Tubeless Percutaneous Renal Surgery

Bellman, Gary C.; Davidoff, Ramin; Candela, Joseph; Gerspach, Jill M.; Kurtz, Stephen G.; Stout, L. Clarke

doi:10.1097/00005392-199705000-00010

Cited by 39 publications

(60 citation statements)

References 8 publications

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“…It has been shown that using a small-caliber nephrostomy tube, a miniperc, an internal stent, and tubeless PCNL can decrease postoperative pain and the length of the hospital stay. [3] The term "tubeless percutaneous nephrolithotomy" was first used by Bellman et al [4] . The tubeless PCNL involves internalization of the postoperative renal drainage by placement of an internal stent (either ureteric or JJ catheter) and bladder catheter instead of the traditional nephrostomy tube.…”

Section: Introductionmentioning

confidence: 99%

Tubeless PNL in the supine position

Wahab¹,

Sherif²,

El-Karamany³

2012

Turkish Journal of Urology

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Objective: To evaluate the safety, feasibility and efficacy of tubeless percutaneous nephrolithotomy (PNL) in a supine position in selected cases with renal stones. Materials and methods:This descriptive study enrolled 120 patients who presented to the urology department at Benha Faculty of Medicine with renal stones between June 2009 and June 2010. All patients were evaluated based on their history, a physical examination, kidney, ureter, bladder (KUB), pelviabdominal U/S and spiral CT of the abdomen and pelvis without contrast or IVP in selected cases. The patients were followed up for postoperative pain, leakage and fever. Perinephric collection with ultrasound (U/S) was performed, and the Hb% and hematocrit were determined after 12 hours. Results:The access to the stones was achieved through the lower calyx (70.8%) and middle calyx (29.2%) with a stone clearance rate of 100%, and there was no need for a 2nd session. The mean operative time was (67.1±19.2 min.), and the mean length of the hospital stay was (3.4±1.7 days). Three cases had perinephric collections <100 cc, which were managed conservatively and resolved within one week. Prolonged leakage occurred in three cases and also resolved spontaneously within five days. Three cases required a one-unit blood transfusion postoperatively. Stone-free status was achieved in all cases through the use of either the lower or middle calyx in the supine position during the operation. A single dose of non-steroidal antiinflammatory drugs (NSAID) was needed in 30 cases for postoperative analgesia. Conclusion:Tubeless PNL with the patients in the supine position can be used in selected cases with a favorable outcome and minimal morbidity with the potential advantage of deceases in the postoperative pain, analgesia requirement and hospital stay.Key words: Percutaneous nephrolithotomy; percutaneous nephrostomy; renal stones; tubeless PNL. ÖZETAmaç: Böbrek taşları olan seçilmiş olgularda sırt üstü pozisyonda tüpsüz PNL'nin güvenilirliği, uygulanabilirliği ve etkinliğini değerlendirmek. Gereç ve yöntem: Bu tanımlayıcı çalışmaya Haziran 2009-Haziran 2010 tarihleri arasındaki dönemdeBenha Tıp Fakültesi üroloji bölümüne böbrek taşı ile başvuran 120 hasta alındı. Hastaların tamamı öykü, fizik muayene, DÜS grafisi, pelviabdominal USG, abdomen ve pelvisin kontrastsız spiral BT'si veya seçilmiş olgularda IVP ile değerlendirildi. Hastalar ameliyat sonrası ağrı, sızıntı, ateş, USG ile perinefrik birikim açısından izlendi, %Hb ve hematokrit 12 saat sonra yapıldı. Bulgular: Taşa erişim alt kaliks (%70.8) ve orta kaliks (%29.2) yoluyla yapıldı, taş temizlenme oranı %100'dü. İkinci bir seansa gerek duyulmadı. Ortalama işlem süresi 67.1±19.2 ve ortalama hastanede kalış 3.4±1.7 idi. Üç olguda konservatif olarak tedavi edilen ve bir hafta içinde düzelen <100 cc perinefrik birikim vardı. Üç olguda uzamış sızıntı görüldü, bunlar da beş gün içinde kendiliğinden düzeldi. Üç olguda ameliyat sonrası bir ünite kan transfüzyonu gerekti. Bütün olgularda sırt üstü pozisyonunda alt veya orta...

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Section: Introductionmentioning

confidence: 99%

Tubeless PNL in the supine position

Wahab¹,

Sherif²,

El-Karamany³

2012

Turkish Journal of Urology

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“…Other researchers opted for a ‘totally tubeless’ approach and as such our analysis is subcategorised into three elements: (1) standard PCNL (tubed). (2) Tubeless with a ureteric stent: in 11 articles, standard PCNL groups were compared to groups whereby drainage was provided by ureteric stents [2,3,4,5,7,9,10,12,18,19,20]. Within this category, 2 studies included three groups: two calibres of nephrostomy (large-bore and small-bore) compared with ureteric stents [3,5].…”

