EAU 2018: Are the Different Renal Drainage Options after Percutaneous Nephrolithotomy Different in Terms of Efficacy and Safety?

Copenhagen, Denmark (UroToday.com) Dr. Pimentel Torres, clinical urologist from the Hospital de Braga in Braga, Portugal, presented his center’s findings on the effectivity of certain drainage options following percutaneous nephrolithotomy (PCNL): Percutaneous Nephrostomy and Ureteral Stents. The reason for this study stems from the issues of current PCNL drainage modalities. In current clinical practice, a nephrostomy tube is often used even though it is widely known to cause discomfort and prolonged hospitalization. On the other hand, the best type of ureteral catheter following PCNL has yet to be classified. Dr. Pimentel Torres and his team set out to determine whether or not the tubeless technique is a safe and efficacious alternative to the nephrostomy tube, while determining the advantages and disadvantages of single and double loop ureteral stents.

To determine an answer to this proposed question, Dr. Pimentel Torres conducted a retrospective analysis of clinical data of patients who underwent PCNL between 2011 and 2017. Patients were divided into groups based on whether they had a nephrostomy or a single/double loop stent placed following PCNL treatment for renal stones. Patient gender, stone size, residual stones, and complications were recorded for each patient.

Through this research, it was shown that a nephrostomy tube was associated with a significantly higher rate of total complications than the tubeless technique. Nephrostomy use was also correlated with longer hospital stays, twice as long as the tubeless technique (4 vs. 2 days, respectively). When comparing stent types to each other, no observable difference was observed in regard to postoperative complications or median length of stay. It is of note that nephrostomy and double loop stent placement was underwent more frequently in patients with more complex stones.

Through this study, the use of postoperative stent placement is a safe and viable alternative to a nephrostomy tube following PCNL. Of these tubeless methods, a single loop stent is most ideal since it has been shown to be a safe alternative to nephrostomy, does not require cystoscopy for removal, and is not associated with post-discharge pain. Though mentioned earlier in the results, Dr. Pimentel Torres claimed that he was not able to make any conclusions regarding the complexity of stones associated with nephrostomy placement and double loop stents due to an apparent selection bias. Nonetheless, this study may allow urologists to consider using stents to improve patient quality of life following PCNL.

Presented by: Pimentel Torres J. MD

Co-Authors: Oliveira J.N. , Mota P. , Cordeiro A. , Morais N. , Anacleto S. , Lima E.
Author Information: Hospital de Braga, Dept. of Urology, Braga, Portugal

Written by: Zachary Valley MD, Department of Urology, University of California-Irvine at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark

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