Adult urologySafety and efficacy of bilateral simultaneous tubeless percutaneous nephrolithotomy
Section snippets
Patients
From August 2004 to January 2005, 12 patients with bilateral large renal and/or upper ureteral calculi, irrespective of the number and size of the stones, amount of hydronephrosis, or the renal parameters, were scheduled to undergo bilateral simultaneous tubeless PCNL. Patients requiring supracostal access were also enrolled in the study. The exclusion criteria for the study were patients needing more than two percutaneous tracts, the presence of significant bleeding that persisted throughout
Results
The two groups had comparable demographic data (Table I). The stone burden was greater in the right renal units in the control group (P = 0.002). However, the average number of tracts required in both groups was comparable. The operating time was longer in the control group, probably owing to the relatively larger stone burden in this group. One patient in the study group had postoperative hemorrhage, with a hemoglobin drop of 6.2 g%. He needed 4 U of blood transfusion postoperatively. One
Comment
Bilateral simultaneous PCNL has been found to be feasible, safe, and cost-effective.1, 2, 3, 4 It helps to decrease the hospital stay, pain, and analgesic requirement, thus allowing an earlier return to normal activity and also probably reducing the psychological impact of two operations.1
After the initial description of the feasibility of tubeless PCNL by Wickham et al.13 in 1984, Bellman et al.5 recently revisited it. They proposed that creation of a nephrostomy tract is an example of
Conclusions
Our initial experience has suggested that bilateral simultaneous tubeless PCNL appears feasible and safe with advantages of reduced postoperative analgesia requirement and hospital stay. Additional clinical studies with larger numbers of patients are required to confirm these potential benefits.
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Cited by (47)
A prospective, single-centered, cohort study comparing the treatment of renal stones by following PCNL types: Standard, tubeless & totally tubeless
2022, Annals of Medicine and SurgeryCitation Excerpt :However, Paul and associates [31] concluded that to perform a tubeless technique, a strict inclusion criterion needs to be decided. According to other studies [15,30–34], tubeless PCNL is preferred due to safety and efficiency even if the patients have deranged kidney functions or have a single kidney or those in need of bilateral simultaneous PCNL or with two to three access tracts or supracostal access. SFRs were found to be much higher in totally tubeless and tubeless PCNL as compared to the standard technique.
Bilateral Single-session vs Staged Mini-percutaneous Nephrolithotomy for Renal Stones: A Comparative Study
2018, UrologyCitation Excerpt :Thus, this time was needed for confirming removal of all stones using nephroscopy and fluoroscopy, followed by insertion of the PCN or antegrade DJ then changing the position of the fluoroscopy to the other side of the patient. In a systematic review,3 which included 11 studies with 594 patients who were subjected to BSS-PNL,5-9,11,14,17,25-27 the approach was performed as planned in 87.1% (71.4%-100%) of cases. In the remaining cases, the contralateral side was postponed due to 1 or more factors of the previously mentioned criteria.
Percutaneous extraction of a ureteral stent after tubeless percutaneous nephrolithotomy
2015, Revista Mexicana de UrologiaPercutaneous Stone Removal
2011, European Urology, SupplementsCitation Excerpt :A tubeless performance with a supracostal approach might be feasible with a low risk of major complications, with the advantage of being superior in terms of reduction of length of hospital stay and pain [38]. Even for special indications like children, obese patients, or large stone burden on both sides, a tubeless procedure seems to be feasible with reduced postoperative morbidity [38,40]. The tubeless procedure showed significant reduction in length of hospitalization compared with groups with either a small or a big nephrostomy tube [37,38,41].
Tubeless percutaneous nephrolithotomy-The new standard of care?
2010, Journal of UrologyCitation Excerpt :These studies suggest that a tubeless PNL approach is superior to standard NT placement in terms of postoperative pain and hospital stay, without increasing postoperative intrathoracic complications. Additional reports on supracostal tubeless PNL suggest low rates of major complications, namely major bleeding (6.6%) minimal hydrothorax (7.6%) and pleural effusion treated conservatively (10%).14,27,32 Overall data from multiple studies support the feasibility of tubeless PNL, even in the supracostal approach, with the advantage of decreased pain and analgesia requirements following the procedure, and without increasing postoperative complications.
Exit Strategy After PCNL
2022, Minimally Invasive Percutaneous Nephrolithotomy