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Is tubeless percutaneous nephrolithotomy safe and effective in treating giant or staghorn stone ? – A single medical center experience

By: Cheng P-Y., Wu W-C., Chung S-D.
Institutes: Far Eastern Memorial Hospital, Dept. of Surgery, New Taipei City, Taiwan

Introduction & Objectives

Standard percutaneous nephrolithotomy(PNL) remains the wide acceptable procedure in treating renal calculi. Recently, many literatures reported shorter hospital stay and less pain after tubeless PNL procedure. Shaobin et al. 2011 published the first meta-analysis to compare standard and tubeless PNL. However, only patients with low stone burden( <3.7cm2), short operative time (< 64.5 minutes) were included in tubeless PNL group. Here, we included patients with larger stone burden or staghorn stone, looking at if tubeless PNL group still acquire preferable outcome in hospitalization and pain, while is safe as standard PNL.

Material & Methods

From March 2014 to March 2017, 64 cases of standard PNL and 35 cases of tubeless PNL were included respectively. Major stone composition, presence of staghorn stone and maximal stone volume were evaluated as stone factors. Postoperative pain, additional analgesic requirement and length of hospitalization were evaluated as postoperative recovery. Operative time, estimated blood loss, stone free rate, perirenal hematoma and postoperative fever were measured to assess the safety and effectiveness. SPSS Ver. 19 was used for statistic analysis. P value less than 0.05 is considered to be statistically significant.

Results

The demographic characteristics were consistent in these two groups. There were no significant differences between standard and tubeless PNL in stone size, stone composition, and presence of staghorn stone. The mean stone size in tubeless PNL was 4.6 cm3(Table 1). In postoperative recovery, tubeless PNL was associated with less pain(P=0.037), with no difference in additional analgesic requirement. Shorter hospitalization was observed in tubeless PNL group(2.4±0.6 days, P<0.001). No statistically differences were found between standard and tubeless PNL in operative time, estimated blood loss, postoperative perirenal hematoma and fever. Stone free rate was significantly higher among tubeless PNL group(82.8%, P=0.018).

Table 1. Results of comparison between standard PNL vs tubeless PNL
  Standard PNL
(n=64)
Tubeless PNL
(n=35)
P-value
Gender(%)     0.261
Man 52(81.3%) 25(71.4%)  
Woman 12(18.8%) 10(28.5%)  
Age 56.17±7.94 55.06±9.97 0.544
Location(%)     0.075
Right 26(40.6%) 8(22.8%)  
Left 38 27  
Staghorn stone(%) 20(31.3%) 6(17.1%) 0.127
Mean stone size(cm3)* 7.97±11.7 4.61±6 0.118
Stone composition     0.575
Calcium Oxalate 30 21  
Calcium P. Ca3(PO4)2 17 8  
Calcium P. CaHPO4.2H 0 1  
Uric Acid 4 2  
Amm. Mg. Phosphate 1 0  
Operative time(mins) 87.8±33.3 96.4±56.1 0.41
Estimated blood loss(ml) 133.8 102.7 0.267
VAS(POD1) 2.15±1.8 1.37±1.29 0.037
Additional analgesic agent(%) 23(35.9%) 9(25.7%) 0.298
Hospitalization(days) 3.5±1.1 2.4±0.6 <0.001
Stone free 35(54.7%) 29(82.8%) 0.018
Perirenal hematoma 8 2 0.155
Postoperative fever 10 7 0.45
* The maximal stone dimension was measured from 2 perpendicular dimensions on KUB, and size was calculated by X*Y*(X+Y)/5 (cm3).
† VAS: Visual Analogue Scale. POD1: Post operative day 1
  • Event: 4th Meeting of the EAU Section of Urolithiasis (EULIS)
  • Type: Abstract
  • Date: 06-10-2017
  • Views: 43
  • Nr: 118
  • Session: PNL 2 and flex URS
  • Location: Friday 6 October 2017, 15:45 - 17:15, Stolz 1