Nephrostomy in percutaneous nephrolithotomy (PCNL): does nephrostomy tube size matter? Results from The Global PCNL Stud
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ORIGINAL ARTICLE
Nephrostomy in percutaneous nephrolithotomy (PCNL): does nephrostomy tube size matter? Results from The Global PCNL Study from The Clinical Research Office Endourology Society Luigi Cormio • Glenn Preminger • Christian Saussine • Niels Peter Buchholz • Xiaochun Zhang • Helena Walfridsson • Andreas J. Gross • Jean de la Rosette
Received: 10 August 2012 / Accepted: 4 October 2012 Ó Springer-Verlag Berlin Heidelberg 2012
Abstract Purpose To explore the relationships between nephrostomy tube (NT) size and outcome of percutaneous nephrolithotomy (PCNL). Methods The Clinical Research Office of the Endourological Society (CROES) prospectively collected data from consecutive patients treated with PCNL over a 1-year This study was conducted on behalf of the CROES PCNL Study Group. L. Cormio Department of Urology, University of Foggia, Foggia, Italy G. Preminger Department of Urology, Duke University Medical Center, Durham, NC, USA C. Saussine Department of Urology, University of Strasbourg, Strasbourg, France N. P. Buchholz Department of Urology, Barts & The London NHS Trust, London, UK X. Zhang Department of Urology, Peking University First Hospital, Beijing, China H. Walfridsson Department of Urology, University Hospital, Orebro, Sweden A. J. Gross Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany J. de la Rosette (&) Department of Urology, AMC University Hospital, Meibergdreef 9, 1105 AZ Amsterdam Z-O, The Netherlands e-mail: [email protected]
period at 96 participating centers worldwide. This report focuses on the 3,968 patients who received a NT of known size. Preoperative, surgical procedure and outcome data were analyzed according to NT size, dividing patients into two groups, namely small-bore (SB; nephrostomy size B 18 Fr) and large-bore (LB; nephrostomy size [ 18 Fr) NT. Results Patients who received a LB NT had a significantly lower rate of hemoglobin reduction (3.0 vs. 4.3 g/ dL; P \ 0.001), overall complications (15.8 vs. 21.4 %; P \ 0.001) and a trend toward a lower rate of fever (9.1 vs. 10.7 %). Patients receiving a LB NT conversely had a statistically, though not clinically significant, longer postoperative hospital stay (4.4 vs. 4.2 days; P = 0.027). There were no differences in urinary leakage (0.9 vs. 1.3 %, P = 0.215) or stone-free rates (79.5 vs. 78.1 %, P = 0.281) between the two groups. Conclusions LB NTs seem to reduce bleeding and overall complication rate. These findings would suggest that if a NT has to be placed, it should better be a LB one. Keywords Exit strategy Nephrostomy tube size Renal access Complications PCNL
Introduction Percutaneous nephrolithotomy (PCNL) is a standard treatment for large or otherwise complex renal or proximal ureteral stones [1]. Since first described by Fernstrom and Johannson [2], great efforts have been made to improve the outcome of this surgical procedure by optimizing its surgical steps, including patient position, puncture of the collecting system, dilation and fragmentation modality, and exit strategy.
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