Tubeless percutaneous nephrolithotomy: outcomes with expanded indications

Abstract

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.

Standart Perkütan Nefrolitotomi ve Tüpsüz Perkütan Nefrolitotomi Sonuçlarının Karşılaştırılması: Prospektif Randomize Çift Kör Çalışma

“…However, there are different approaches in the literature. In a retrospective study by Isac et al (12) in 2014 comparing standard PNL and tubeless PNL with wider indications, no exclusion criteria were set except for bilateral PNL procedures. In their study, one of the two surgeons completed the whole case using the standard PNL, while the other used the tubeless PNL.…”

“…(10) However, in recent years, shorter hospital stay, less postoperative pain and analgesic requirements, insignificant difference in postoperative complications and positive contributions to patient comfort have brought the tubeless PNL forward and led to an increased interest in this surgical procedure. (10)(11)(12)(13)(14) Zilbermann et al (10) assessed standard PNL and tubeless PNL complications in their meta-analysis and reported no significant difference in complication rates between the two groups. In the Singh et al (15) study in 2008 on whether the morbidity rate of tubeless PNL is lower, 60 selected patients were operated on by a single urologist.…”

Outcomes of Standard or Tubeless Percutaneous Nephrolithotomy

“…Araştırmacılar sadece sekonder PNL yapılacak hastalarda tüp konulmasını önermişlerdir. 10 Avrupa Üroloji Kıla-vuzu'nda, komplike olmayan PNL operasyonlarında tüpsüz ve total tüpsüz PNL'nin güvenli bir alternatif olduğu belirtilmiştir. 8 Literatürde tüpsüz PNL'nin hastanede kalış sü-resini kısalttığını ve analjezi gereksinimini azalttı-ğını vurgulayan birçok çalışma mevcuttur.…”

“…8 Literatürde tüpsüz PNL'nin hastanede kalış sü-resini kısalttığını ve analjezi gereksinimini azalttı-ğını vurgulayan birçok çalışma mevcuttur. [10][11][12][13] Standart bir operasyon sonrası takılan nefrostomi tüpünün, özellikle de geniş çaplı kateterlerin, hastanın ameliyat sonrası ağrı skorlarını artırdığı gös-terilmiştir. 3 Agrawal ve ark.nın prospektif, randomize çalışmalarında, tüpsüz hastalarda PNL sonrası ağrının istatistiksel olarak daha az ve hastanede kalış süresinin daha kısa olduğu vurgulanmış, ayrıca gruplar arasında kan kaybı yönünden de fark saptanmadığı bildirilmiştir.…”

Порівняльне Дослідження Результатів Лікування Пацієнтів З Сечокам’яною Хворобою: Нефростомний Дренаж Проти Бездренажної Перкутанної Нефролітотомії

“…It is an appropriate between uretero-renoscopy and shock wave lithotripsy [1]. The PCNL is followed by placement of nephrostomy tube and stent that help in tamponade of percutaneous tract, postoperative kidney drainage and allowance of secondary intervention [2] but ended sometimes in postoperative pain and long hospital stay [3]. The advantage of tubeless PCNL was to ensure safety, effectiveness and short hospital stay [4].…”