Tubeless Percutaneous Renal Surgery

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

doi:10.1016/s0022-5347(01)64799-2

Cited by 318 publications

(187 citation statements)

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“…Several new techniques of PCNL such as mini-PCNL and tubeless PCNL were reported to decrease morbidity, analgesic requirement and duration of hospitalization (7). The method of anesthesia was reported to minimize morbidity following PCNL.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and safety of percutaneous nephrolithotomy (PCNL): a prospective and randomized study comparing regional epidural anesthesia with general anesthesia

2012

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Objective: To compare the efficacy and safety of regional epidural anesthesia and general anesthesia in patients who underwent PCNL. Materials and Methods: Fifty patients submitted to percutaneous nephrolithotomy (PCNL) were randomized into two groups: Group I (N = 26) received general anesthesia and Group II (N = 24) received regional epidural anesthesia. Demographic and operative data including age, BMI, stone position, stone size, postoperative pain, amount of postoperative analgesic usage, length of hospital stay, patient satisfaction, preoperative and postoperative hemoglobin and hematocrit, adverse effects and surgical complications were compared between both groups.

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Section: Resultsmentioning

confidence: 99%

Efficacy and safety of percutaneous nephrolithotomy (PCNL): a prospective and randomized study comparing regional epidural anesthesia with general anesthesia

2012

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“…18 Bellman et al describe the advantages of placement of nephrostomy tube after PCNL and demonstrated that the haemostatic process was easy, it provide an access if second look procedure is required and prevent urinary extravasation. 19 Tubeless PCNL was found by Falahatkaret al on 42 renal units for staghorn stones, they found that the procedure is safe and effective even with less complications. 20 The major concern in PCNL surgery involves serious postoperative complications such as blood loss, adjacent organ injuries and life threatening infection.…”

Section: Discussionmentioning

confidence: 97%

Initial Experience of Percutaneous Nephrolithotomy at Lumbini Medical College

Sapkota¹,

Tambey²,

Thapa³

et al. 2013

J Lumbini Med Coll

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ABSTRACT:Introduction: Renal stone disease is a challenging problem in urologic practice especially in our locality because of large stone burden and recurrence. Since ,the early 1980s when percutaneous nephrolithotomy (PCNL) was established for management of renal stones, open surgical procedures have virtually been replaced. PCNL is a safe, effective and minimally invasive approach compared to open surgery for patients with large single, multiple or staghorn stones. The aim of this prospective study was to evaluate and to review our experience with PCNL in management of renal and upper ureteric stones. Methods: Prospective study carried out at Lumbini Medical College and Teaching Hospital during 1stJanuary 2011 to 31st October 2011. Sixty patients were evaluated and subjected to PCNL. After clinical investigations like ultrasonography (USG) and intravenous urography (IVU), once patients were found to have renal or upper ureteric stones they were informed and explained about PCNL, its likely complications, probable hospital stay, the cost of treatment and data were recorded along with the operative time, estimated blood loss, stone burden, stone-free rate, length of hospitalization and complications .Patients were followed up after three months to rule out recurrence of stones by plain abdominal x-ray of kidney, ureter and bladder and USG. Results: Out of 60 patients 35 were male and 25 were female (M: F=1.4:1) with mean age of 37 years and were subjected to PCNL monotherapy. With the average stone size of 3.26cm, the mean operative time was 78 minutes. Complete stone removal achieved by PCNL alone in 60 cases, with insignificant residual small stones we achieved 97% stone clearance rate. The mean hospital stay was 3.7 days. No Serious complications were encountered, 9 (15%) patients required blood transfusion and 3 (5%) patients developed transient post-operative pyrexia. Conclusion: PCNL is the first line treatment option for management of large renal stones which as monotherapy has advantages in removal of renal and upper ureteric stones and achieving excellent results with minimal morbidity.

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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 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 318 publications

References 10 publications

Efficacy and safety of percutaneous nephrolithotomy (PCNL): a prospective and randomized study comparing regional epidural anesthesia with general anesthesia

Efficacy and safety of percutaneous nephrolithotomy (PCNL): a prospective and randomized study comparing regional epidural anesthesia with general anesthesia

Initial Experience of Percutaneous Nephrolithotomy at Lumbini Medical College

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

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