PNL Articles

Percutaneous nephrolithotomy (PNL) has long been considered the bench-mark intervention for complicated urinary stones and has undergone important advancements since it was first described. Given the proven safety and efficacy of PNL, simultaneous bilateral PNL has been attempted for bilateral renal calculi to cut down on total procedure costs.

Lower pole calyceal stones (LPS) represent lower spontaneous passage rates and, therefore, require several interventional treatment approaches. The aim of this survey study was to investigate the attitudes of the urology practitioners and the factors affecting their decision making in the management of small asymptomatic LPS.

Percutaneous nephrolithotomy is a common surgical treatment for large and complex stones within the intrarenal collecting system. A wide variety of complications can result from this procedure, including bleeding, injury to surrounding structures, infection, positioning-related injuries, thromboembolic disease, and even death.

In developed countries, the incidence of cardiovascular disease is increasing, therefore, anticoagulant and antiplatelet drugs are a widespread treatment nowadays. Percutaneous nephrolithotomy (PNL) is the first-line treatment for large or complex stones (> 2 cm) and remains an alternative for the smaller ones.

ABSTRACT

Objective: To study the ability of rendering our patients tube and stent free after percutaneous nephrolithotomy (PNL).

Patients and Methods: Between February 2011 and March 2012, 38 patients (40 units) with 20 to 60 mm (mean: 31.17) renal stones underwent tubeless stentless PNL. The sample consisted of 28 males and 10 females, and their ages ranged between 17 and 65 years (mean: 33.7). Twenty-two cases were in the right kidney while 18 were in the left, and the stones were bilateral in 2. Most of the stones were in the renal pelvis and lower calyx and removed through the lower calyx subcostal with a single puncture. After ensuring that the patient was almost stone free, no nephrostomy was left and the ureteric catheter was removed within 30 minutes.

Results: Operative time ranged between 15 and 80 mins (mean: 42.34) and no blood transfusion was needed. The mean reduction in hemoglobin level was 1.52 gm (range: 0.3 to 4.8) and the hospital stay ranged between 12 to 36 hours (mean: 17.7). The success rate was 100% while the stone free rate was 95%. Analgesia was needed in 20% of cases. There were no intraoperative complications while postoperative complications occurred in 3 patients (9.7%) in the form of leakage, perirenal collection, and secondary hemorrhage.

Conclusion: Tubeless, stentless PNL is safe with acceptable complications, provided patients are stone free with no or minimal extravasations, have acceptable bleeding, and there is a single puncture. It decreases hospital stay, postoperative pain, and the need for analgesia, and subsequently lowered work abstinence. A further study with a larger sample is needed.

Tawfik H. Al- Ba’adani, Qaid Al-Ghashami, Shihab Al Germozi, Salah Ahmed, Shoukry Al Flahi, Ibrahim Al-Nadhari, Gamil Al Alimi, Walid Al Asbahi, Khalid Telha, Ibrahim El-Nono

Urology Department, Urology and Nephrology Center, Thawra Hospital, Sana'a University, Sana'a, Yemen

Submitted May 16, 2013 - Accepted for Publication September 13, 2013

KEYWORDS: Stentless, tubeless, PNL

CORRESPONDENCE: Tawfik H. Al- Ba’adani, Urology Department, Urology and Nephrology Center, Thawra Hospital, Sana'a University, Sana'a, Yemen ()

CITATION: UroToday Int J. 2013 October;6(5):art 57. http://dx.doi.org/10.3834/uij.1944-5784.2013.10.04

OBJECTIVE - To study kidney injury molecule-1 (KIM-1) biomarker levels, indicating renal tubular damage, in patients with kidney stones and in those who underwent minimally invasive method stone treatment.

PATIENTS AND METHODS - Sixty patients with renal stones between 10 and 20 mm were included into the present study.