Dr Md Fazlul Haq Siddique, Associate Professor, Department of Urology, Mymensingh Medical College (MMC), Mymensingh, Bangladesh; E-mail:
Mymensingh Med J. 2024 Oct;33(4):980-988.
Traditionally, percutaneous nephrolithotomy (PCNL) includes placing a nephrostomy tube and a Double J (DJ) stent to drain the kidney and operative tract following the procedure. However, more recent techniques, such as tubeless or totally tubeless PCNL, eliminate these drainage methods. The objective was to assess the feasibility, safety and effectiveness of performing tubeless or totally tubeless PCNL in comparison to standard PCNL a retrospective analysis was performed on 156 patients who underwent PCNL treatment From September 2022 to September 2023. Of these, 78 patients received traditional nephrostomy PCNL, while 46 patients underwent the tubeless procedure and the remaining 32 received the totally tubeless procedure. The three groups showed no significant differences in preoperative patient characteristics. The operation time, analgesic requirements and hospital stay were lower in the tubeless and totally tubeless PCNL group than in the standard PCNL group (p<0.05). No significant differences were found in the mean stone size, stone-free status or the occurrence of major complications. The overall complications (Grade-1, 2 and 3) rate was 14.2% in the standard PCNL group, 8.7% in the tubeless PCNL and 9.4% in the totally tubeless PCNL group. The tubeless and totally tubeless PCNL techniques have proven to be safe and effective, even for patients with incomplete staghorn stones and a moderate pelvic stone burden. These approaches are associated with reduced pain, lower analgesic needs, shorter operative times, and decreased hospital stays, making them more cost- effective and less likely to result in complications, while also improving patient satisfaction. Further research is essential to validate the safety of these techniques, encouraging urologists to adopt them in clinical practice.
传统的经皮肾镜碎石术（PCNL）包括在手术后放置肾造瘘管和双 J（DJ）支架来引流肾脏和手术通道。然而，最近的技术，如无管或完全无管 PCNL，消除了这些引流方法。目的是评估与标准 PCNL 相比，无管或完全无管 PCNL 的可行性、安全性和有效性。回顾性分析了 2022 年 9 月至 2023 年 9 月期间接受 PCNL 治疗的 156 例患者。其中，78 例患者接受传统肾造瘘 PCNL，46 例患者接受无管手术，32 例患者接受完全无管手术。三组患者术前患者特征无显著差异。无管和完全无管 PCNL 组的手术时间、镇痛需求和住院时间均低于标准 PCNL 组（p<0.05）。无管和完全无管 PCNL 组的平均结石大小、结石清除率或主要并发症的发生无显著差异。标准 PCNL 组的总体并发症（1 级、2 级和 3 级）发生率为 14.2%，无管 PCNL 组为 8.7%，完全无管 PCNL 组为 9.4%。无管和完全无管 PCNL 技术已被证明是安全有效的，即使对于不完全鹿角结石和中度骨盆结石负担的患者也是如此。这些方法与减少疼痛、降低镇痛需求、缩短手术时间和减少住院时间有关，使其更具成本效益，并发症发生的可能性更低，同时提高患者满意度。进一步的研究对于验证这些技术的安全性至关重要，鼓励泌尿科医生在临床实践中采用这些技术。
