Nephrostomy tube-free percutaneous nephrolithotomy for patients with large stones and staghorn stones

Abstract Background Percutaneous Nephrolithotomy (PCNL) is the preferred technique for treating large renal stones (over 2cm in diameter). It involves keyhole surgery performed through a small skin incision overlying the kidney. Objectives Our study aimed at evaluating the safety and efficacy of local hemostatic sealant (surgiflo®) use in tubeless PCNL to enhance postoperative outcomes of PCNL. Patients and Methods We randomized our patients into two groups, Group A nephrostomy tube was used as standard PCNL, and at group B tubeless PCNL was done followed by injection of the local hemostatic flowable gelatin matrix (surgiflo®) under fluoroscopic guidance in the prone position Results There was no statistically significant difference between two groups regarding demographic data age, sex and BMI (P- value 0.280, 0.736 and 0.440 respectively), stone site and size (P- value 0.525 and 0.533 respectively), operative time (P- value 0.855), intraoperative complications as blood loss and pelvicalyceal perforation, (P- value 0.92 and P- value 0.83 respectively), postoperative complication as fever, haematuria and UTI (P- value 1.000, 0,113 and 1.000 respectivly), and Hb drop (P- value 0.735). Conclusion Tubeless PCNL with hemostatic sealant use is associated with less pain, no leakage from nephrostomy tract, less narcotic agent use, and a shorter hospital stay.

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[37] Assessment of lower calyceal single-access percutaneous nephrolithotomy (PCNL) for staghorn stones: A single surgeon and a single centre experience at King Abdulaziz Medical City, Riyadh

Arab Journal of Urology ◽

10.1016/j.aju.2018.10.084 ◽

2018 ◽

Vol 16 (sup1) ◽

pp. S18-S18

Author(s):

Ahmed Aljuhayman ◽

Yahya Ghazwani

Keyword(s):

Percutaneous Nephrolithotomy ◽

Single Centre ◽

Single Access ◽

Single Centre Experience ◽

Medical City ◽

Staghorn Stones

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Pain After Percutaneous Nephrolithotomy: Impact of Nephrostomy Tube Size

The Journal of Urology ◽

10.1016/s0022-5347(05)61044-0 ◽

2005 ◽

Vol 173 (4) ◽

pp. 1199-1200 ◽

Cited By ~ 2

Author(s):

Ralph V. Clayman

Keyword(s):

Percutaneous Nephrolithotomy ◽

Nephrostomy Tube ◽

Tube Size

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Safety and efficacy of the supracostal access for percutaneous nephrolithotomy: Our initial experience

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v37i1.7797 ◽

1970 ◽

Vol 37 (1) ◽

pp. 34-38 ◽

Cited By ~ 4

Author(s):

M Hossain ◽

ATMA Ullah ◽

S Regmi ◽

H Rahman ◽

SAMG Kibria

Keyword(s):

Percutaneous Nephrolithotomy ◽

Complication Rate ◽

Postoperative Hospital Stay ◽

Initial Experience ◽

Safety And Efficacy ◽

Stone Clearance ◽

Secondary Procedures ◽

Residual Stones ◽

Staghorn Stones ◽

Made In

The aim of this study was to evaluate the safety and efficacy of the supracostal access for percutaneous nephrolithotomy (PCNL). Between July 2007 and June 2010, 122 patients underwent PCNL, of whom 28 (23%) had supracostal access. All procedures were performed in a single sitting under general anesthesia. The data were analysed for indications, stone clearance rates and the complications associated with supracostal puncture. The indications for a supracostal access were staghorn stones (50%), pelvis stones (28.5%), calyceal stones in high-lying kidney (18%) and upper ureter/ureteric stones (3.5%). All tracts were made in the 11th intercostal space. Single tract access was used in 22 cases (78%), but 6 (22%) required a second tract. Additional punctures were required mainly for staghorn stones (4 out of 14). Overall, 82% of the patients were rendered stone free or had clinically insignificant residual stones with PCNL monotherapy, and this increased to 96% with secondary procedures. In patients with staghorn stones, they were completely cleared in 78%. Overall complication rate was 28% and included hydrothorax in 3 (10%) patients, which required insertion of a chest tube. One (3.5%) patient developed haemothorax secondary to injury of the intercostal artery, pelvic perforation in 1 (3.5%), perinephric collection in 1 (3.5%), infection/sepsis in 2 (7%). Except those patients who had complication, all other patient recovered uneventfully. Postoperative hospital stay ranged from 2 to 9 days. In conclusion, supracostal access gives high clearance rate with acceptable complications and should not be avoided for fear of chest complications. DOI: http://dx.doi.org/10.3329/bmrcb.v37i1.7797 Bangladesh Med Res Counc Bull 2011; 37: 34 - 38

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