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

Year 2014, Volume: 41 Issue: 3, 468 - 473, 01.09.2014
https://doi.org/10.5798/diclemedj.0921.2014.03.0456

Abstract

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.

References

  • Matlaga BR, Assimos DG. Changing indications of open stone sur- gery. Urology 2002;59:490-494.
  • Fernstrom I, Johansson B. Percutaneous pyelolithotomy: a new ex- traction technique. Scand J Urol Nephrol 1976;10:257-259.
  • Bellman GC, Davidoff R, CandelaJ, et al. Tubeless percutaneous re- nal surgery. J Urol 1997;157:1578-1582.
  • Crook TJ, Lockyer CR, Keoghane SR, Walmsley BH. Totally tube- less percutaneous nephrolithotomy. J Endourol 2008;22:267-271.
  • Paul EM, Markovic R, Lee BR, Smith AD. Choosing the ideal neph- rostomy tube. BJU Int 2003;92:672-677.
  • Kader AK, Finelli A, Honey RJ. Nephroureterostomy-drained per- cutaneous nephrolithotomy: modification combining safety with decreased morbidity. J Endourol 2004;18:29-32.
  • Marcovich R, Jacobson AI, Singh J, et al. No panacea for drainage after percutaneous nephrolithotomy. J Endourol 2004;18:743-747.
  • Wickham JEA, Miller RA, Kellett MJ, Payne SR. Percutaneous nephrolithotomy: one stage or two? Br J Urol 1984;56:582-584.
  • Winfield HN, Weyman P, Clayman RV. Percutaneous nephrostoli- thotomy: complications of premature nephrostomy tube removal. J Urol 1986;136:77-79.
  • Kara C, Resorlu B, Bozkurt of, et al. Totally tubeless (tubeless and stentless) percutaneous nephrolithotomy in selected patients. Turk- ish J Urology 2009;35:241-249.
  • Karami H, Gholamrezaie HR. Totally tubeless percutaneous neph- rolithotomy in selected patients. J Endourol 2004;18:475-476.
  • Crook TJ, Lockyer CR, Keoghane SR, Walmsley BH. A random- ized controlled trial of nephrostomy placement versus tubeless per- cutaneous nephrolithotomy. J Urol 2008;180:612-614.
  • Falahatkar S, Khosropanah I, Roshani A, et al. Tubeless per- cutaneous nephrolithotomy for staghorn stones. J Endourol 2008;22:1447-1451.
  • Yang RM, Bellman GC. Tubeless percutaneous renal surgery in obese patients. Urology 2004;63:1036-1040.
  • Shah HN, Mahajan AP, Hedge SS, Bansal M. Tubeless percutane- ous nephrolitotomy in patients with previous ipsilateral open renal surgery: a feasibility study with review of literature. J Endourol 2008;22:19-24.
  • Ozturk A, Güven S, Kilinc M, et al: Totally tubeless percutaneous nephrolithotomy: is it safe and effective in preschool children? J Endourol 2010;24:1935-1939.
  • Aghamir SM, Hosseini SR, Gooran S. Totally tubeless percutaneous nephrolithotomy. J Endourol 2004;18:647-662.
  • Istanbulluoglu OM, Ozturk B, Cicek T, et al. Case report: Bilateral simultaneous tubeless and stentless percutaneous nephrolitotomy. J Endourol 2008;22:25-27.

Böbrek taşı olgularında tam tüpsüz standart perkütan nefrolitotominin etkinlik ve güvenirliği

Year 2014, Volume: 41 Issue: 3, 468 - 473, 01.09.2014
https://doi.org/10.5798/diclemedj.0921.2014.03.0456

