Elsevier

Urology

Volume 66, Issue 3, September 2005, Pages 500-504
Urology

Adult urology
Safety and efficacy of bilateral simultaneous tubeless percutaneous nephrolithotomy

https://doi.org/10.1016/j.urology.2005.03.064Get rights and content

Abstract

Objectives

To evaluate the feasibility and safety of bilateral simultaneous tubeless percutaneous nephrolithotomy (PCNL).

Methods

From August 2004 to January 2005, 10 patients underwent bilateral simultaneous tubeless PCNL. Patients needing more than two percutaneous tracts, having significant intraoperative bleeding, or a residual stone burden were excluded from the study group. The outcome of these 10 patients was compared with a control group of 10 patients who had previously undergone bilateral simultaneous PCNL with routine placement of a nephrostomy tube.

Results

The two groups had comparable demographic data, except for a greater stone burden in the right renal units in patients undergoing standard PCNL. The study and control groups needed a total of 22 and 23 tracts, respectively. The difference in the mean drop in hemoglobin, transfusion requirement, and complication rate between the two groups was not statistically significant. Patients undergoing tubeless PCNL required less analgesia (P = 0.001) and were discharged 20 hours earlier (40 versus 60 hours) than those in the control group. However, the difference in mean hospital stay was not statistically significant owing to the small sample size. Complete stone clearance was achieved in 80% of the renal units in the study group and 75% of the renal units in the control group. Three renal units in the tubeless group and four in the standard PCNL group had less than 5-mm residual fragments.

Conclusions

Bilateral simultaneous tubeless PCNL appears to be a feasible, safe, and effective procedure offering potential advantages of decreased analgesic requirement and hospital stay without increasing the complications. Additional clinical studies with a larger number of patients are required to confirm these potential benefits.

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.

References (17)

There are more references available in the full text version of this article.

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    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.

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