Abstract
A randomized controlled study was performed to evaluate the feasibility and outcome of staged versus simultaneous bilateral tubeless PCNL for bilateral renal staghorn stones. A total of 99 patients, with bilateral renal staghorn stones, were prospectively randomized into two groups, and underwent staged tubeless PCNL (49 patients) or simultaneous bilateral tubeless PCNL (50 patients). Preoperative data included urinalysis, urine culture, complete blood count, biochemistry study, renal ultrasonography, intravenous urography, and Tc 99m DTPA clearance for the determination of selective glomerular filtration rate. Intraoperative findings, operative time, and outcome were also recorded. All patients were followed regularly at clinic every 3 months during year 1 and every 6 months thereafter, and Tc 99m DTPA clearance for determination of selective glomerular filtration rate was performed to assess the kidney function 6 months later. There was no difference between the groups with regard to serum creatinine change, hemoglobin decrease, and complication grading. The length of stay, convalescence period, pain visual analog scale, analgesic requirements, and direct cost favored the simultaneous bilateral tubeless group with statistical significance. There was no significant statistical difference in relative perfusion rate between preoperative and postoperative in both groups. This study demonstrates that simultaneous bilateral tubeless PCNL is a safe, efficacious, and cost-effective option in bilateral renal staghorn calculi, which is associated with low morbidity, short hospital stay, high stone-free rate, and early return-to-normal activity.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- PCNL:
-
Percutaneous nephrolithotomy
- Tc 99m DTPA:
-
99m technetium diethylenetriaminepentaacetic acid
- GFR:
-
Glomerular filtration rate
- ESWL:
-
Extracorporeal shock wave lithotripsy
- VAS:
-
Visual analog scale
References
Lingeman JE, Coury TA, Newman DM et al (1987) Comparison of results and morbidity of percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy. J Urol 138:485–490
Wong MY (2001) An update on percutaneous nephrolithotomy in the management of urinary calculi. Curr Opin Urol 11:367–372
Ahlawat R, Banerjee GK, Dalela D (1995) Bilateral simultaneous percutaneous nephrolithotomy. A prospective feasibility study. Eur Urol 28:116–118
Desai M, Grover R, Manohar T et al (2007) Simultaneous bilateral percutaneous nephrolithotomy: a single-center experience. J Endourol 21:508–514
Dushinski JW, Lingeman JE (1997) Simultaneous bilateral percutaneous nephrolithotomy. J Urol 158:2065–2068
Holman E, Khan AM, Pasztor I et al (2002) Simultaneous bilateral compared with unilateral percutaneous nephrolithotomy. BJU Int 89:334–338
Holman E, Salah MA, Toth C (2002) Comparison of 150 simultaneous bilateral and 300 unilateral percutaneous nephrolithotomies. J Endourol 16:33–36
Silverstein AD, Terranova SA, Auge BK et al (2004) Bilateral renal calculi: assessment of staged v synchronous percutaneous nephrolithotomy. J Endourol 18:145–152
Shah H, Khandkar A, Sodha H et al (2009) Tubeless percutaneous nephrolithotomy: 3 years of experience with 454 patients. BJU Int 104:840–846
Gonen M, Ozturk B, Ozkardes H (2009) Double-J stenting compared with one night externalized ureteral catheter placement in tubeless percutaneous nephrolithotomy. J Endourol 23:27–32
Shelbaia A, Rahman SA, Hussein A (2009) Tubeless percutaneous nephrolithotomy. UroToday Int J 02:02
Aghamir SMK, Mohammadi A, Mosavibahar SH et al (2008) Totally tubeless percutaneous nephrolithotomy in renal anomalies. J Endourol 22:2131–2134
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Preminger GM, Assimos DG, Lingeman JE et al (2005) AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol 173:1991–2005
Rous SN, Turner WR (1997) Retrospective study of 95 patients with staghorn calculus disease. J Urol 118:902–904
Koga S, Arakaki Y, Matsuoka M et al (1999) Staghorn calculi—long-term results of management. Br J Urol 68:122–129
Bagrodia A, Raman JD, Bensalah K et al (2009) Synchronous bilateral percutaneous nephrostolithotomy: analysis of clinical outcomes, cost and surgeon reimbursement. J Urol 181:149–153
Bellman GC, Davidoff R, Candela J et al (1997) Tubeless percutaneous renal surgery. J Urol 157:1578–1582
Delnay KM, Wake RW (1998) Safety and efficacy of tubeless percutaneous nephrostolithotomy. World J Urol 16:375–377
Karami H, Gholamrezaie HR (2004) Totally tubeless percutaneous nephrolithotomy in selected patients. J Endourol 18:475–476
Limb J, Bellman GC (2002) Tubeless percutaneous renal surgery: review of first 112 patients. Urology 59:527–531
Troxel SA, Low RK (2002) Renal intrapelvic pressure during percutaneous nephrolithotomy and its correlation with the development of postoperative fever. J Urol 168:1348–1351
Dogan HS, Guliyev F, Cetinkaya YS et al (2007) Importance of microbiological evaluation in management of infectious complications following percutaneous nephrolithotomy. Int Urol Nephrol 39:737–742
Mariappan P, Tolley DA (2005) Endoscopic stone surgery minimizing the risk of post-operative sepsis. Curr Opin Urol 15:101–105
Fowler JE Jr (1984) Bacteriology of branched renal calculi and accompanying urinary tract infection. J Urol 131:213–215
McAleer I, Kaplan GW, Bradley JS et al (2003) Endotoxin content in the renal calculi. J Urol 16:1813–1814
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Wang, CJ., Chang, CH. & Huang, SW. Simultaneous bilateral tubeless percutaneous nephrolithotomy of staghorn stones: a prospective randomized controlled study. Urol Res 39, 289–294 (2011). https://doi.org/10.1007/s00240-010-0342-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00240-010-0342-x