- Email: [email protected]
1033 “Tubeless” is beautiful… and definitely safe
1033 - “Tubeless” is beautiful… and definitely safe
Page 1 of 2
e1033 “Tubeless” is beautiful… and definitely safe Giusti G., Peschechera R., Conti A., Taverna G., Seveso M., Graziotti P. Istituto Clinico Humanitas, IRCCS, Stone Center, Dept. of Urology, Milan, Italy INTRODUCTION & OBJECTIVES: In an effort to reduce hospital stay and patient discomfort related to standard PCNL, while maintaining the same positive outcomes, the need for the nephrostomy tube after completion of the procedure has recently come into question. Several reports have already reported encouraging results of tubeless PCNL (only a double-J stent without nephrostomy tube) in selected patients. The aim of this retrospective study is to further confirm this finding on a large series at a single center. MATERIAL & METHODS: After its introduction at our “Stone Center ” back in June 2002, we have performed 209 tubeless PCNLs for renal calculi. Among them, 89 were after prone PCNL while 120 after supine PCNL. Selection criteria for tubeless procedure do not differ between the 2 positions (Stone free status; absence of major perforations of the collecting system; absence of major active bleeding) . NO sealing nor cauterization of the tract has been carried out. Table 1: demographycs supine prone Number of patients 120 89 Mean age (years) 49.4 (20-77) 50.3 (29-71) BMI 26.9 25.1 Stone burden (cm2)5.2 (2.1-17.0) cm25.4 (2.2-23.2) cm2 RESULTS: Results are reported in table 2 Supine (120)Prone (89) Overall (209) Operative time (min) 72 Mean blood loss (ΔHb) g/dL-2.24
file://F:\RamShankar\April\04-05-12\Cip\Sour\1033.html
109 -1.9
90,5 -2.07
4/7/2012
1033 - “Tubeless” is beautiful… and definitely safe
e1033a # of transfused patients Embolization Colonic injuries Fever higher than 38C Hospital stay (days) Time to recovery (days) Stone free rate (%)
4 (3.3%) 3 ( 2.5 %) 0 12 (10%) 2.2 (1-10) 14.3 96.1%
Page 2 of 2
3 (3.3%) 7 (3.34%) 2 (2.2%) 5 (2.3%) 0 0 10 (11.2%)22 (10.5%) 2.5 (2-12) 2.35 (1-12) 15.2 14.7 97.5% 96.6%
CONCLUSIONS: Based on our experience, after a PCNL regardless the position, omitting placement of nephrostomy in rigorously selected patients determined intra and postoperative complications’ rate similar to that traditionally reported for standard technique. In addition, the tubeless approach offered significant advantages in terms of less discomfort, and shorter hospital stay and convalescence. Our confidence in the tubeless technique increased over time and similarly did the percentage of PCNL carried out in this way. Tubeless PCNL has thus become a routine procedure at our “Stone center” and is currently performed in nearly 80% of patients with renal calculi suitable for percutaneous treatment. As such,Tubeless PCNL is definitely not an hazard but should be the natural ending of a successful and uneventful PCNL.
file://F:\RamShankar\April\04-05-12\Cip\Sour\1033.html
4/7/2012
Page 1 of 2
e1033 “Tubeless” is beautiful… and definitely safe Giusti G., Peschechera R., Conti A., Taverna G., Seveso M., Graziotti P. Istituto Clinico Humanitas, IRCCS, Stone Center, Dept. of Urology, Milan, Italy INTRODUCTION & OBJECTIVES: In an effort to reduce hospital stay and patient discomfort related to standard PCNL, while maintaining the same positive outcomes, the need for the nephrostomy tube after completion of the procedure has recently come into question. Several reports have already reported encouraging results of tubeless PCNL (only a double-J stent without nephrostomy tube) in selected patients. The aim of this retrospective study is to further confirm this finding on a large series at a single center. MATERIAL & METHODS: After its introduction at our “Stone Center ” back in June 2002, we have performed 209 tubeless PCNLs for renal calculi. Among them, 89 were after prone PCNL while 120 after supine PCNL. Selection criteria for tubeless procedure do not differ between the 2 positions (Stone free status; absence of major perforations of the collecting system; absence of major active bleeding) . NO sealing nor cauterization of the tract has been carried out. Table 1: demographycs supine prone Number of patients 120 89 Mean age (years) 49.4 (20-77) 50.3 (29-71) BMI 26.9 25.1 Stone burden (cm2)5.2 (2.1-17.0) cm25.4 (2.2-23.2) cm2 RESULTS: Results are reported in table 2 Supine (120)Prone (89) Overall (209) Operative time (min) 72 Mean blood loss (ΔHb) g/dL-2.24
file://F:\RamShankar\April\04-05-12\Cip\Sour\1033.html
109 -1.9
90,5 -2.07
4/7/2012
1033 - “Tubeless” is beautiful… and definitely safe
e1033a # of transfused patients Embolization Colonic injuries Fever higher than 38C Hospital stay (days) Time to recovery (days) Stone free rate (%)
4 (3.3%) 3 ( 2.5 %) 0 12 (10%) 2.2 (1-10) 14.3 96.1%
Page 2 of 2
3 (3.3%) 7 (3.34%) 2 (2.2%) 5 (2.3%) 0 0 10 (11.2%)22 (10.5%) 2.5 (2-12) 2.35 (1-12) 15.2 14.7 97.5% 96.6%
CONCLUSIONS: Based on our experience, after a PCNL regardless the position, omitting placement of nephrostomy in rigorously selected patients determined intra and postoperative complications’ rate similar to that traditionally reported for standard technique. In addition, the tubeless approach offered significant advantages in terms of less discomfort, and shorter hospital stay and convalescence. Our confidence in the tubeless technique increased over time and similarly did the percentage of PCNL carried out in this way. Tubeless PCNL has thus become a routine procedure at our “Stone center” and is currently performed in nearly 80% of patients with renal calculi suitable for percutaneous treatment. As such,Tubeless PCNL is definitely not an hazard but should be the natural ending of a successful and uneventful PCNL.
file://F:\RamShankar\April\04-05-12\Cip\Sour\1033.html
4/7/2012