CHOOSING A METHOD OF DRAINING THE UPPER URINARY TRACT FOLLOWING PERCUTANEOUS NEPHROLITHOTRIPSY


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Purpose: to compare various methods of upper urinary tract drainage in patients with urolithiasis. Patients and Methods: 60 patients were included into a prospective study which ran from March 2013 through December 2014. All patients underwent PCNL with a nephrostomy tract diameter of (28-30 Ch.) at the I.M. Sechenov First Moscow State Medical University urology clinic. Patients were divided into 2 groups. Group 1 30 (patients) underwent nephrostomy after PCNL with nephrostomy tract placement, in group 2 (29 patients) internal drainage was performed. One patient withdrew from the study due to residual stone. Adequacy of urinary tract draining was assessed by operative time and blood loss. A comparative analysis was performed to outline difference in both groups by length of hospital stay, severity of flank pain in early postoperative period and 5 days after the procedure, day of drain removal. Results: the average operative time in group №1 was 104 minutes (+/-17 min.), and 71 minutes (+/- 19 minutes) in group №2 . The average hemoglobin level before surgery in both groups was roughly comparable and amounted to: 141.5g / l (+/-13) in group №1, in group № 2 143.6 g / l (+/-18). At the same time, hemoglobin level in the early postoperative period varied in both groups and was as follows: 121g / l (+/-13) in group №1, and 128g / l (+/-14) in group 2. Evaluation of pain severity by VAS score showed that severity of pain in an early postoperative period was roughly comparable in both groups and amounted to 6.29 and 6.05 points, respectively, but from the second day, and since the activation of the patients, the values of the intensity of pain in both groups became differ. Group №1: - 5.33 (+/-1.5) on day 2, 3.25 (+/-1.8) on day 3, - 2.5 (+/-1.6) on day 5. A more thorough elucidation of the cause of pain showed that in 56 (88%) patients the pain was due to the nephrostomy and pain in the nephrostomy stroke while driving and only 7 (11%) patients complained of a pain in the operated kidney. Group №2: - 3.5 (+/-1.2) on day 2, - 2.9 (+/-1.4) on day 3, 1.22 (+/-0.8) on day 5. Conclusion: A detailed and thorough history, taking together with multislice computed tomography and multiplanar 3D modeling allows for better preoperative assessment regarding a size, a number and location of stones, vascular architecture of the kidney. This enebles an experienced endoscopic surgeon to plan an operation, and avoid the possible difficulties associated with lithotripsy and choose a more suitable method of pyelocaliceal system draining after the operation. In turn, tubeless PCNL, with proper intraoperative managamant and careful selection of patients appears to be safe and effective. Drainage of the upper urinary tract with internal drainage reduces intensity of postoperative pain, which improves the quality of life of patients in the postoperative period, and reduces the length of postoperative stay.

Full Text

Restricted Access

About the authors

Yu. G Alyaev

Sechenov First Moscow State Medical University; Research Institute of Uronephrology and Human Reproductive Health

N. A Grigoriev

Sechenov First Moscow State Medical University; Research Institute of Uronephrology and Human Reproductive Health

Email: grigna69@gmail.com

N. I Sorokin

Sechenov First Moscow State Medical University; Research Institute of Uronephrology and Human Reproductive Health

Email: nisorokin@mail.ru

I. V Diakonov

Sechenov First Moscow State Medical University; Research Institute of Uronephrology and Human Reproductive Health

Email: vonterkaus@mail.ru
Urologist Urology Clinic

S. H Ali

Sechenov First Moscow State Medical University; Research Institute of Uronephrology and Human Reproductive Health

