Huseyin KOCAKGOL, Şenol ADANUR, Ali H. YILMAZ, Fatih ÖZKAYA, İbrahim KARABULUT, Özkan POLAT

A Comparison of Standard Percutaneous Nephrolithotomy and Tubeless Percutaneous Nephrolithotomy: Does Tubeless Realy Superior? A Prospective Randomized Double-Blind Study

Objective: We aimed to compare patient groups who underwent either a standard percutaneous nephrolithotomy (PNL) or tubeless PNL for safety, effectiveness and patient comfort. Material and Methods: 78 patients were included in the study. Patients who underwent the standard PNL (n=38) or tubeless PNL (n=40) were randomized into Groups 1 and 2, respectively. This study was designed as a prospective, randomized, double-blind investigation. Patients who had active bleeding at the end of the operation and those with multiple access tracts were excluded from the study. To evaluate postoperative pain and complications, a visual analogue scale (VAS) and a modified Clavien classification were used, respectively. Results: A statistically significant difference was not found between the two patient groups for demographic data (age and gender), or for size, laterality, and intrarenal location of the stone(s) (p>0.05). Perioperative data, including operative and fluoroscopy times and stonefree rates, perioperative changes in creatinine and haemoglobin values, blood transfusion, VAS 2 to 3 pain scores, analgesic requirements, fever and complications requiring additional surgical treatment were not statistically different between groups (p>0.05). A VAS 1 pain score and hospital stays were significantly decreased in the tubeless PNL group (p=0.003). Conclusions: Tubeless PNL surgery is an effective and safe endourological procedure that can be performed by experienced surgeons. Its advantages over standard PNL include less pain during the early postoperative period, shorter hospital stays but the rates of complications are not significantly lower.

Standart Perkütan Nefrolitotomi ve Tüpsüz Perkütan Nefrolitotomi Sonuçlarının Karşılaştırılması: Tüpsüz Gerçekten Üstün mü? Prospektif Randomize Çift Kör Çalışma

Amaç: Standart PNL ve tüpsüz PNL yapılan hasta gruplarının güvenlik, etkinlik ve hasta konforu açısından karşılaştırılmalarını amaçladık. Gereç ve Yöntemler: PNL endikasyonu alan 78 hasta çalışmaya alındı. Standart PNL yapılan 38 hasta Grup I ve tüpsüz PNL prosedürü uygulanan 40 hasta Grup II olarak randomize edildi. Çalışma prospektif randomize çift kör çalışma olarak dizayn edildi. Operasyon sonunda aktif kanaması olan ve multipl akses kullanılan hastalar çalışma dışı bırakıldı. Ameliyat sonrası ağrı ve komplikasyonların değerlendirilmesinde sırasıyla VAS (visual analogue scale) ve modifiye Clavien sınıflaması kullanıldı. Bulgular: Yaş, cinsiyet, taş boyutu, taşların böbrekteki lokalizasyonları, taraf gibi verilerde iki hasta grubu arasında istatistiksel fark yoktu (P>0,05). Yine perioperatif verilerde; operasyon süresi, skopi süresi, taşsızlık oranları, peroperatif kreatin ve hemoglobin değişimi, kan transfüzyonu, VAS 2-VAS 3 ağrı skorları, analjezik gereksinimi, ateş ve ek cerrahi gerektiren komplikasyonlarda iki grup arasında istatistiksel fark bulunmadı (P>0,05). VAS 1 skoru ve hastanede kalış süreleri açısından her iki grup karşılaştırıldığında, her iki parametre tüpsüz PNL grubunda istatistiksel olarak anlamlı düşük bulundu (P=0,003). Sonuç: Tüpsüz PNL operasyonu, erken postoperatif dönemde daha az ağrı ve kısa hastanede kalış süresi gibi avantajları ve standart PNL operasyonuna göre anlamlı olmayacak derecede düşük komplikasyon oranları ile deneyimli cerrahlar tarafından etkin ve güvenle uygulanabilecek endoürolojik bir yöntemdir.

PDF

___

1. Gonen M, Cicek T, Ozkardes H. Tubeless and stentless percutaneous nephrolithotomy in patients requiring supracostal access. Urologia internationalis 2009;82:440-3.

