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Percutaneous nephrolithotomy: tubeless or not tubeless?

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Abstract

The objective of this study is to evaluate the safety and outcomes of tubeless PCNL in comparison with standard PCNL. Since June 2002, we have performed 99 tubeless PCNL. Tubeless technique involves antegrade placement of a 6Fr double-J stent without nephrostomy tube at the end of the procedure. This series has been compared with a total of 110 patients in which revision of operative reports ruled out the presence of intraoperative conditions necessary to candidate a patient to tubeless procedure but standard PCNL was performed because prior to its introduction or because of surgeon’s attitude afterward. Mean stone burden was 5.4 for standard group and 4.9 cm2 for tubeless group, respectively. Mean BMI was 24.1 in the first group and 23.6 in the second one. In this retrospective study, complications rate, postoperative pain, length of hospitalization and convalescence were evaluated by chart review. Hematocrit drop did not differ significantly between tubeless PCNL and standard PCNL (5.5 vs. 5.9%). Conversely, there was statistically significant difference between tubeless and standard PCNL in terms of the amount of analgesics (49.5 vs. 84.2 mg), immediate postoperative patients’ discomfort, hospitalization (2.2 vs. 5.3 days) and time to resume normal activities (11.0 vs. 16.5 days). In conclusion, in our series, tubeless approach did not determine increase in complication rate. Conversely, tubeless PCNL reduced analgesics’ requirement, patients’ discomfort, hospitalization and time to recovery. As such, at our institution, tubeless PCNL has become routine procedure that actually is feasible in almost two-third of renal calculi suitable for percutaneous treatment.

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Acknowledgments

Dr. Emanuela Morenghi for technical assistance in the preparation of the statistical analysis; Serena Pagani for fundamental collaboration as head of nursing services in the OR department; and Martin D’Elia, Giovanna Gambirasio, and Silvana Pintos for their continued support as scrub nurses.

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Authors and Affiliations

  1. Stone Center at Department of Urology, Istituto Clinico Humanitas, IRCCS, Studi Medici Est, via Manzoni 56, 20089, Rozzano (Milan), Italy

    Guido Giusti, Alessandro Piccinelli, Orazio Maugeri, Alessio Benetti, Gianluigi Taverna & Pierpaolo Graziotti

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  1. Guido Giusti
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  2. Alessandro Piccinelli
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  3. Orazio Maugeri
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  4. Alessio Benetti
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  6. Pierpaolo Graziotti
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Correspondence to Guido Giusti.

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Giusti, G., Piccinelli, A., Maugeri, O. et al. Percutaneous nephrolithotomy: tubeless or not tubeless?. Urol Res 37, 153–158 (2009). https://doi.org/10.1007/s00240-009-0183-7

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  • DOI: https://doi.org/10.1007/s00240-009-0183-7

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