Post-operative Events with Post-operative Day One Stent Removal after Percutaneous Nephrolithotomy
Main Article Content
Abstract
Introduction: Percutaneous nephrolithotomy (PCNL) is the gold standard for treating large or complex renal stones. Renal drainage after the procedure is most commonly via nephrostomy tube or indwelling ureteral stent, but the optimal duration of ureteral stents after PCNL is currently unknown. This study describes the post-operative events occurring with early stent removal on post-operative day one (POD1) in patients undergoing uncomplicated PCNL.
Methods: We identified 336 patients from a single institution that underwent PCNL between 1/1/2020 and 6/1/2021. Of these, 106 patients with uncomplicated procedures that met inclusion criteria for early stent removal on POD1 were included. Retrospective chart review was performed to collect demographic information, operative data, and to identify adverse outcomes including additional procedures, patient telephone calls for symptoms, complications and emergency department (ED) visits.
Results: Mean (SD) patient age was 54 (15.1) years and 56% of patients were morbidly obese (Body Mass Index [BMI] >30). Overall post-operative complication rate was low (18.8%) and limited primarily to Clavien I/II complications with only two Clavien III (1.9%) complications. Telephone calls or electronic messages were received from 37.7% of patients, with 16% requiring a visit to the ED or clinic. The most common reason for an ED visit was flank pain (11.1%).
Conclusions: Early stent removal on POD1 may lead to pain-related telephone calls but appears to be a generally safe and effective management option in carefully selected patients undergoing uncomplicated PCNL.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright of articles published in all DPG titles is retained by the author(s). The author(s) grants DPG the rights to publish the article and identify itself as the original publisher. The author grants DPG exclusive commercial rights to the article. The author grants any party the rights to use the article freely for non-commercial purposes provided that the original work is properly cited.
References
2. Türk C, Petřík A, Sarica K, et al. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol. Mar 2016;69(3):475-82. doi:10.1016/j.eururo.2015.07.041
3. Mouracade P, Spie R, Lang H, Jacqmin D, Saussine C. Tubeless percutaneous nephrolithotomy: what about replacing the Double-J stent with a ureteral catheter? J Endourol. Feb 2008;22(2):273-5. doi:10.1089/end.2007.0162
4. Crook TJ, Lockyer CR, Keoghane SR, Walmsley BH. Totally tubeless percutaneous nephrolithotomy. J Endourol. Feb 2008;22(2):267-71. doi:10.1089/end.2006.0034
5. Zhao PT, Hoenig DM, Smith AD, Okeke Z. A Randomized Controlled Comparison of Nephrostomy Drainage vs Ureteral Stent Following Percutaneous Nephrolithotomy Using the Wisconsin StoneQOL. J Endourol. Dec 2016;30(12):1275-1284. doi:10.1089/end.2016.0235
6. Pimentel Torres J, Oliveira JN, Morais N, et al. Efficacy and safety of renal drainage options for percutaneous nephrolithotomy. Minerva Urol Nefrol. Oct 2020;72(5):629-636. doi:10.23736/s0393-2249.19.03643-9
7. Limb J, Bellman GC. Tubeless percutaneous renal surgery: review of first 112 patients. Urology. Apr 2002;59(4):527-31; discussion 531. doi:10.1016/s0090-4295(01)01627-2
8. Mandhani A, Goyal R, Vijjan V, Dubey D, Kapoor R. Tubeless percutaneous nephrolithotomy--should a stent be an integral part? J Urol. Sep 2007;178(3 Pt 1):921-4. doi:10.1016/j.juro.2007.05.021
9. Istanbulluoglu MO, Cicek T, Ozturk B, Gonen M, Ozkardes H. Percutaneous nephrolithotomy: nephrostomy or tubeless or totally tubeless? Urology. May 2010;75(5):1043-6. doi:10.1016/j.urology.2009.06.104
10. Komeya M, Usui K, Asai T, et al. Outcome of flexible ureteroscopy for renal stone with overnight ureteral catheterization: a propensity score-matching analysis. World J Urol. Nov 2018;36(11):1871-1876. doi:10.1007/s00345-018-2328-1
11. Tang L, Gao X, Xu B, et al. Placement of ureteral stent after uncomplicated ureteroscopy: do we really need it? Urology. Dec 2011;78(6):1248-56. doi:10.1016/j.urology.2011.05.004
12. Paul CJ, Brooks NA, Ghareeb GM, Tracy CR. Pilot Study to Determine Optimal Stent Duration Following Ureteroscopy: Three versus Seven days. Curr Urol. Feb 2018;11(2):97-102. doi:10.1159/000447201
13. Bhat S, Lal J, Paul F. A randomized controlled study comparing the standard, tubeless, and totally tubeless percutaneous nephrolithotomy procedures for renal stones from a tertiary care hospital. Indian J Urol. Oct-Dec 2017;33(4):310-314. doi:10.4103/iju.IJU_52_17
14. Crook TJ, Lockyer CR, Keoghane SR, Walmsley BH. A randomized controlled trial of nephrostomy placement versus tubeless percutaneous nephrolithotomy. J Urol. Aug 2008;180(2):612-4. doi:10.1016/j.juro.2008.04.020
15. Thomas K, Smith NC, Hegarty N, Glass JM. The Guy's stone score--grading the complexity of percutaneous nephrolithotomy procedures. Urology. Aug 2011;78(2):277-81. doi:10.1016/j.urology.2010.12.026
16. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. Apr 2009;42(2):377-81. doi:10.1016/j.jbi.2008.08.010
17. Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. Jul 2019;95:103208. doi:10.1016/j.jbi.2019.103208
18. Ichaoui H, Samet A, Ben Hadjalouane H, et al. Percutaneous Nephrolithotomy (PCNL): Standard Technique Versus Tubeless - 125 Procedures. Cureus. Mar 14 2019;11(3):e4251. doi:10.7759/cureus.4251
19. Gupta S, Maurya AK, Pal DK. Observational prospective study for surgical outcome and anesthetic feasibility of tubeless and totally tubeless supine PCNL: A single centre initial experience. Turk J Urol. Mar 2019;45(2):146-149. doi:10.5152/tud.2018.97345
20. Lee JY, Jeh SU, Kim MD, et al. Intraoperative and postoperative feasibility and safety of total tubeless, tubeless, small-bore tube, and standard percutaneous nephrolithotomy: a systematic review and network meta-analysis of 16 randomized controlled trials. BMC Urol. Jun 27 2017;17(1):48. doi:10.1186/s12894-017-0239-x
21. Minami T, Yamana H, Matsui H, Fushimi K, Yasunaga H. Postoperative Outcomes after Tubeless, Totally Tubeless, Standard, and Standard with Ureteral Stent Percutaneous Nephrolithotomy: A Nationwide Retrospective Study in Japan. Urol Int. 2020;104(5-6):445-451. doi:10.1159/000505103