Abstract

Amaç: Perkütan nefrolitotomi (PNL) büyük ve kompleks böbrek taşı tedavisinde ilk seçenek tedavidir. Bu çalışmada tam tüpsüz PNL ile standart PNL yapılan hastaları işlemlerin etkinlik ve güvenilirlikleri yönünden karşılaştırmayı amaçladık. Yöntemler: Kliniğimizde, Ocak 2012 - Temmuz 2013 tarihleri arasında 73 hastaya standart ve tam tüpsüz PNL uygulandı, 35 (%39,7) tanesine işlem sonunda nefrostomi tüpü ve üreteral stent yerleştirilmedi, 38 (%43,1) tanesine ise standart PNL yapıldı. Taşlar pnömatik litotriptor ile kırıldı. Geriye dönük hasta ve taş verileri, operasyon süreleri, hastanede kalış süreleri, analjezi ihtiyaçları, taşsızlık oranları, operasyon bulguları, kan kaybı ve perioperatif komplikasyonlar her iki grupta karşılaştırıldı. Bulgular: Hazırlık süresi hariç ortalama operasyon süresi ve floroskopi süresi Grup 1 için 38,3±15,4 dakika, Grup 2 için 51,2±12,9 dakika iken, floroskopi süreleri Grup 1 ve Grup 2 için sırasıyla 4,5±2,4 dakika ve 4,8±2,1 dakika olarak saptandı. Her iki grupta intraoperatif önemli komplikasyon yada artık taş nedeniyle ikinci bir PNL işlemi gerekmedi. Her iki grupta hiçbir hastada postoperatif birinci günde yapılan ultrasonografide ve direk üriner sistem grafisinde, ürinom, kanama ya da rezidü taşa rastlanmadı. Grup 1\'de sadece 1 hastada, Grup 2\'de ise 2 hastada kan transfüzyonu ihtiyacı oldu. İki grup arasında preoperatif hasta verileri ve postoperatif komplikasyonlar açısından anlamlı bir farklılık yoktu, fakat tam tüpsüz grubun hastanede kalış süresi daha kısa ve analjezik ihtiyacı daha az idi. Sonuçlar: Nefrostomi tüpü ve üreteral stentin konulmaması ameliyat sonrası hasta konforunu arttırır, analjezik ihtiyacını ve hastanede kalış süresini azaltır. Tam tüpsüz PNL operasyonunun seçilmiş uygun vakalarda güvenilir ve etkin bir tedavi yöntemi olduğunu düşünmekteyiz.

References

  • Matlaga BR, Assimos DG. Changing indications of open stone sur- gery. Urology 2002;59:490-494.
  • Fernstrom I, Johansson B. Percutaneous pyelolithotomy: a new ex- traction technique. Scand J Urol Nephrol 1976;10:257-259.
  • Bellman GC, Davidoff R, CandelaJ, et al. Tubeless percutaneous re- nal surgery. J Urol 1997;157:1578-1582.
  • Crook TJ, Lockyer CR, Keoghane SR, Walmsley BH. Totally tube- less percutaneous nephrolithotomy. J Endourol 2008;22:267-271.
  • Paul EM, Markovic R, Lee BR, Smith AD. Choosing the ideal neph- rostomy tube. BJU Int 2003;92:672-677.
  • Kader AK, Finelli A, Honey RJ. Nephroureterostomy-drained per- cutaneous nephrolithotomy: modification combining safety with decreased morbidity. J Endourol 2004;18:29-32.
  • Marcovich R, Jacobson AI, Singh J, et al. No panacea for drainage after percutaneous nephrolithotomy. J Endourol 2004;18:743-747.
  • Wickham JEA, Miller RA, Kellett MJ, Payne SR. Percutaneous nephrolithotomy: one stage or two? Br J Urol 1984;56:582-584.
  • Winfield HN, Weyman P, Clayman RV. Percutaneous nephrostoli- thotomy: complications of premature nephrostomy tube removal. J Urol 1986;136:77-79.
  • Kara C, Resorlu B, Bozkurt of, et al. Totally tubeless (tubeless and stentless) percutaneous nephrolithotomy in selected patients. Turk- ish J Urology 2009;35:241-249.
  • Karami H, Gholamrezaie HR. Totally tubeless percutaneous neph- rolithotomy in selected patients. J Endourol 2004;18:475-476.
  • Crook TJ, Lockyer CR, Keoghane SR, Walmsley BH. A random- ized controlled trial of nephrostomy placement versus tubeless per- cutaneous nephrolithotomy. J Urol 2008;180:612-614.
  • Falahatkar S, Khosropanah I, Roshani A, et al. Tubeless per- cutaneous nephrolithotomy for staghorn stones. J Endourol 2008;22:1447-1451.
  • Yang RM, Bellman GC. Tubeless percutaneous renal surgery in obese patients. Urology 2004;63:1036-1040.
  • Shah HN, Mahajan AP, Hedge SS, Bansal M. Tubeless percutane- ous nephrolitotomy in patients with previous ipsilateral open renal surgery: a feasibility study with review of literature. J Endourol 2008;22:19-24.
  • Ozturk A, Güven S, Kilinc M, et al: Totally tubeless percutaneous nephrolithotomy: is it safe and effective in preschool children? J Endourol 2010;24:1935-1939.
  • Aghamir SM, Hosseini SR, Gooran S. Totally tubeless percutaneous nephrolithotomy. J Endourol 2004;18:647-662.
  • Istanbulluoglu OM, Ozturk B, Cicek T, et al. Case report: Bilateral simultaneous tubeless and stentless percutaneous nephrolitotomy. J Endourol 2008;22:25-27.
There are 18 citations in total.

