Tubeless percutaneous nephrolithotomy : a prospective feasibility study and review of previous reports

摘要: OBJECTIVE To evaluate the status of tubeless percutaneous nephrolithotomy (PCNL) in managing renal and upper ureteric calculi, from initial experience a review previous reports. PATIENTS AND METHODS From September 2004 to December 2004, 46 patients were scheduled for PCNL prospective study. Patients with solitary kidney, or undergoing bilateral simultaneous requiring supracostal access also enrolled. needing more than three tracts, significant bleeding residual stone burden necessitating staged second-look nephroscopy excluded. At end procedure, JJ stent was placed antegradely nephrostomy tube avoided. The patients’ demographic data, outcomes during after surgery, complications, success rate, stent-related morbidity analysed. Previous reports reviewed current PCNL. RESULTS Of initially considered only 40 (45 units) assessed. mean size these 33 mm 23 had multiple stones. Three serum creatinine level >2 mg/dL (>177 µmol/L). Five successful PCNL. In all, 51 tracts required 45 units, 30 which supracostal. decrease haemoglobin 1.2 g/dL two blood transfusion There no urine leakage formation urinoma major chest complications tract, except one hydrothorax, managed conservatively. hospital stay 26 h analgesic requirement 40.6 mg diclofenac. Stones completely cleared 87% units 9% fragments < 5 mm. Two extracorporeal lithotripsy calculi. 30% bothersome symptoms 60% needed analgesics and/or antispasmodics treat them. CONCLUSION Tubeless safe effective even access, deranged values those literature suggested need prospective, randomized studies role fibrin sealant cauterization tract