Yıl 2019, Cilt 14 , Sayı 3, Sayfalar 160 - 165 2019-10-01

A Comparison of Standard Percutaneous Nephrolithotomy and Tubeless Percutaneous Nephrolithotomy: Does Tubeless Realy Superior? A Prospective Randomized Double-Blind Study
Standart Perkütan Nefrolitotomi ve Tüpsüz Perkütan Nefrolitotomi Sonuçlarının Karşılaştırılması: Prospektif Randomize Çift Kör Çalışma

Huseyin Kocakgol [1] , Senol Adanur [2] , Ali Haydar Yilmaz [3] , Fatih Ozkaya [4] , Ibrahim Karabulut [5] , Ozkan Polat [6]


Aim: We aimed to compare patient groups who underwent either a standard percutaneous nephrolithotomy (PNL) or tubeless PNL for safety, effectiveness and patient comfort.

Material and Methods: 78 patients were included in the study. Patients who underwent the standard PNL (n=38) or tubeless PNL (n=40) were randomized into Groups 1 and 2, respectively. This study was designed as a prospective, randomized, double-blind investigation. Patients who had active bleeding at the end of the operation and those with multiple access tracts were excluded from the study. To evaluate postoperative pain and complications, a visual analogue scale (VAS) and a modified Clavien classification were used, respectively.

Results: A statistically significant difference was not found between the two patient groups for demographic data (age and gender), or for size, laterality, and intrarenal location of the stone(s) (p>0.05). Perioperative data, including operative and fluoroscopy times and stone‑free rates, perioperative changes in creatinine and haemoglobin values, blood transfusion, VAS 2 to 3 pain scores, analgesic requirements, fever and complications requiring additional surgical treatment were not statistically different between groups (p>0.05). A VAS 1 pain score and hospital stays were significantly decreased in the tubeless PNL group (p=0.003).

Conclusions: Tubeless PNL surgery is an effective and safe endourological procedure that can be performed by experienced surgeons. Its advantages over standard PNL include less pain during the early postoperative period, shorter hospital stays but the rates of complications are not significantly lower.

Amaç: Standart PNL ve tüpsüz PNL yapılan hasta gruplarının güvenlik, etkinlik ve hasta konforu açısından karşılaştırılmalarını amaçladık.

Gereç ve Yöntemler: PNL endikasyonu alan 78 hasta çalışmaya alındı. Standart PNL yapılan 38 hasta Grup I ve tüpsüz PNL prosedürü uygulanan 40 hasta Grup II olarak randomize edildi. Çalışma prospektif randomize çift kör çalışma olarak dizayn edildi. Operasyon sonunda aktif kanaması olan ve multipl akses kullanılan hastalar çalışma dışı bırakıldı. Ameliyat sonrası ağrı ve komplikasyonların değerlendirilmesinde sırasıyla VAS (visual analogue scale) ve modifiye Clavien sınıflaması kullanıldı.

Bulgular: Yaş, cinsiyet, taş boyutu, taşların böbrekteki lokalizasyonları, taraf gibi demografik verilerde iki hasta grubu arasında istatistiksel fark yoktu (P>0,05). Yine perioperatif verilerde; operasyon süresi, skopi süresi, taşsızlık oranları, peroperatif kreatin ve hemoglobin değişimi, kan transfüzyonu, VAS 2-VAS 3 ağrı skorları, analjezik gereksinimi, ateş ve ek cerrahi gerektiren komplikasyonlarda iki grup arasında istatistiksel fark bulunmadı (P>0,05). VAS 1 skoru ve hastanede kalış süreleri açısından her iki grup karşılaştırıldığında, her iki parametre tüpsüz PNL grubunda istatistiksel olarak anlamlı düşük bulundu (P=0,003).

Sonuç: Tüpsüz PNL operasyonu, erken postoperatif dönemde daha az ağrı ve kısa hastanede kalış süresi gibi avantajları ve standart PNL operasyonuna göre anlamlı olmayacak derecede düşük komplikasyon oranları ile deneyimli cerrahlar tarafından etkin ve güvenle uygulanabilecek endoürolojik bir yöntemdir.    

