Tubeless PCNL versus standard PCNL: a prospective study
Wednesday, 26 May 2010- Tubeless percutaneous nephrolithotomy (PCNL) has been reported to be associated with better patient compliance and shorter hospital stay; nevertheless, the procedure has not gained wide acceptance, probably due to fear of tract complications.
L. Cormio and colleagues conducted a study to evaluate the efficacy and safety of TachoSil-sealed tubeless PCNL as compared to standard PCNL, i.e. with a dwelling nephrostomy tube. They presented their findings at the 25th Anniversary EAU Congress held in Barcelona, Spain.
Following board approval, 82 consecutive patients scheduled for PCNL in supine antero-lateral position were randomised to receive a 16F nephrostomy tube at the end of the procedure (Group A) or TachoSil-sealing of the tract (Group B) under visual and radioscopic control. Electrocoagulation of the tract was carried out in both groups when necessary.
All patients had a 7-F mono-J ureteric catheter and a 16-F Foley urethral catheter. In the absence of complications, the mono-J and urethral catheter were removed on postoperative day 1 in Group B, and on postoperative day 3 in Group A, after having closed the nephrostomy tube on day 1 and removed it on day 2.
Renal ultrasounds were taken twice-a-day, starting the evening of the procedure, to monitor possible tract complications. Analgesic requirement and complications occurring up to 20 days after the procedures were also recorded.
The results showed that Clinical variables (sex, age, and mean stone size) were comparable in both groups. Three patients were excluded because of intra-operative complications (one hydrothorax and two relevant bleeding), thus leaving 39 patients in Group 1 and 40 in Group 2.
Surprisingly, analgesic requirement was found to be similar in both groups; conversely, postoperative hospital stay was significantly shorter in Group B than in Group A (mean ± sd 2,95 ± 1,81 and 5,41 ± 2,18, respectively; P<0,0001 according to Student’s t-test). As for tract complications, there was no bleeding, but 4 urinary fistulas, 3 in Group A and 1 in Group B (3/39 vs. 1/40, P=0,5530), requiring double-J stenting in 3 cases.
The researchers concluded that TachoSil-sealed tubeless PCNL was found to provide an excellent tract control, as there was no bleeding and the number of urinary fistulas was smaller than that of standard PCNL.
"Though failing to reduce analgesic requirement, it provided a significant reduction in postoperative hospital stay and consequent costs. Overall, TachoSil-sealing seemed to improve safety and consequently use of tubeless PCNL, thus enabling to extend the indications of this technique to the majority of the procedures," the researchers added.
Source: L. Cormio, et al., "TachoSil-sealed tubeless percutaneous nephrolithotomy in supine antero-lateral position: A prospective study," Poster session on Percutaneous Stone Removal; Abstract 2, 25th Anniversary EAU Congress, April 16 to 20, 2010, Barcelona, Spain.