommended a "totally tubeless" approach (21,22).…”

Section: Discussionmentioning

confidence: 88%

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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“…blood transfusion, emergency nephrostomy, significant bleeding needing intervention or worse stone clearance rates (Table 3). [6][7][8][9][10][11][12][13] Agrawal et al 7 conducted a randomised comparison of 101 'tubeless' PCNLs (Group B; with JJ stent) with 101 standard PCNLs (Group A; with nephrostomy). All patients had an 'uneventful' postoperative recovery.…”

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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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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Tubeless Percutaneous Nephrolithotomy: Is it Really Less Morbid?

Cited by 69 publications

References 24 publications

Prospective study comparing the safety and efficacy of totally tubeless percutaneous nephrolithotomy vs standard percutaneous nephrolithotomy

Prospective study comparing the safety and efficacy of totally tubeless percutaneous nephrolithotomy vs standard percutaneous nephrolithotomy

Tubeless percutaneous nephrolithotomy: outcomes with expanded indications

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

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