INTRODUCTION: Tubeless PCNL, though an accepted technique by now, continues to suffer from two major limitations: the need for post-operative cystoscopy for ureteral stent removal, and inability to perform a 'second-look' procedure for any residual fragments.
We share our experience with a modification of the standard tubeless PCNL technique that allows us to prevail over these shortcomings.
METHODS: 166 patients selected to have PCNL were randomized into two groups of 83 each; Group A (control group): the patients underwent standard PCNL with the insertion of a nephrostomy tube at completion; Group B: (intervention group): modified tubeless PCNL with a double-J stent inserted with a tether attached to its proximal end, taken out through the percutaneous tract. The nephrostomy tube in group A was removed post-operatively on second or third day, whereas group B had their stent removed directly by pulling the attached tether within office setting 10-14 days post-operatively.
RESULTS: The need for post-operative analgesia was significantly higher in group A compared to group B (mean dose of tramadol required 128mg vs 81.3mg) (p< 0.001). Four patients had post-operative urinary leak from the nephrostomy site in group A, whereas there were no leaks in group B. Group B patients spent significantly shorter average time in hospital (21.6 hours) compared to group A (54 hours)(p< 0.001). Two of the patients in group B required 'second-look' procedure, performed by the insertion of a guide wire down the stent which was pulled out partially by its tether. Presence of the tether in the flank or the process of subsequent removal did not cause any discomfort to any patient.
CONCLUSION: The present study demonstrates that tubeless PCNL with tethered DJ stent overcomes its main drawback, namely the need for cystoscopy for stent removal, and also allows access to the pelvi-calyceal system for 'second-look' nephroscopy.
Agrawal MS Dr, Sharma M, Agarwal K. Are you the author?
Rainbow hospital, dept of urology, Mathura road, Agra, Agra, UP, India.
Reference: J Endourol. 2014 Jan 23. Epub ahead of print.