ABSTRACT
Objective To compare intrarenal pelvic pressure or endoureteral pressure and infection index between perfusion pump and low pressure of gravity drip during percutaneous nephrolithotomy (PCNL). Methods From 2015 April to 2017 June, 107 patients with ureteral or renal calculus were randomly divided into two groups, among whom 46 cases underwent perfusion pump PCNL and 61 cases underwent low pressure gravity drip PCNL. No statistical significance of preoperative variables was found between the two groups such as age, gender,preoperative status of infection,status of hydrpnephrosis,size and location of stone (P＞0.05).A 5Fr ureteral catheter was positioned into the renal pelvic or ureter,and the intrarenal pelvic or endoureteral pressure was measured by anesthesia monitor during PCNL for all patients.We recorded and compared removing calculus time, postoperative hemoglobin changing, fever rate, procalcitonin abnormal rate, white blood cell counts and calculi clearance rate.Results The average pelvic or endoureteral pressures in the group undergoing perfusion pump and the one undergoing low pressure gravity drip were (22.7±4.6) mmHg VS (29.8±5.3) mmHg and the maximum pressure were (28.8 ±6.56) mmHg VS (50 ±9.25) mmHg.The statistics was significantly different (P＜0.05).Compared with perfusion pump group, the group undergoing low pressure gravity drip had significant differences in fever rate [4.9%(3/61) VS.17.3%(8/46) ], procalcitonin abnormal rate [3.2%(2/61) VS. 15.2%(7/46) ] and white blood cell counts abnormal rate[9.8%(6/61) VS.28.26%(13/46) ] (P＜0.05). However,no significant difference was seen in postoperative hemoglobin changing[(8.3±3.7) g/L VS.(7.2 ± 3.3) g/L] (P＞0.05) and the time of removing calculus [(42.4 ±14.5) min VS (43.6 ±13.5) min] (P＞0.05) .Conclusions Compared with perfusion pump, low pressure gravity drip PCNL maintains lower renal pelvic or endoureteral pressure, which is less than reflux limit during calculi fragmentation. It might be contributed to reduce the postoperative fever rate, white blood cell counts abnormal rate and procalcitonin abnormal rate. Hemoglobin changing and the time of removing calculus show no obvious disadvantage.
ABSTRACT
Objective To evaluate the safety of tubeless micro-percutaneous nephrolithotomy (MPCNL). Methods Forty patients who met the criteria(single percutaneous tract, no serious bleeding or perforation in the collecting system and absence of insignificant residual fragments under B-US)were included. After the operation of stone fragmentation, all patients were randomly divided into 2 groups. Twenty patients underwent standard MPCNL(group A), 16 eases had stones in kidney and 4 in upper ureter. Longitudinal sizes of calculi were 1.3-8. 6 era(mean 3.4 era). Twenty patients in group B were with tubeless procedures, 14 patients had stones in kidney and 6 in upper ureter. Longi-tudinal sizes of calculi were 1.1-7. 9 era(mean 3.1 era). Double J stents were placed in all eases. Changes of hemoglobins, pain and complications were recorded and ststistieally analyzed. Results There were no differences in stone size(P=0. 23), operation time (98±29 rain vs 92±31 min, P=0. 63) between the 2 groups. The changes of hemoglobin had no significant difference between 2 groups[(3.3±1.6)% vs (3.1±1.6)%, P=0. 49]. Postoperative pain was assessed using a visual analog scale. The scores of both groups on the first postoperative day were 3.6±1.8(group A) and 3.3±1.5(group B,P=0. 66). On the third day the scores were 1.6±1.2 and 1.8±1.3(P=0. 62). Both groups had 1 patient suffered from mild fever. No transfuaion was performed and no renal colic happened in 2 groups. Conclustion Under certain circumstance, tubeless MPCNL is a safe procedure for patients with urolithiasis.