Details

Primary Language Turkish
Journal Section Research Articles
Authors

Cemil Aydın This is me

Ramazan Topaktaş This is me

Selçuk Altın This is me

Ali Akkoç This is me

Zeynep Banu Aydın This is me

Aykut Aykaç This is me

Publication Date September 1, 2014
Submission Date March 1, 2015
Published in Issue Year 2014 Volume: 41 Issue: 3

Cite

APA Aydın, C., Topaktaş, R., Altın, S., Akkoç, A., et al. (2014). Böbrek taşı olgularında tam tüpsüz standart perkütan nefrolitotominin etkinlik ve güvenirliği. Dicle Tıp Dergisi, 41(3), 468-473. https://doi.org/10.5798/diclemedj.0921.2014.03.0456
AMA Aydın C, Topaktaş R, Altın S, Akkoç A, Aydın ZB, Aykaç A. Böbrek taşı olgularında tam tüpsüz standart perkütan nefrolitotominin etkinlik ve güvenirliği. diclemedj. September 2014;41(3):468-473. doi:10.5798/diclemedj.0921.2014.03.0456
Chicago Aydın, Cemil, Ramazan Topaktaş, Selçuk Altın, Ali Akkoç, Zeynep Banu Aydın, and Aykut Aykaç. “Böbrek taşı olgularında Tam tüpsüz Standart perkütan Nefrolitotominin Etkinlik Ve güvenirliği”. Dicle Tıp Dergisi 41, no. 3 (September 2014): 468-73. https://doi.org/10.5798/diclemedj.0921.2014.03.0456.
EndNote Aydın C, Topaktaş R, Altın S, Akkoç A, Aydın ZB, Aykaç A (September 1, 2014) Böbrek taşı olgularında tam tüpsüz standart perkütan nefrolitotominin etkinlik ve güvenirliği. Dicle Tıp Dergisi 41 3 468–473.
IEEE C. Aydın, R. Topaktaş, S. Altın, A. Akkoç, Z. B. Aydın, and A. Aykaç, “Böbrek taşı olgularında tam tüpsüz standart perkütan nefrolitotominin etkinlik ve güvenirliği”, diclemedj, vol. 41, no. 3, pp. 468–473, 2014, doi: 10.5798/diclemedj.0921.2014.03.0456.
ISNAD Aydın, Cemil et al. “Böbrek taşı olgularında Tam tüpsüz Standart perkütan Nefrolitotominin Etkinlik Ve güvenirliği”. Dicle Tıp Dergisi 41/3 (September 2014), 468-473. https://doi.org/10.5798/diclemedj.0921.2014.03.0456.
JAMA Aydın C, Topaktaş R, Altın S, Akkoç A, Aydın ZB, Aykaç A. Böbrek taşı olgularında tam tüpsüz standart perkütan nefrolitotominin etkinlik ve güvenirliği. diclemedj. 2014;41:468–473.
MLA Aydın, Cemil et al. “Böbrek taşı olgularında Tam tüpsüz Standart perkütan Nefrolitotominin Etkinlik Ve güvenirliği”. Dicle Tıp Dergisi, vol. 41, no. 3, 2014, pp. 468-73, doi:10.5798/diclemedj.0921.2014.03.0456.
Vancouver Aydın C, Topaktaş R, Altın S, Akkoç A, Aydın ZB, Aykaç A. Böbrek taşı olgularında tam tüpsüz standart perkütan nefrolitotominin etkinlik ve güvenirliği. diclemedj. 2014;41(3):468-73.