  • 1. Gonen M, Cicek T, Ozkardes H. Tubeless and stentless percutaneous nephrolithotomy in patients requiring supracostal access. Urologia internationalis. 2009;82(4):440-3.
  • 2. Garofalo M, Pultrone CV, Schiavina R. et al.Tubeless procedure reduces hospitalization and pain after percutaneous nephrolithotomy: results of a multivariable analysis. Urolithiasis. 2013 Aug 1;41(4):347-53.
  • 3. Istanbulluoglu MO, Ozturk B, Gonen M, Cıcek T, Ozkardes H. Effectiveness of totally tubeless percutaneous nephrolithotomy in selected patients: a prospective randomized study. International urology and nephrology. 2009 Sep 1;41(3):541-5.
  • 4. Yoon GH, Bellman GC. Tubeless percutaneous nephrolithotomy: a new standard in percutaneous renal surgery. Journal of endourology. 2008 Sep 1;22(9):1865-8.
  • 5. Bellman GC, Davidoff R, Candela J, Gerspach J, Kurtz S, Stout L. Tubeless percutaneous renal surgery. The Journal of urology. 1997 May;157(5):1578-82.
  • 6. Berkman DS, Lee MW, Landman J, Gupta M. Tubeless Percutaneous Nephrolithotomy (PCNL) with Reversed Polaris™ Loop Stent: Reduced Postoperative Pain and Narcotic Use. Journal of endourology. 2008 Oct 1;22(10):2245-50.
  • 7. Wickham JE, Miller RA, Kellett MJ, Payne SR. Percutaneous Nephrolithotomy: One Stage or Two?. The Journal of Urology. 1985 Sep;134(3):634-.
  • 8. Gupta NP, Mishra S, Suryawanshi M, Seth A, Kumar R. Comparison of standard with tubeless percutaneous nephrolithotomy. Journal of endourology. 2008 Jul 1;22(7):1441-6.
  • 9. Sofer M, Lidawi G, Keren-Paz G, Yehiely R, Beri A, Matzkin H. Tubeless percutaneous nephrolithotomy: first 200 cases in Israel. IMAJ-Israel Medical Association Journal. 2010 Mar 1;12(3):164.
  • 10. Zilberman DE, Lipkin ME, De la Rosette JJ.et al.Tubeless percutaneous nephrolithotomy—the new standard of care?. The Journal of urology. 2010 Oct 1;184(4):1261-6.
  • 11. Amer T, Ahmed K, Bultitude M. et al. Standard versus tubeless percutaneous nephrolithotomy: a systematic review. Urologia internationalis. 2012;88(4):373-82.
  • 12. Isac W, Rizkala E, Liu X, Noble M, Monga M. Tubeless percutaneous nephrolithotomy: outcomes with expanded indications. International braz j urol. 2014 Apr;40(2):204-11.
  • 13. Desai MR, Kukreja RA, Desai MM, et al. A prospective randomized comparison of type of nephrostomy drainage following percutaneous nephrostolithotomy: large bore versus small bore versus tubeless. The Journal of urology. 2004 Aug;172(2):565-7.
  • 14. Feng MI, Tamaddon K, Mikhail A, Kaptein JS, Bellman GC. Prospective randomized study of various techniques of percutaneous nephrolithotomy. Urology. 2001 Sep 1;58(3):345-50.
  • 15. Singh I, Singh A, Mittal G. Tubeless percutaneous nephrolithotomy: is it really less morbid?. Journal of Endourology. 2008 Mar 1;22(3):427-34.
  • 16. Crook TJ, Lockyer CR, Keoghane SR, Walmsley BH. Totally tubeless percutaneous nephrolithotomy. Journal of endourology. 2008 Feb 1;22(2):267-72.
  • 17. Tefekli A, Altunrende F, Tepeler K, Tas A, Aydin S, Muslumanoglu AY. Tubeless percutaneous nephrolithotomy in selected patients: a prospective randomized comparison. International urology and nephrology. 2007 Mar 1;39(1):57-63.
  • 18. Agrawal MS, Agrawal M, Gupta A, Bansal S, Yadav A, Goyal J. A randomized comparison of tubeless and standard percutaneous nephrolithotomy. Journal of endourology. 2008 Mar 1;22(3):439-42.
  • 19. Shoma AM, Elshal AM. Nephrostomy tube placement after percutaneous nephrolithotomy: critical evaluation through a prospective randomized study. Urology. 2012 Apr 1;79(4):771-6.
  • 20. Winfield HN, Weyman P, Clayman RV. Percutaneous nephrostolithotomy: complications of premature nephrostomy tube removal. The Journal of urology. 1986 Jul;136(1 Part 1):77-9.
Birincil Dil en
Konular Üroloji ve Nefroloji
Bölüm Özgün Araştırma
Yazarlar

Orcid: 0000-0002-7683-3282
Yazar: Huseyin Kocakgol
Kurum: Kanuni Training and Research Hospital, Department of Urology, Trabzon
Ülke: Turkey


Orcid: 0000-0002-2508-199X
Yazar: Senol Adanur
Kurum: Department of Urology, Faculty of Medicine, Ataturk University, Erzurum
Ülke: Turkey


Orcid: 0000-0001-5797-0655
Yazar: Ali Haydar Yilmaz (Sorumlu Yazar)
Kurum: Bilecik State Hospital, Department of Urology, Bilecik
Ülke: Turkey


Orcid: 0000-0002-7776-4231
Yazar: Fatih Ozkaya
Kurum: Ataturk University, Faculty of Medicine, Department of Urology
Ülke: Turkey


Orcid: 0000-0001-6766-0191
Yazar: Ibrahim Karabulut
Kurum: Health Sciences University, Erzurum Training and Research Hospital, Department of Urology
Ülke: Turkey


Orcid: 0000-0001-9961-662X
Yazar: Ozkan Polat
Kurum: Ataturk University, Faculty of Medicine, Department of Urology
Ülke: Turkey


