Tubeless percutaneous nephrolithotomy: a prospective feasibility study and review of previous reports
| Autor: | Vikram B. Kausik, Jignesh N. Shah, Hemendra N. Shah, Sunil S. Hegde, Manish B. Bansal |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
Adult
Male Nephrology medicine.medical_specialty Ureteral Calculi Percutaneous Urology medicine.medical_treatment Nephroscopy Kidney Calculi Postoperative Complications Internal medicine medicine Humans Ureteric stent Percutaneous nephrolithotomy Aged Nephrostomy Percutaneous medicine.diagnostic_test business.industry Length of Stay Middle Aged medicine.disease Surgery Lithotomy position Treatment Outcome Nephrostomy Feasibility Studies Female business Kidney disease |
| Zdroj: | BJU International. 96:879-883 |
| ISSN: | 1464-410X 1464-4096 |
| DOI: | 10.1111/j.1464-410x.2005.05730.x |
| Popis: | OBJECTIVE To evaluate the status of tubeless percutaneous nephrolithotomy (PCNL) in managing renal and upper ureteric calculi, from initial experience and a review of previous reports. PATIENTS AND METHODS From September 2004 to December 2004, 46 patients were scheduled for tubeless PCNL in a prospective study. Patients with solitary kidney, or undergoing bilateral simultaneous PCNL or requiring a supracostal access were also enrolled. Patients needing more than three percutaneous access tracts, or with significant bleeding or a significant residual stone burden necessitating a staged second-look nephroscopy were excluded. At the end of the procedure, a JJ ureteric stent was placed antegradely and a nephrostomy tube avoided. The patients’ demographic data, the outcomes during and after surgery, complications, success rate, and stent-related morbidity were analysed. Previous reports were reviewed to evaluate the current status of tubeless PCNL. RESULTS Of the 46 patients initially considered only 40 (45 renal units) were assessed. The mean stone size in these patients was 33 mm and 23 patients had multiple stones. Three patients had a serum creatinine level of >2 mg/dL (>177 µmol/L). Five patients had successful bilateral simultaneous tubeless PCNL. In all, 51 tracts were required in 45 renal units, 30 of which were supracostal. The mean decrease in haemoglobin was 1.2 g/dL and two patients required a blood transfusion after PCNL. There was no urine leakage or formation of urinoma after surgery, and no major chest complications in patients requiring a supracostal access tract, except for one with hydrothorax, managed conservatively. The mean hospital stay was 26 h and analgesic requirement 40.6 mg of diclofenac. Stones were completely cleared in 87% of renal units and 9% had residual fragments of |
| Databáze: | OpenAIRE |
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