1 Department of Urology, Konya Training and Research Hospital, Konya, Turkey.
2 Department of Pediatric Urology, Konya Training and Research Hospital, Konya, Turkey.
J Endourol. 2019 Apr;33(4):291-294. doi: 10.1089/end.2018.0875.
The aim of this study is to evaluate overnight ureteral catheterization vs nephrostomy tube for urinary diversion in patients undergoing percutaneous nephrolithotomy (PNL) under spinal anesthesia.
Patients were enrolled using block randomization between February 2016 and July 2016. Patients with renal stones >2 cm confirmed via noncontrast-enhanced CT were included. All patients underwent PNL under spinal anesthesia. Group 1 refers to patients who had a nephrostomy tube following PNL, whereas group 2 refers to overnight ureteral catheterization. Those who refuse spinal anesthesia, <18 years of age, >70 years of age, and anomalous kidneys (ectopic pelvic kidney, horseshoe kidney, etc.) were excluded. In group 1, nephrostomy tube (14F) was removed 48 hours after surgery, whereas the ureteral catheter (6F) was removed at postoperative 12th hour in group 2. Visual analogue scores (VASs) at 24th hour and mean narcotic analgesic (tramadol) amounts were compared.
There were 30 patients in both groups. Mean age, mean body mass index, and stone area were not significant between groups (p > 0.05, for all). With regard to operative measures, mean duration of surgery, mean number of accesses, and mean drop in Hb levels were comparable. Besides, mean hospitalization period in group 1 was 68.8 ± 12 hours, whereas it was 54.5 ± 10 hours in group 2 (p < 0.001). No patients in either group needed transfusion. Stone-free rates were similar in both groups (83% vs 90%, p = 0.391). Mean 24th hour VAS was 6.17 ± 1.4 in group 1 and 3.37 ± 1.4 in group 2 (p < 0.001). Also, there was a statistically significant difference in mean tramadol requirements between groups (181.67 ± 56.45 vs 86.67 ± 57.13, groups 1 and 2, respectively).
In patients undergoing PNL under spinal anesthesia, using an open-ended ureteral catheter to be removed at early postoperative period reduces analgesic requirement and duration of hospital stay without compromising surgical outcomes and complication rates.
本研究旨在评估脊髓麻醉下经皮肾镜碎石取石术（PNL）中，患者术后行输尿管导管持续引流与肾造瘘管引流的效果。
本研究采用区组随机分组方法，于 2016 年 2 月至 2016 年 7 月期间招募患者。纳入标准为经非增强 CT 证实的>2cm 肾结石患者。所有患者均在脊髓麻醉下接受 PNL。PNL 术后患者被分为两组，一组为肾造瘘管引流组（组 1），另一组为输尿管导管持续引流组（组 2）。排除拒绝脊髓麻醉、年龄<18 岁、年龄>70 岁以及存在异常肾脏（异位盆腔肾、马蹄肾等）的患者。组 1 患者术后 48 小时拔除肾造瘘管，组 2 患者术后 12 小时拔除输尿管导管。比较两组患者术后 24 小时的视觉模拟评分（VAS）和平均阿片类镇痛药（曲马多）用量。
两组各有 30 例患者。两组患者的平均年龄、平均体重指数和结石面积差异均无统计学意义（p>0.05）。在手术操作方面，手术时间、通道数量和血红蛋白下降水平均无显著差异。此外，组 1 的平均住院时间为 68.8±12 小时，组 2 为 54.5±10 小时（p<0.001）。两组均无患者需要输血。两组患者的结石清除率相似（83%比 90%，p=0.391）。组 1 术后 24 小时 VAS 平均为 6.17±1.4，组 2 为 3.37±1.4（p<0.001）。组间曲马多用量的差异也具有统计学意义（分别为 181.67±56.45 和 86.67±57.13）。
在脊髓麻醉下接受 PNL 的患者中，使用开放式输尿管导管在术后早期拔除可减少镇痛需求和住院时间，而不会影响手术效果和并发症发生率。
