Tubeless PNL in the supine position

Abstract

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...

Observational prospective study for surgical outcome and anesthetic feasibility of tubeless and totally tubeless supine PCNL: A single centre initial experience

“…Other studies reported mean operative times ranging between 67.1±19.2 and 78.93±3.8 minutes with tubeless supine PCNL. [20,21] In our study (Table 4) only 2 (3.7%) patients received blood transfusion which is comparable to available literature indicating requirement for blood transfusion in 2.5-4% of the relevant patients. [12,20] Regarding Two (3.7%) patients developed complication of perinephric collection which was managed conservatively.…”

“…Forty-six (86.7%) patients were managed by inferior calyceal puncture which is at higher rates compared to relevant reports in the literature ranging between 72 and 70.8 percent. [12,20] Overall mean operative time was 57±12.3 minutes (range:34-90 minutes). For tubeless and totally tubeless PCLs mean operative times were 62.91±11.9, and 52.50±10.7 minutes, respectively.…”

“…Previous studies reported the incidence of perinephric collection ranging between 0.5% and 2.5 percent. [12,20] Reason for this could be access tract dilatation with 30 Fr dilators. A totally of 4 patients (7.5%) developed postoperative fever which was comparable to 5.8% incidence of postoperative fever mentioned in the literature.…”

“…A totally of 4 patients (7.5%) developed postoperative fever which was comparable to 5.8% incidence of postoperative fever mentioned in the literature. [20] There are very few studies concerning the role and outcome of regional anesthesia in supine PCNL. [22] But in our best knowledge there is no data available in the literature regarding anesthetic outcome for supine totally tubeless/tubeless PCNL.…”

Supine PCNL-5 year experience in a tertiary care center

“…Similar studies reported mean operative time of around 67.1 ± 19.2 and 78.93 ± 3.8 min with tubeless supine PCNL. 21,24 We achieved complete clearance in single stage in 93.7% of cases. Two cases were postponed because of blood on the initial puncture.…”