ABSTRACT
OBJECTIVE@#To describe the outcomes of standard-sized tubeless PCNL (TSPCNL) in terms of clinical efficacy (stone-free rate, operative time and length of hospital stay) and safety (transfusion rate, infection and complications).@*METHODS@#A chart review was done on all patients who underwent standard-sized PCNL from 2017 to 2019. All cases of TSPCNL were identified. The patient and stone demographics were analyzed including intraoperative and postoperative outcomes. Complications were analyzed using the Clavien-Dindo classification.@*RESULTS@#Seventy-nine consecutive cases of prone, single-tract, upper pole access, tubeless PCNL were identified and analyzed. The mean age was 52.74±11.26 with a female to male ratio of 1:1.4. The Guy’s Stone Score showed 12 (15.2%) Grade 1; 23 (29.1%) Grade 2, 11(13. 9%) Grade 3 and 33 (41.8%) Grade 4 renal stones. Mean stone size was 33.7±14.1mm. The stone-free rate was 98.73%. The mean hemoglobin change was 13.6±13.9 g/L. The mean creatinine change was 2.65±23 umol/L. The mean length of hospital stay was 2.46±1.84 days. Twenty-four (30.4%) experienced significant pain, which required analgesics in the form of opioid derivatives. According to the modified Clavien-Dindo classification, 6/79 (7.6%) had Grade 1; 4/79 (5.1%) had Grade 2 and 2/79 (2.5%) had Grade 3 complications. There was no mortality.@*CONCLUSION@#The authors’ experience adds to the growing evidence that TSPCNL is a reasonable, efficient and safe approach for large volume nephrolithiasis. Clear indications are needed prior to nephrostomy tube placement after standard-sized PCNL.
ABSTRACT
OBJECTIVE@#To describe utilization of pretransplant cystography and hydrodistention among anuric end stage renal disease patients (ESRD) on renal replacement therapy (RRT) and its impact on cost and timing of transplantation.@*METHODS@#A chart review was done on all anuric ESRD pretransplant patients on renal replacement therapy who underwent cystography and hydrodistention from 2014 to 2019. The authors analyzed patient demographics, post-transplant outcomes, process indicators and costs incurred due to cystography and hydrodistention.@*RESULTS@#A total of 151 patients were included in the study. There was female predominance (86, 57%) with a median age of 32 (range 18-61) years. Majority of the patients underwent hemodialysis (144, 95%). Glomerulonephritis was the prevailing etiology of ESRD (119, 79%). Majority had normal bladder capacity (107, 71.5%), while 44 (29%) patients had small bladder capacity who subsequently underwent hydrodistention. There is a moderately negative correlation between bladder capacity and duration of dialysis and anuria. Hydrodistention did not significantly increase duration from diagnosis to kidney transplant (4.2 vs 3.5 months; p = .083). Median cost of cystography was Php 4377 (range 1978 – 5282) and the average total cost incurred per patient due to hydrodistention was Php 643.53.@*CONCLUSION@#Longer duration of RRT and anuria yields to lesser bladder capacity. Cystography is recommended in ESRD patients who are anuric for at least three years. Hydrodistention does not significantly prolong duration of diagnosis to kidney transplant.