2. Garofalo M, Pultrone CV, Schiavina R. et al.Tubeless procedure reduces hospitalization and pain after percutaneous nephrolithotomy: results of a multivariable analysis. Urolithiasis 2013 1;41:347-53.

3. Istanbulluoglu MO, Ozturk B, Gonen M, Cıcek T, Ozkardes H. Effectiveness of totally tubeless percutaneous nephrolithotomy in selected patients: a prospective randomized study. International urology and nephrology 2009 1;41:541- 5.

4. Yoon GH, Bellman GC. Tubeless percutaneous nephrolithotomy: a new standard in percutaneous renal surgery. Journal of endourology 2008 1;22:1865-8.

5. Bellman GC, Davidoff R, Candela J, Gerspach J, Kurtz S, Stout L. Tubeless percutaneous renal surgery. The Journal of urology 1997;157:1578-82.

6. Berkman DS, Lee MW, Landman J, Gupta M. Tubeless Percutaneous Nephrolithotomy (PCNL) with Reversed Polaris™ Loop Stent: Reduced Postoperative Pain and Narcotic Use. Journal of endourology 2008 1;22:2245-50.

7. Wickham JE, Miller RA, Kellett MJ, Payne SR. Percutaneous Nephrolithotomy: One Stage or Two?. The Journal of Urology 1985;134:634.

8. Gupta NP, Mishra S, Suryawanshi M, Seth A, Kumar R. Comparison of standard with tubeless percutaneous nephrolithotomy. Journal of endourology. 2008 Jul 1;22(7):1441-6.

9. Sofer M, Lidawi G, Keren-Paz G, Yehiely R, Beri A, Matzkin H. Tubeless percutaneous nephrolithotomy: first 200 cases in Israel. IMAJ-Israel Medical Association Journal. 2010 Mar 1;12(3):164.

10. Zilberman DE, Lipkin ME, De la Rosette JJ.et al.Tubeless percutaneous nephrolithotomy—the new standard of care?. The Journal of urology 2010 Oct 1;184(4):1261-6.

11. Amer T, Ahmed K, Bultitude M. et al. Standard versus tubeless percutaneous nephrolithotomy: a systematic review. Urologia internationalis 2012;88:373-82.

12. Isac W, Rizkala E, Liu X, Noble M, Monga M. Tubeless percutaneous nephrolithotomy: outcomes with expanded indications. International braz j urol 2014 Apr;40(2):204-11.

13. Desai MR, Kukreja RA, Desai MM, et al. A prospective randomized comparison of type of nephrostomy drainage following percutaneous nephrostolithotomy: large bore versus small bore versus tubeless. The Journal of urology 2004;172:565-7.

14. Feng MI, Tamaddon K, Mikhail A, Kaptein JS, Bellman GC. Prospective randomized study of various techniques of percutaneous nephrolithotomy. Urology 2001 Sep 1;58(3):345-50.

15. Singh I, Singh A, Mittal G. Tubeless percutaneous nephrolithotomy: is it really less morbid?. Journal of endourology 2008 Mar 1;22(3):427-34.

16. Crook TJ, Lockyer CR, Keoghane SR, Walmsley BH. Totally tubeless percutaneous nephrolithotomy. Journal of endourology 2008 Feb 1;22(2):267-72.

17. Tefekli A, Altunrende F, Tepeler K, Tas A, Aydin S, Muslumanoglu AY. Tubeless percutaneous nephrolithotomy in selected patients: a prospective randomized comparison. International urology and nephrology 2007 Mar 1;39(1):57-63.

18. Agrawal MS, Agrawal M, Gupta A, Bansal S, Yadav A, Goyal J. A randomized comparison of tubeless and standard percutaneous nephrolithotomy. Journal of endourology 2008 Mar 1;22(3):439-42.

19. Shoma AM, Elshal AM. Nephrostomy tube placement after percutaneous nephrolithotomy: critical evaluation through a prospective randomized study. Urology 2012 Apr 1;79(4):771-6.

20. Winfield HN, Weyman P, Clayman RV. Percutaneous nephrostolithotomy: complications of premature nephrostomy tube removal. The Journal of urology 1986 Jul;136(1 Part 1):77-9.