Objective: To prescribe our experience in performing tubeless percutaneous nephrolithotomy and how we diagnose its indication, safety, and effectiveness.
Methods: Two hundred and fifty-three patients with renal stones were enrolled for a tubeless percutaneous nephrolithotomy with an externalized ureteric catheter. Their ages ranged between 4 to 80 years old, and of the sample, 168 were male and 85 were female. The stones ranged from 15 to 80 mm in size and were located in different areas of the pelvicalceal system. The majority of the procedures were conducted in the prone position while 24 cases were supine. The majority of the patients were treated with a single puncture, 20 patients were treated with double punctures, and 2 patients required 3 punctures. Haemostatic substances were used in only 50 of the patients, with no significant differences when compared to 50 who were treated without. In addition, 40 patients had a history of previous ipsilateral renal surgery, 20 had renal impairments, and 15 had a solitary kidney.
Results: The mean operative time was 44.34 minutes, the mean stent time was 1.1 days, and the mean hospital stay was 1.6 days. The mean drop in Hb levels was 1.67gm/dl, with 3.95% of the patients needing blood transfusions and 12.65% needing postoperative analgesia. The stone-free rate was 91.76% while the overall success rate was 97.25%. Complications were encountered in 7.9% of the patients, most of which were minor and were managed conservatively. One patient suffered from a colonic injury and 2 patients suffered from hydrothorax.
Conclusion: In the era of tubeless percutaneous nephrolithotomy, nephrostomy tube insertion should only be used for large residuals that need a second look. Tubeless percutaneous nephrolithotomy should be extended to include large stones, multiple numbers, multiple punctures, prone or supine positions, sub- or supracostal approaches, recurrent cases, solitary kidneys, renal impairment, extended time, and bilateral simultaneous cases. It’s safe and effective, and it decreases postoperative pain, discomfort, the need for analgesia, and the length of hospital stay.
Tawfik H Al-Ba’adani, Khaled Telha, Shihab Al-Gormozi, Khalid Al-Badwey, Gamil Al-Alimi, Mohammed Alwan, Nabil Al-Gonaid, Ibraheim H El-Nono
KEYWORDS: Percutaneous, nephrolithotomy, tubeless, ureteric, catheter
CORRESPONDENCE: Tawfik H Al-Ba’adani, MD, Urology Department, Urology and Nephrology Center, Al-Thawra Modern General/Teaching Hospital, Medical College-Sana’a University, Sana’a, Yemen ( ).
CITATION: UroToday Int J. 2012 June;5(3):art 17.
doi: http://dx.doi.org/10.3834/uij.1944-5784.2012.06.04
