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International Journal of Surgery Science
Vol. 5, Issue 1, Part E (2021)

Tubeless percutaneous nephrolithotomy (PCNL) as a standard treatment: observations from a tertiary care hospital

Author(s): Dr. Rehan Fareed, Dr. Huma Shamim and Dr. Brijesh Kumar Agarwal
Abstract: Aim: To observe the safety and efficacy of tubeless percutaneous nephrolithotomy (PCNL).
Materials and methods: Since January 2016 to 2019, 210 consecutive tubeless PCNL performed at our hospital were enrolled into this retrospective chart review. The average age of the patients (134 males and 76 females) was 57 ± 11.8 years, and 7 patients were between 8 to 12 years. The stone characteristics were 71 pelvic or calyceal solitary stones, 62 non-complete staghorn kidney stones, 17 ureteral stones, 32 kidney + ureteral stones (concomitant kidney and ureteral stones), and 28 complete staghorn stones. Mean stone size range 3. 5+2.8[range 0.7cm to 11.8 cm]. Patient’s position was prone. Tract size varied from 26 F to 30 F and number of tracts varied single tract to 4 tracts.
Results: The average operative time was 85.0 ± 29.4 minutes. Average hospital stay was 21.7 hrs (6 patients had longer stay due to fever) and the blood transfusion rate was 1.4%. Postoperative fever was noted in 19 (9.02%) patients, no urosepsis was noted. No Pulmonary complications and mortality noted. No re exploration was done. No major leak was noted. Angioembolisation rate 0.95%. We did not use any haemoseal ent or cautery in the tracts.
Conclusion: PNT serves purpose of relook PCNL and drainage of urine if there is pyonephrosis or surgeon has doubt about PUJ competency like edema, perforation etc., but other factors like bleeding, fever, sepsis, AV aneurysm, AV fistula, pulmonary complications if puncture is in upper calyx, mortality are comparable to standard PCNL and advantage of tubeless PCNL are reduced post-operative pain which leads to lesser analgesia requirement, less apprehension as no tube is there, therefore more comfort, early discharge and indirectly less hospital expenses, early return to work. Our observation is that Tubeless PCNL is effective and safe. There is limitation of our study that our sample size is small and it is not a case-control study, therefore significance was not established.
Pages: 277-280  |  29 Views  14 Downloads
How to cite this article:
Dr. Rehan Fareed, Dr. Huma Shamim, Dr. Brijesh Kumar Agarwal. Tubeless percutaneous nephrolithotomy (PCNL) as a standard treatment: observations from a tertiary care hospital. Int J Surg Sci 2021;5(1):277-280. DOI: https://doi.org/10.33545/surgery.2021.v5.i1e.623
International Journal of Surgery Science