Efficacy and safety of totally tubeless standard percutaneous nephrolithotomy in patients with kidney stones

• Main Authors: Cemil Aydın, Ramazan Topaktaş, Selçuk Altın, Ali Akkoç, Zeynep Banu Aydın, Aykut Aykaç
• Format: Article
• Language: English
• Published: Dicle University Medical School 2014-09-01
• Series: Dicle Medical Journal
• Subjects: Kidney stone; percutaneous nephrolithotomy; totally tubeless
• Online Access: http://www.diclemedj.org/upload/sayi/33/Dicle%20Med%20J-02093.pdf

Objective: Percutaneous nephrolithotomy (PNL) is the first- line treatment for large and complex renal calculi. In this study, we aimed to compare the efficacy and safety of the totally tubeless PNL versus the standard PNL. Methods:Between January 2012 and July 2013, 73 selected patients were treated standard or totally tubeless PNL, nephrostomy tube and ureteral stent was not placed at the end of the operation in 35 (39.7%) (Group 1) of them and 38 (43.1%) (Group 2) patient underwent standard PNL. Stone disintegration was performed with a pneumatic lithotripter. We retrospectively compared patient and stone characteristics, operation time, duration of hospitalization, analgesia requirements, stone-free rate, operative findings, blood loss, and perioperative complications between two groups. Results:The mean operation time, excluding the preparation course, was 38,3±15,4 minutes vs 51,2±12,9 minutes and mean fluoroscopy time was 4,5±2,4 minutes vs 4,8±2,1 minutes, respectively. No significant intraoperative complication or indication additional access or second-look PNL due to residual stones was observed. In both groups none of the patients demonstrated a urinoma, hemorrhage or residual stones in postoperative ultrasonography and plain radiograph. Blood transfusion was needed only in a patient vs two patients for group 1 and 2, respectively. There were no significant differences in preoperative patient characteristics, postoperative complications between two groups, but the totally tubeless PNL group showed a shorter hospitalization and a lesser analgesic requirement compared with other group. Conclusion: Absence of the nephrostomy tube and ureteral stent may help in keeping the patient comfortable after the operation and reduction in the analgesia requirement and length of hospital stay. We believe totally tubeless PNL is safe and effective management option in properly selected cases.