References

  1. Аляев Ю.Г. Мочекаменная болезнь. Современные методы диагностики и лечения. Ю.Г. Аляев (ред.). М. ГЭОТАР-Медиа. 2010;224 с
  2. Глыбочко П.В., Лопаткин Н.А., Аляев Ю.Г., Ахвелидиани Н.Д. Диагностика и лечение мочекаменной болезни. Что изменилось за последние 20 лет? Саратовский научно-медицинский журнал. 2010;7(2):9-12
  3. Мартов А.Г., Сафаров Р.М., Гущин Б.Л., Кудрявцев Ю.В. Сравнительная характеристика эффективности и безопасности применения различных типов контактных литотриптеров. Материалы Пленума правления Всероссийского общества урологов. Саратов. 1998;312-313
  4. Мартов А.Г., Ергаков Д.В., Серебрянный С.А., Дзеранов Н.К., Лисовченко С.А. Перкутанная хирургия коралловидного нефролитиаза в “эпоху ДЛТ”. Материалы Пленума правления Российского общества урологов (Сочи, 28-30 апреля 2003). М.: 2003:411-412
  5. Теодорович О.В. Чрескожная пункционная нефростомия и нефролитотомия. Автореф. дисс. канд. мед. наук, М.: 1990
  6. Дзеранов Н.К., Лопаткин Н.А. Мочекаменная болезнь: клинические рекомендации. М.: Изд-во «Оверлей». 2007. С. 296
  7. Hesse A.I., Tiselius H.G., Siener R. et al. Uriary stones. Diagnosis, treatment and prevention recurrence. 3 rd ed. Basel S. Karger A.G. 2009.
  8. Tiselius H.G., Aiken P., Buck C. et al. Tiselius H.G. Guidelines on urolithiasis. European Urological Association Guidelines, 2008.
  9. Gurhan G.C. Epidemiology of stone disease. Urol. clin. North Am. 2007;34(3):287-293.
  10. Winfield H.N., Weyman P., Clayman R.V. Percutaneous nephrostolithotomy: Complications of premature nephrostomy tube removal. J Urol. 1986;136:77-79.
  11. Turna B., Nazli O., Demiryoguran S., Mammadov R., Cal C. Percutaneous nephrolithotomy: Variables that influence hemorrhage. Urology. 2007;69:603-607.
  12. Вешкурцев В.В., Воронов А.К., Хван О.В. и др. Геморрагические осложнения перкутанных операций. I Российский конгресс по эндоурологии. Материалы. М.: 2008;148-149
  13. Гулиев Б.Г. Перкутанное лечение коралловидного нефролитиаза. Эндоскопическая хирургия. 2009;5:21-25
  14. Wickham J.E., Miller R.A., Kellett М.J. el al. Percutaneous nephrolithotomy: One stage or two? Br. J. Urol. 1984;56:582-585
  15. Григорьев Н.А. Размышления о бездренажной (tubeless) чрескожной нефролитотрипсии. Урология сегодня. 2012;2:15
  16. Цинаев М.А. Сравнительная оценка эффективности современных методов лечения больных коралловидным нефролитиазом: дисс ... канд. мед. Наук. СПб.: 2009;134 c
  17. Aquil S., Rana M., Zaidi Z. Laparoscopic assisted percutaneous nephrolithotomy in ectopic pelvic kidney. J. Рак Med Assoc. 2006;56:381-383.
  18. Breda A., Ogunyemi O., Leppert J.T., Lam J.S., Schulam P.G. Flexible ureteroscopy and laser lithotripsy for single intrarenal stones
  19. cm or greater - is this the new frontier? Urol. 2008;179:981-984.
  20. Chung B.I., Aron M., Hegarty H.J. Ureteroscopic versus percutaneous treatment for medium size (1-2 cm) renal calculi. J. Endourol. 2008;22:343-346.
  21. Crook T.J., Lockyer C.R., Keoghane S.R., Walmsley B.H. Totally tubeless percutaneous nephrolithotomy. J Endourol. 2008;22:267-271.
  22. Bellman G.C., Davidoff R., Candela J., Gerspach J., Kurtz S., Stout L. Tubeless percutaneous renal surgery. J Urol. 1997;157:1578-1582.
  23. Shpall A.I., Parekh A.R., Bellman G.C. Tubeless Percutaneous Nephrolithotomy with Antegrade Stent Tether: Clinical Experience. J Endourol. 2007;21:973-976.
  24. Choi S.W., Kim K.S., Kim J.H., Park Y.H., Bae W.J, Hong S.H., Lee J.Y., Kim S.W., Hwang T.K., Cho H.J. Totally tubeless versus standard percutaneous nephrolithotomy for renal stones: analysis of clinical outcomes and cost. J Endourol. 2014;28(12):1487-94. doi: 10.1089/end.2014.0421.
  25. Аляев Ю.Г., Терновой С.К., Ахвледиани Н.Д., Фиев Д.Н. Инновационная диагностика урологических заболеваний. ВРАЧ. 2010; 6:2 с
  26. Глыбочко П.В., Аляев Ю.Г. 3D-технологии при операциях на почке: от хирургии виртуальной к хирургии реальной. Москва: ГЭОТАР-Медиа. 2014
  27. Dogan H.S., Sahin A., Cetinkaya Y., Akdogan B., Ozden E., Kendi S. Antibiotic prophylaxis in percutaneous nephrolithotomy: prospective study in 81 patients. J Endourol. 2002;16(9):649-653

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2016 Bionika Media

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies