TUBELESS VERSUS STANDARD PERCUTANEOUS NEPHROLITHOTOMY AT DUHOK PROVINCE, KURDISTAN, IRAQ
Background: Urolithiasis is one of the common diseases of human being. The introduction of endoscopic and minimally invasive procedures [extra corporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and Ureteroscopy] has revolutionized the treatment of stone disease. Percutaneous nephrolithotomy is the gold standard for the treatment of renal calculi. Recently, modifications to the standard PCNL regarding tube placement have evolved. This study aimed to evaluate the safety, benefits and feasibility of tubeless PCNL in comparison to the standard PCNL.
Subject and Methods: Fifty patients were prospectively randomized equally into two groups, group 1 (tubeless PCNL) and group 2 (standard PCNL). All patients underwent PCNL for the treatment of upper urinary tract stones. The operations were done under general anesthesia with antimicrobial cover; of them 29 were males and 21 were females. In group 1, 25 patients had no nephrostomy tube placed while in group 2, 25(50%) patients had nephrostomy tube. We evaluated and compared between both groups in operative time, length of hospitalization, analgesic requirements; stone free rate and post-operative complications (infection or blood transfusion).
Results: Thirty-one patients (62%) in both groups had a single stone, while 19 patients (38%) had multiple stones. PCNL alone was successful in completely clearing all the stone(s) in (88%) of patients, while 5 patients (10%) were treated by ESWL and one patient required another session of PCNL. The mean operative time for group 1 was 56.72 minutes vs. 77.0 minutes for group 2. The mean hospital stay was 1.2 days and 2.32 days in group 1 and group 2 respectively. Only 12% of group1 needed more than 2 analgesia (injectable), while 52% of group2 needs more than 2 analgesia (injectable). Blood transfusion was required in one patient (4%) of each group.
Conclusions: Tubeless PCNL is a safe and effective procedure with advantage of short hospital stay and lesser analgesic requirement without increasing complications.
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