Comparison one-step procedure with two-step procedure in percutaneous nephrolithotomy

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• 作者：Szu-Han Chen (1) (2)
  Wen-Jeng Wu (1) (2) (3) (5)
  Yii-Her Chou (1) (3)
  Hsin-Chih Yeh (1) (2) (4)
  Chia-Chun Tsai (1) (2) (4)
  Kuang-Shun Chueh (1) (4)
  Nien-Ting Hou (4)
  Siou-Jin Chiu (1)
  Hung-Pin Tu (6)
  Ching-Chia Li (1) (2) (3) (4)
  
• 关键词：Renal stone ; Percutaneous nephrolithotomy ; Complication ; Wound pain
• 刊名：Urological Research
• 出版年：2014
• 出版时间：April 2014
• 年：2014
• 卷：42
• 期：2
• 页码：121-126
• 全文大小：172 KB
• 参考文献：1. Ritter M, Krombach P, Michel MS (2011) Percutaneous stone removal. Eur Urol 10(5):433-39 CrossRef
  2. Mishra S, Sabnis RB, Kurien A et al (2010) Questioning the wisdom of tubeless percutaneous nephrolithotomy (PCNL): a prospective randomized controlled study of early tube removal vs tubeless PCNL. BJU Int 106(7):1045-049 CrossRef
  3. Frattini A, Barbieri A, Salsi P et al (2001) One shot: a novel method to dilate the nephrostomy access for percutaneous lithotripsy. J Endourol 15(9):919-23 CrossRef
  4. de la Rosette JJ, Opondo D, Daels FP et al (2012) Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy. Eur Urol 62(2):246-55 CrossRef
  5. Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205 CrossRef
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  10. Lam HS, Lingeman JE, Barron M et al (1992) Staghorn calculi: analysis of treatment results between initial percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy monotherapy with reference to surface area. J Urol 147(5):1219-225
  11. Auge BK, Sekula JJ, Springhart WP et al (2004) In vitro comparison of fragmentation efficiency of flexible pneumatic lithotripsy using 2 flexible ureteroscopes. J Urol 172(3):967-70 CrossRef
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  13. Ni S, Qiyin C, Tao W et al (2011) Tubeless percutaneous nephrolithotomy is associated with less pain and shorter hospitalization compared with standard or small bore drainage: a meta-analysis of randomized, controlled trials. Urology 77(6):1293-298 CrossRef
  
• 作者单位：Szu-Han Chen (1) (2)
  Wen-Jeng Wu (1) (2) (3) (5)
  Yii-Her Chou (1) (3)
  Hsin-Chih Yeh (1) (2) (4)
  Chia-Chun Tsai (1) (2) (4)
  Kuang-Shun Chueh (1) (4)
  Nien-Ting Hou (4)
  Siou-Jin Chiu (1)
  Hung-Pin Tu (6)
  Ching-Chia Li (1) (2) (3) (4)
  
  1. Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tzyou First Rd, Kaohsiung, 807, Taiwan
  2. Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  3. Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  5. Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  4. Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
  6. Department of Public Health and Environmental Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  
• ISSN：1434-0879

文摘

The aim of this study was to compare the effects of one-step percutaneous nephrolithotomy (PCNL) by the urologist alone and two-step PCNL by cooperating with the radiologist. We included 168 patients who underwent surgery by the same surgeon, 83 who underwent two-step PCNL, in which percutaneous nephrostomy insertion was performed by the radiologists on the day before endo-surgery, and 85 who underwent one-step PCNL, which involved the creation of a nephrostomy tract and performing the PCNL at the same time in the operating room, by a urologist. We compared the perioperative and postoperative parameters between these two groups. The result revealed that there were no significant differences between one-step and two-step PCNL in the decreases in haemoglobin level and blood transfusion volume, and the hospital stay was shorter in the one-step PCNL group. In addition, the one-step PCNL group was associated with significantly lower visual analogue score (VAS), which were 2.3, 1.1, and 0.4 on the post-operative days 1, 2, and 3, respectively, compared with 3.2, 1.7, and 1.0 in the two-step PCNL group. The number of parenteral analgesic prescriptions was fewer in the one-step PCNL group (0.8?±?1.1 amps/vials) than in the two-step PCNL group (4.1?±?2.4 amps/vials). Furthermore, different stone locations barely affected VAS and analgesic administrations. The results indicate that the one-step PCNL by the urologist alone, compared to two-step PCNL with the radiologist, has better wound pain outcome and shorter hospital stay with comparable successful rate and complication grade