Observational prospective study for surgical outcome and anesthetic feasibility of tubeless and totally tubeless supine PCNL: A single centre initial experience

Özet

Objective: To evaluate surgical outcome and spinal anesthetic feasibility of supine percutaneous nephrolithotomy (PCNL) by tubeless and totally tubeless method.Material and methods: This observational study included a totally 53 patients. Initial diagnosis of renalstone was based on urinary ultrasonography, kidney, ureter and bladder X-ray, and later confirmed by computed tomography urography. PCNL was done with the patient in Galdakao-modified supine Valdivia position. Nephrostomy was not done using tubeless method, while in totally tubeless method instead of insertionof double j stent, ureteral catheterization was done and the ureter catheter was kept for <24 hours. Duringpostprocedural period, patients were observed for development of fever, perinephric collection, need forblood transfusion and duration of hospital stay.Results: Patients aged between 14 and 75 years were included in the study. Out of totally 53 patients, supinetubeless PCNL was done in 23 patients while 30 were operated using totally tubeless method. Twenty-ninepatients were induced by spinal anesthesia and 24 by general anesthesia. Stone sizes were found to be inthe range of 1.4cm to 5.1 cm. Forty-six (86.7%) patients were managed by inferior calyceal puncture. Threepatients required double puncture in whom 2 had developed perinephric collection. Complete stone clearance achieved in 49 (92.4%) patients. Four patients developed fever and 2 cases required one unit bloodtransfusion postoperatively.Conclusion: Tubeless and totally tubeless supine PCNL is technically feasible with good surgical outcomesand can be done under spinal and general anesthesia in properly selected patients.