Department of Urology, Hospital of Braga, Braga, Portugal -
Life and Health Sciences Research Institute, University of Minho, Braga, Portugal.
Minerva Urol Nefrol. 2020 Oct;72(5):629-636. doi: 10.23736/S0393-2249.19.03643-9. Epub 2020 Jan 7.
Percutaneous nephrolithotomy (PCNL) is the gold-standard for treatment of renal stones larger than 20 mm. Traditionally, a nephrostomy tube (NT) is placed, causing discomfort and prolonged hospitalization but some surgeons prefer the tubeless technique (TL). Simultaneously, the effectiveness of ureteral stents after PNCL is doubtful. We investigated the safety of the TL technique as well as that of the single loop (SL) over double loop (DL) stents.
Three hundred and twenty-one individuals submitted to PCNL in a single center were retrospectively reviewed. Statistical analysis was performed to compare procedures regarding safety and effectiveness (stone size, residual stones, operative time, peri- and post-operative complications, need for blood transfusion and length of hospital stay) between two groups regarding presence or absence of NT placement (NT [N.=198] vs. TL [N.=123]); and according to the type of stent used (SL [N.=74] vs. DL [N.=247]).
NT was associated with a higher complications rate compared to the TL (30.3% and 13%, respectively; P=0.001) and longer hospitalization (4 vs. 2 days; P=0.001). Regarding ureteral stents, they cause similar morbidities (20.7% and 24.4%; P=0.881), and median length of stay (3 days; P=0.947). NT and DL were more frequent in patients with higher stone burden.
Tubeless PCNL encompasses lower morbidity and should be considered as an option for select patients, particularly with less stone burden and uncomplicated procedures. Regarding ureteral stents, SL is a safe option and does not require further procedures for removal.
经皮肾镜碎石术（PCNL）是治疗大于 20mm 的肾结石的金标准。传统上，会放置肾造瘘管（NT），这会引起不适和延长住院时间，但一些外科医生更喜欢无管技术（TL）。同时，PNCL 后输尿管支架的效果也存在疑问。我们调查了 TL 技术的安全性以及单环（SL）与双环（DL）支架的安全性。
回顾性分析了在一家中心接受 PCNL 的 321 名患者。对两种术式（有 NT 放置[N=198]与无 NT 放置[N=123]；使用 SL 支架[N=74]与 DL 支架[N=247]）的安全性和有效性（结石大小、残留结石、手术时间、围手术期和术后并发症、输血需求和住院时间）进行比较。
与 TL 相比，NT 与更高的并发症发生率相关（分别为 30.3%和 13%；P=0.001）和更长的住院时间（4 天与 2 天；P=0.001）。对于输尿管支架，它们引起的并发症相似（分别为 20.7%和 24.4%；P=0.881），且中位住院时间（3 天；P=0.947）也相似。NT 和 DL 更常用于结石负荷较高的患者。
无管 PCNL 具有较低的发病率，应作为某些患者的选择，特别是结石负荷较小且手术简单的患者。关于输尿管支架，SL 是一种安全的选择，不需要进一步取出。
