Tubeless mini-percutaneous nephrolithotomy
Objective: to compare postoperative periods after tubeless percutaneous nephrolithotomy with different variants of internal drainage of the upper urinary tract. Patients and methods. This retrospective study included 60 patients with urolithiasis that underwent mini-percutaneous nephrolithotomy using a 16 Ch urethral catheter between March 2017 and April 2018. At the end of the procedure, the upper urinary tract was drained internally by a stent, not a nephrostomy tube, which is considered a golden standard of percutaneous nephrolithotomy. Study participants were divided into two groups. Group 1 included 44 patients that underwent stent placement for upper urinary tract drainage. Group 2 included 18 patients who had a stent with a ligature, fixed to the proximal curl of the drainage and threaded through the nephrostomy opening for subsequent translumbar removal of the drainage. We evaluated the efficacy of drainage systems by measuring the duration of surgery and intraoperative blood loss. In the postoperative period, we assessed the duration of hospital stay, time to drainage removal, and pain intensity at different stages (evaluated using the visual analog scale (VAS)). Results. The mean duration of surgery was comparable in the two groups analyzed: 69 min in Group 1 and 58 min in Group 2. The mean intraoperative blood loss was 279.8 ± 108.6 mL and 290.1 ± 109.3 ml in Groups 1 and 2, respectively. Pain intensity did not significantly vary between the two groups. Patients from group 1 had pain VAS score of 6.6, 4.8, 3.3, and 1.8 on days 1,2,3, and 5, respectively. Patients from group 2 had pain VAS score of 6.4, 5.2, 3.2, and 2.1 on days 1,2,3, and 5, respectively. The mean duration of hospital stay was 6.8 days in Group 1 and 6.5 days in Group 2. However, 31 patients from Group 1 underwent stent removal not earlier than 10 days postoperatively, whereas patients from Group 2 had their stents removed within 10 days after surgery. Conclusion. Stent placement after mini-percutaneous nephrolithotomy is an effective and safe method for upper urinary tract drainage. In the case of uncomplicated percutaneous nephrolithotomy in the absence of pronounced intraoperative bleeding, the choice of the internal drainage variant (with or without ligature) should be based on the presence of retention changes and the need for long-term postoperative drainage of the upper urinary tract. Placement of a stent with a ligature threaded through the nephrostomy fistula is a safe and effective method of drainage after percutaneous nephrolithotomy. This method does not require any invasive instrumental procedures for stent replacement/removal during the postoperative period.