Experience and Performance of Tubeless Percutaneous Nephrolitotomy

##plugins.themes.bootstrap3.article.main##

Roman Sergiychuk

Abstract

Percutaneous nephrolithotripsy is a standard method in the treatment of nephrolithiasis, in the final stage of which nephrostomy drainage is established, but there are known methods of performing this operation without nephrostomy.


This article shows our experience of performing tubeless percutaneous nephrolithotomy, as well as evaluates the safety and efficacy of tubeless PNL with placement of a JJ-stent.


The objective: establish opportunities to perform a tubeless mini percutaneous nephrolithotomy and evaluate the safety and effectiveness of its implementation.


Materials and methods. For the period 2017–2021. performed more than 500 percutaneous nephrolitotomy. 53 mini-PNL tubeless (II group), the other group (I group) included 58 patients who underwent mini-PNL by standard method. There were no significant differences in age and sex, location and size of stones in the study groups (p>0,05). All operations were performed under regional anesthesia.


Results. The average duration of the operation in group I was 57,2±17,9 minutes, in group II 54,9±15,6 minutes (p>0,05). The average drop of hemoglobin in I group was 0,39 g/l compared with 4,1 g/l in II group. The difference between the groups was not statistically significant (p>0,05). The level of pain in this study was assessed using a visual analog scale, in group I the average pain was 3,7 compared with 1,6 in patients of II group (p<0,05). Accordingly, the necessity of analgesia for I group was higher and amounted to 58,4±17,3 mg of dexketoprofen, against 27,3±15,2 mg of dexketoprofen in the second group (p<0,05).


Postoperative fever ≥38,0 °С was observed in 5 (8,6%) patients who performing the operation according to the standard method, and 1 (1,9%) of the patient (p>0,05) who performed drainage-free PNL. The stone free rate in I group was achieved in 56 (96,6%), in group II in 53 (100%) (p>0,05). The postoperative hospital stay in I group was 2,92±0,24 days, and in II group – 1,22±0,11 days (p>0,05). Analyzing the results of tubeless percutaneous nephrolithotomy, we can say that its effectiveness is due to careful selection of patients and strict compliance with the rules of PNL.


Conclusions. This study demonstrates the advantages of tubeless percutaneous nephrolithotomy over standard methods in the form of reducing the level of postoperative pain, according to the need for analgesics, and reduces the duration of postoperative hospital stay. However, it should be noted that drainage techniques of percutaneous nephrolithotomy should be performed in strictly selected patients.

##plugins.themes.bootstrap3.article.details##

Section
Urology
Author Biography

Roman Sergiychuk, Shupyk National Healthcare University of Ukraine

Roman V. Sergiychuk,

Department of Urology

References

Tiselius HG. Epidemiology and medical management of stone disease. BJU Int. 2003;91:758–67.

Teichman JM. Clinical practice. Acute renal colic from ureteral calculus. N Engl J Med. 2004;350:684–93.

Fernström I, Johansson B. Percutaneous Pyelolithotomy. Scandinavian Journal Of Urology And Nephrology. 1976;10(3):257–9.

Türk C, Neisius A, Petrik A, et al. EAU Guidelines: Urolithiasis. Uroweb. 2021. Available from: https://uroweb.org/guideline/urolithiasis/

Osther P, Razvi H, Liatsikos E, Averch T, Crisci A & Garcia J et al. Percutaneous Nephrolithotomy Among Patients with Renal Anomalies: Patient Characteristics and Outcomes; a Subgroup Analysis of the Clinical Research Office of the Endourological Society Global Percutaneous Nephrolithotomy Study. Journal Of Endourology. 2011;25(10):1627–32.

Castaneda-Zuniga W, Formanek A, Tadavarthy M, Vlodaver Z, Edwards J, Zollikofer C, Amplatz K. The mechanism of balloon angioplasty. Radiology. 1980;135(3):565–1.

Alken P. The telescope dilators. World Journal Of Urology. 1985;3(1):7–10.

