Truly tubeless percutaneous nephrolithotomy
| Autor: | Stephen R. Keoghane, Byron H. Walmsley, Richard J. Cetti |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Hospitals General Hemoglobins Kidney Calculi Young Adult medicine Humans Blood Transfusion Percutaneous nephrolithotomy Ureteric stent Abscess Aged Nephrostomy Percutaneous Aged 80 and over Pain Postoperative business.industry Letters and Comments Stent General Medicine Length of Stay Middle Aged medicine.disease Surgery Catheter Treatment Outcome Nephrostomy Drainage Female Tamponade Analgesia Complication business |
| Popis: | The technique of percutaneous nephrolithotomy (PCNL) has been steadily refined since its development in the 1970s. As the procedure has evolved, avoiding the potential morbidity of a large bore nephrostomy tube has led to the search for alternatives to drain the kidney. These have included a smaller bore nephrostomy, externalised ureteric catheter, or internal ureteric stent. Desai and colleagues1 compared uncomplicated PCNLs randomised to have a small 9-Fr nephrostomy versus a conventional 20-Fr tube versus a JJ stent. The group with a smaller tube had reduced analgesic requirements and hospital stay, without additional complications, and the stented group had the lowest analgesic requirement and shortest hospital stay. However, this approach does induce stent-related morbidity which is variable in nature but sometimes significantly affects the patient's quality of life and requires a separate procedure for removal.1 In a recent series of 170 patients in whom a stent was placed post PCNL, five required a postoperative emergency nephrostomy insertion for obstruction.2 In the series of Yates et al.,3 immediate and early complication rates were higher in the stented group including haematuria requiring re-admission, clot colic, stent pain and stent migration. They also described a delayed presentation of perinephric haematoma and abscess formation.3 True tubeless PCNL has been evaluated by Crook and colleagues4,5 and found to be safe and well-tolerated. No differences were seen in stone free rates, transfusion, and complication or re-admission rates. Mean length of stay was shorter in the tubeless group (2.3 days vs 3.4 days).4,5 Yates and colleagues advocate that a nephrostomy-free PCNL should be adopted as the standard for patients requiring PCNL in the UK. We would argue that this exposes patients to an increased risk of complication, as demonstrated by their study. Instead, patients should be treated as individuals. If postoperative bleeding or retained calculi are a possibility requiring a ‘second-look’, then a nephrostomy should be sited to provide access or a tamponade effect. The use of a ureteric stent or catheter provides neither of these. They should otherwise be left truly tubeless. By stenting every patient, are the authors' treating the patient or themselves? |
| Databáze: | OpenAIRE |
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