Urology Research Center, School of Medicine, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran.
BMC Urol. 2024 Oct 7;24(1):216. doi: 10.1186/s12894-024-01610-9.
It is controversial whether double-J (DJ) stent insertion is necessary in tubeless percutaneous nephrolithotomy (PCNL) for patients with staghorn stones. We compared the outcomes of using ureteral catheters and double-J stents in tubeless complete supine PCNL (csPCNL) of staghorn stones.
In this analytical cross-sectional study, from May 2008 to August 2022, 123 patients who underwent tubeless csPCNL were assessed. Patients were divided into two groups by either tubeless csPCNL with DJ stent (Group I; n = 23) or totally tubeless just with perioperative ureteral stent (Group II; n = 100). Demographic characteristics, stone-related factors, perioperative and postoperative parameters were compared in groups.
Baseline characteristics were comparable in groups. The operative time in group I was significantly longer than group II (68.26 vs. 55.25 min, P = 0.05). However, the duration of hospitalization in Group I was shorter than the other group (1.81 vs. 2.37 days, P = 0.03). Stone free rate was notably higher in Group I (90.5% vs. 79.8.0%) with no statistically significant difference. No significant differences were found in major complications. Patients in Group II had a significantly shorter time to return to normal life (6.48 vs. 7.91 day; P = 0.043). Multivariable linear regression showed the preoperative creatinine level and stone size can affect the operative time (P = 0.02). In addition, stone number and underlying disease can affect the length of hospital stay (P = 0.007 & 0.030, respectively).
Although not inserting a double J stent after csPCNL has acceptable results, because of higher residual rate in staghorn stone which cause more incidence of renal colic, longer time of hospital stay and return to normal life, inserting DJ stent is recommended.
对于鹿角结石患者，经皮肾镜碎石取石术（PCNL）中是否需要放置双 J 支架存在争议。我们比较了无管经皮肾镜碎石取石术（csPCNL）中使用输尿管导管和双 J 支架治疗鹿角结石的效果。
在这项分析性横断面研究中，纳入了 2008 年 5 月至 2022 年 8 月期间接受无管 csPCNL 的 123 例患者。根据是否在无管 csPCNL 中放置双 J 支架，将患者分为两组：放置双 J 支架组（I 组，n=23）和单纯围手术期使用输尿管支架组（II 组，n=100）。比较两组患者的人口统计学特征、结石相关因素、围手术期和术后参数。
两组患者的基线特征无显著差异。I 组的手术时间明显长于 II 组（68.26 分钟 vs. 55.25 分钟，P=0.05）。然而，I 组的住院时间短于 II 组（1.81 天 vs. 2.37 天，P=0.03）。I 组的结石清除率显著更高（90.5% vs. 79.8%，P=0.04），但无统计学差异。两组主要并发症发生率无显著差异。II 组患者恢复正常生活的时间明显缩短（6.48 天 vs. 7.91 天，P=0.043）。多变量线性回归显示，术前血肌酐水平和结石大小会影响手术时间（P=0.02）。此外，结石数量和基础疾病会影响住院时间（P=0.007 和 0.030）。
尽管 csPCNL 后不放置双 J 支架具有可接受的效果，但由于鹿角结石的残留率较高，导致肾绞痛发生率较高、住院时间和恢复正常生活的时间较长，因此建议放置双 J 支架。