Section: Resultsmentioning

confidence: 99%

“…PCNL is now the operation of choice for the management of large, complex renal calculi [2,3,4,5,6,7]. Historically temporary nephrostomy tubes of varying calibre and type have been left in place at the end of PCNL procedures for several reasons: drainage, tamponade of bleeding and to permit second-look procedures [1,2,3,8,9,10,11]. There is an ever-growing literature base documenting numerous technological and procedural refinements to this approach, such as the use of smaller calibre nephrostomies [4,5,6,10].…”

Section: Introductionmentioning

confidence: 99%

“…There is an ever-growing literature base documenting numerous technological and procedural refinements to this approach, such as the use of smaller calibre nephrostomies [4,5,6,10]. Bellman et al [9] challenged the need for a nephrostomy at all in their seminal work in 1997. Their study was based on 50 patients who were age-, sex- and procedure-matched.…”

Section: Introductionmentioning

confidence: 99%

“…The authors highlighted compelling advantages of the tubeless approach: shorter hospitalisation and convalescence, reduced analgesic requirements and savings of up to USD 2,000 per case. Since then, there has been a literature base corroborating these outcomes [3,4,5,8,9,10,11,12,13,14]. The technique involves internalising the renal drainage process (ureteric catheter or JJ stent placement) or alternatively no stent at all (totally tubeless PCNL) [4].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Standard versus Tubeless Percutaneous Nephrolithotomy: A Systematic Review

Amer¹,

Ahmed²,

Bultitude³

et al. 2012

Urol Int

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Objective: This article systematically analyses comparative studies to evaluate the efficacy and safety of tubeless percutaneous nephrolithotomy (PCNL) versus standard PCNL. Methods: The Medline, EMBASE, PsycINFO, Cochrane and DARE databases were searched from 1997 to February 2011. Comparative studies evaluating outcomes from standard versus tubeless PCNL were included. Primary outcome measures were post-operative pain scoring, analgesic requirements, duration of hospitalisation/convalescence, operation time, major/minor complications and stone-free rates. Results: Twenty-four studies were included (11 randomised control trials and 13 retrospective or prospective studies). Levels of pain recorded, analgesic requirements, duration of inpatient stay and convalescence time were all significantly reduced in the tubeless PCNL group. Cost was reduced in two studies. Morbidity was not significantly different between the groups. There was no significant difference between groups regarding stone-free status. Discussion: This systematic review has demonstrated that tubeless PCNL is a viable alternative to tubed PCNL in uncomplicated cases. Benefits are as described above. There is no evidence suggesting that patient safety is compromised by the absence of post-operative nephrostomy. The tubeless method has been reported in challenging cases such as stag-horn stones, horseshoe or ectopic kidneys. Promising outcomes have been demonstrated in elderly patients and when clinical needs demand a supracostal approach. Multi-centre randomised controlled trials are needed to fully establish the effectiveness of the tubeless method.

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Percutaneous nephrolithotomy: keeping the bridge for one night

El-Nahas

Shokeir

2011

Urol Res

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This study was conducted to compare nephrostomy-free percutaneous nephrolithotomy (PCNL) with early nephrostomy tube removal (after 1 day). A prospective study started from January 2008 through December 2009 and included patients who underwent non-complicated PCNL through a single tract without intra-operative residual stones. Nephrostomy-free technique was performed during 2008 (nephrostomy-free group). During 2009, a nephrostomy tube was placed for 1 day (1-day nephrostomy group). Both groups were compared for post-operative events, dose of analgesia, hemoglobin deficit and hospital stay. The study included 55 patients (27 in nephrostomy-free group and 28 in 1-day nephrostomy group). There were no statistically significant differences between patients, renal and stone characteristics of both groups. Post-operative events were significantly more in nephrostomy-free group (26 vs. 14.3%, p = 0.039). They include hematuria in three (11.1%) of nephrostomy-free patients and one (3.6%) of 1-day nephrostomy patient, severe renal colic in four patients of nephrostomy-free group (14.8%), and temporary urinary leakage via the nephrostomy site in three patients of 1-day nephrostomy group (10.7%). Mean dose of post-operative analgesia, mean hemoglobin deficit and hospital days were comparable for both groups (p = 0.946, 0.541, 0.807, respectively). A second look PCNL was performed through the already present tract to retrieve residual stones in two patients with nephrostomy. In conclusion, 1-day nephrostomy technique after PCNL showed significantly better post-operative course. It was comparable to nephrostomy-free technique in analgesic requirements and hospital stay. The nephrostomy tube provided a bridge for second look nephroscopy.

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Tubeless Percutaneous Renal Surgery

Abstract: Tubeless percutaneous renal surgery is a safe procedure and offers numerous advantages over routine placement of a nephrostomy tube. The hospitalization, analgesia requirements, return to normal activities as well as cost are significantly less with this new technique.

Cited by 39 publications

References 8 publications

Tubeless PNL in the supine position

Tubeless PNL in the supine position

Standard versus Tubeless Percutaneous Nephrolithotomy: A Systematic Review

Percutaneous nephrolithotomy: keeping the bridge for one night

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