Lahme S, Bichler KH, Strohmaier WL, et al. Minimally invasive PCNL in patients with renal pelvic and calyceal stones. Eur. Urol. 2001;40(6):619–24.

Heinze A, Gozen AS, Rassweiler J. Tract sizes in percutaneous nephrolithotomy: does miniaturization improve outcome? Curr Opin Urol. 2019;29(2):118–23.

Lee JY, Jeh SU, Kim MD, Kang DH, Kwon JK, Ham WS, Cho KS. Intraoperative and postoperative feasibility and safety of total tubeless, tubeless, smallbore tube, and standard percutaneous nephrolithotomy: a systematic review and network meta-analysis of 16 randomized controlled trials. BMC Urology. 2017;17(1):1–16.

Hennessey DB, Kinnear NK, Troy A, Angus D, Bolton DM, Webb DR. Mini PCNL for renal calculi: does size matter? BJU Int. 2017;119(5):39–46.

Lahme S. Miniaturisation of PCNL. Urolithiasis. 2018;46(1):99–106.

Heinze A, Gozen AS, Rassweiler J. Tract sizes in percutaneous nephrolithotomy: does miniaturization improve outcome? Curr Opin Urol. 2019;29(2):118–23.

Wickham J, Miller R, Kellett M, Payne S. Percutaneous Nephrolithotomy: One Stage or Two? Journal Of Urology. 1985;134(3):634.

Winfield H, Weyman P, Clayman R. Percutaneous Nephrostolithotomy: Complications of Premature Nephrostomy Tube Removal. Journal Of Urology. 1986;136(1):77–9.

Bellman G, Davidoff R, Candela J, Gerspach J, Kurtz S, Stou L. Tubeless Percutaneous Renal Surgery. The Journal Of Urology. 1997:1578–82.

Shah HN, Sodha HS, Khandkar AA, Kharodawala S, Hegde SS, Bansal MB. A randomized trial evaluating type of nephrostomy drainage after percutaneous nephrolithotomy: Small bore v tubeless. J Endourol. 2008;22:1433–9.

Istanbulluoglu MO, Ozturk B, Gonen M, Cicek T, Ozkardes H. Effectiveness of totally tubeless percutaneous nephrolithotomy in selected patients: a prospective randomized study. Int Urol Nephrol. 2009;41(3):541–5.

Xun Y, Wang Q, Hu H, Lu Y, Zhang J, Qin B, Wang S. Tubeless versus standard percutaneous nephrolithotomy: an update meta-analysis. BMC Urology. 2017;17(1).

Shpall A, Parekh A & Bellman G. Modification of tubeless percutaneous nephrolithotomy: Anterograde stent with flank tether. Urology. 2006;68(4):880–2.

Tirtayasa PM, Yuri P, Birowo P, Rasyid N. Safety of tubeless or totally tubeless drainage and nephrostomy tube as a drainage following percutaneous nephrolithotomy: A comprehensive review. Asian Journal of Surgery. 2017;40(6):419–23.

Quibo L, Liang G, Jie L. et al. Total tubeless versus standard percutaneous nephrolithotomy: a meta-analysis. Minim Invasive Ther Allied Technol. (2020).29(2);61–69.

Choi SW, Kim KS, Kim JH, et al. Totally tubeless versus standard percutaneous nephrolithotomy for renal stones: analysis of clinical outcomes and cost. J Endourol. 2014;28:1487–94.

Sahalevych AY, Vozyanov SA, Dzhuran BV, Kohut VV, Haiseniuk FZ, Marynychenko MV. Drainage percutaneous nephrolithotripsy. Our first experience. Clinical surgery. 2016;9:43–46.

Sagalevich AI, Vozianov OS, Ozhohin VV, Dzhuran BV, Kogut VV, Gaysenyuk FZ, Sergiychuk RV. Treatment of ureterolithiasis with the use of percutaneous antegrade ureterolithotripsy. Zaporozhye medical journal. 2018;2(107):162–6.