Tarihler

Yayımlanma Tarihi : 1 Ekim 2019

Bibtex @araştırma makalesi { yud508649, journal = {Yeni Üroloji Dergisi}, issn = {1305-2489}, eissn = {2687-1955}, address = {dergi@avrasyauroonkoloji.org}, publisher = {Ali İhsan TAŞÇI}, year = {2019}, volume = {14}, pages = {160 - 165}, doi = {10.33719/yud.508649}, title = {A Comparison of Standard Percutaneous Nephrolithotomy and Tubeless Percutaneous Nephrolithotomy: Does Tubeless Realy Superior? A Prospective Randomized Double-Blind Study}, key = {cite}, author = {Kocakgol, Huseyin and Adanur, Senol and Yilmaz, Ali Haydar and Ozkaya, Fatih and Karabulut, Ibrahim and Polat, Ozkan} }
APA Kocakgol, H , Adanur, S , Yilmaz, A , Ozkaya, F , Karabulut, I , Polat, O . (2019). A Comparison of Standard Percutaneous Nephrolithotomy and Tubeless Percutaneous Nephrolithotomy: Does Tubeless Realy Superior? A Prospective Randomized Double-Blind Study. Yeni Üroloji Dergisi , 14 (3) , 160-165 . DOI: 10.33719/yud.508649
MLA Kocakgol, H , Adanur, S , Yilmaz, A , Ozkaya, F , Karabulut, I , Polat, O . "A Comparison of Standard Percutaneous Nephrolithotomy and Tubeless Percutaneous Nephrolithotomy: Does Tubeless Realy Superior? A Prospective Randomized Double-Blind Study". Yeni Üroloji Dergisi 14 (2019 ): 160-165 <https://dergipark.org.tr/tr/pub/yud/issue/47273/508649>
Chicago Kocakgol, H , Adanur, S , Yilmaz, A , Ozkaya, F , Karabulut, I , Polat, O . "A Comparison of Standard Percutaneous Nephrolithotomy and Tubeless Percutaneous Nephrolithotomy: Does Tubeless Realy Superior? A Prospective Randomized Double-Blind Study". Yeni Üroloji Dergisi 14 (2019 ): 160-165
RIS TY - JOUR T1 - A Comparison of Standard Percutaneous Nephrolithotomy and Tubeless Percutaneous Nephrolithotomy: Does Tubeless Realy Superior? A Prospective Randomized Double-Blind Study AU - Huseyin Kocakgol , Senol Adanur , Ali Haydar Yilmaz , Fatih Ozkaya , Ibrahim Karabulut , Ozkan Polat Y1 - 2019 PY - 2019 N1 - doi: 10.33719/yud.508649 DO - 10.33719/yud.508649 T2 - Yeni Üroloji Dergisi JF - Journal JO - JOR SP - 160 EP - 165 VL - 14 IS - 3 SN - 1305-2489-2687-1955 M3 - doi: 10.33719/yud.508649 UR - https://doi.org/10.33719/yud.508649 Y2 - 2019 ER -
EndNote %0 Yeni Üroloji Dergisi A Comparison of Standard Percutaneous Nephrolithotomy and Tubeless Percutaneous Nephrolithotomy: Does Tubeless Realy Superior? A Prospective Randomized Double-Blind Study %A Huseyin Kocakgol , Senol Adanur , Ali Haydar Yilmaz , Fatih Ozkaya , Ibrahim Karabulut , Ozkan Polat %T A Comparison of Standard Percutaneous Nephrolithotomy and Tubeless Percutaneous Nephrolithotomy: Does Tubeless Realy Superior? A Prospective Randomized Double-Blind Study %D 2019 %J Yeni Üroloji Dergisi %P 1305-2489-2687-1955 %V 14 %N 3 %R doi: 10.33719/yud.508649 %U 10.33719/yud.508649
ISNAD Kocakgol, Huseyin , Adanur, Senol , Yilmaz, Ali Haydar , Ozkaya, Fatih , Karabulut, Ibrahim , Polat, Ozkan . "A Comparison of Standard Percutaneous Nephrolithotomy and Tubeless Percutaneous Nephrolithotomy: Does Tubeless Realy Superior? A Prospective Randomized Double-Blind Study". Yeni Üroloji Dergisi 14 / 3 (Ekim 2019): 160-165 . https://doi.org/10.33719/yud.508649
AMA Kocakgol H , Adanur S , Yilmaz A , Ozkaya F , Karabulut I , Polat O . A Comparison of Standard Percutaneous Nephrolithotomy and Tubeless Percutaneous Nephrolithotomy: Does Tubeless Realy Superior? A Prospective Randomized Double-Blind Study. Yeni Üroloji Dergisi. 2019; 14(3): 160-165.
Vancouver Kocakgol H , Adanur S , Yilmaz A , Ozkaya F , Karabulut I , Polat O . A Comparison of Standard Percutaneous Nephrolithotomy and Tubeless Percutaneous Nephrolithotomy: Does Tubeless Realy Superior? A Prospective Randomized Double-Blind Study. Yeni Üroloji Dergisi. 2019; 14(3): 165-160.