METHODS: The present study was designed to include 100 patients with upper urinary tract calculi who were prospectively randomized to tubeless (group 1) and standard (group 2) PCNL using closed envelopes. The hemoglobin and hematocrit deficits, development of hematuria and hematoma, and blood transfusion rate were compared to assess the hemostatic effect. The drainage effect was evaluated by comparing the incidence of postoperative urinary leakage, urinoma, and/or hydrothorax development.
RESULTS: A total of 123 patients were assessed for eligibility, and 100 fulfilled the study requirements. The hemoglobin and hematocrit deficits were comparable. Significant hematuria and/or hematoma were recorded in 5 and 4 patients in groups 1 and 2, respectively. Blood transfusion was required in 5 and 6 patients in groups 1 and 2, respectively. One patient with chronic kidney disease in the tubeless group required abdominal exploration because of respiratory embarrassment and a large hematoma. Transient urinary leakage was recorded in 2 and 31 patients in groups 1 and 2, respectively (P < .05). No urinoma developed. Hemothorax developed in 1 patient in the tubeless group with supracostal puncture. Postoperative pain was significantly less in the tubeless group. No statistically significant difference was found in the success rate, morbidity, or hospital stay between the 2 groups.
CONCLUSION: The hemostatic and drainage functions of the nephrostomy tube were modest. However, the tubeless approach might be not suitable for the patients with chronic kidney disease or a supracostal approach.
Written by:
Shoma AM, Elshal AM. Are you the author?
Urology and Nephrology Center, Mansoura, Egypt.
Reference: Urology. 2011 Nov 28. Epub ahead of print.
doi: 10.1016/j.urology.2011.09.042
PubMed Abstract
PMID: 22130359
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