Efficacy and safety of partial tubeless versus standard percutaneous nephrolithotomy in the treatment of upper urinary tract calculi / 现代泌尿外科杂志

【Objective】 To compare the efficacy and safety between partial tubeless and standard percutaneous nephrolithotomy in the treatment of upper urinary tract calculi. 【Methods】 The clinical data of 802 patients with upper urinary tract calculi treated at our hospital during Jun.2018 and Dec.2021 were retrospectively analyzed. The patients were divided into the partial tubeless group and standard group, and 60 cases in either group were selected by a simple random method. Clinical data, complications and stone-free rate were compared between the two groups. 【Results】 All 120 patients completed the operation successfully. The postoperative hospital stay, pain score and postoperative recovery of the partial tubeless group were significantly superior to those of the standard group (P0.05). 【Conclusion】 In the treatment of upper urinary tract calculi, partial tubeless percutaneous nephrolithotomy can achieve satisfactory surgical results, and has obvious advantages in postoperative recovery and patients’ experience. It is worthy of clinical application.

Tubeless video-assisted thoracoscopic surgery for primary palmar hyperhidrosis: A retrospective cohort study in a single center / 中国胸心血管外科临床杂志

@#Objective    To explore the safety, feasibility and superiority of tubeless video-assisted thoracoscopy in the treatment of primary palmar hyperhidrosis (PPH). Methods    The clinical data of 46 patients with palmar hyperhidrosis treated by thoracoscopy in the Department of Thoracic Surgery of the First Hospital of Lanzhou University from March 2017 to September 2020 were retrospectively analyzed. Among them, 22 received tubeless video-assisted thoracoscopic surgery, and were divided into a tubeless group, including 10 males and 12 females with an average age of 24.3±6.4 years; 24 received conventional thoracoscopic surgery, and were divided into a control group, including 13 males and 11 females with an average age of 23.5±4.8 years. The operation status, anesthesia effect and postoperative complications of the two groups were compared. Results    Forty-six patients successfully completed the operation with the assistance of thoracoscopy. There was no intraoperative transfer to thoracotomy, or intraoperative transfer to tracheal intubation in the tubeless group. Anesthetic recovery time (14.4±1.6 min vs. 20.1±1.8 min, P=0.000), time to get out of bed on the first postoperative day (3.1±0.6 h vs. 1.6±0.4 h, P=0.000), visual analogue score for postoperative pain (1.4±0.6 points vs. 3.4±1.1 points, P=0.000), postoperative hospital stay (1.7±0.5 d vs. 2.8±0.6 d, P=0.000), postoperative satisfaction rate of patients (95.5% vs. 66.7%, P=0.037) in the tubeless group were shorter or better than those in the control group. There was no statistical difference in age, gender, smoking history, palmar hyperhidrosis classification, palms or other  associated parts, the total time of bilateral surgery, intraoperative blood loss, postoperative complications, or compensatory hyperhidrosis (mild) between the two groups (P>0.05). Conclusion    Compared with traditional thoracoscopic surgery for PPH, tubeless video-assisted thoracoscopic surgery for PPH has the advantages of safety, reliability, light pain and quick recovery, in line with the concept of accelerated rehabilitation surgery.

Clinical effect of 3 mm thoracoscope combined with needle electrocoagulation hook in the treatment of primary palmar hyperhidrosis: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To explore the clinical effect of tubeless 3 mm ultra-fine thoracoscope combined with needle electrocoagulation hook thoracic sympathicotomy in the treatment of primary palmar hyperhidrosis. Methods    The clinical data of 77 patients with primary palmar hyperhidrosis who underwent surgery in the First Hospital of Lanzhou University from September 2017 to July 2021 were retrospectively analyzed, including 50 males and 27 females, with an average age of 23.60±5.60 years. A total of 36 patients were treated with tubeless 3 mm ultra-fine thoracoscopic electrocoagulation hook thoracic sympathicotomy (an observation group), and 41 patients were treated with conventional thoracoscopic thoracic sympathicotomy (a control group). The baseline data, perioperative data and the results of 12 hours after operation were compared between the two groups. Results    All the 77 patients completed the operation successfully, no conversion to thoracotomy, no intraoperative bleeding, and no conversion to endotracheal intubation in the observation group. In the observation group, the time of anesthesia before operation [19.00 (17.00, 23.75) min vs. 25.00 (21.00, 27.00) min, P=0.001] and postoperative hospital stay [2.00 (1.00, 2.00) d vs. 2.00 (1.00, 3.00) d, P=0.012] were shorter than those in the control group. The operation time [22.50 (21.00, 25.75) min vs. 26.00 (23.50, 28.50) min, P=0.001], intraoperative blood loss [5.00 (2.25, 5.00) mL vs. 6.00 (5.00, 10.00) mL, P=0.003], postoperative pain index [2.00 (1.00, 2.00) vs. 3.00 (2.00, 3.00), P=0.001], hospitalization cost (14 246.58±879.28 yuan vs. 15 085.90±827.15 yuan, P<0.001) and postoperative inflammation index: white blood cell count [(12.96±2.32)×109/L vs. (14.47±2.05)×109/L, P=0.003], percentage of neutrophils (76.31%±5.40% vs. 79.97%±7.12%, P=0.014) were significantly lower or less than those in the control group. There was no significant difference in the incidence of major postoperative complications or adverse consequences between the two groups (P>0.05). In the evaluation of 12 hours after operation, the time of getting out of bed [2.00 (1.00, 2.00) h vs. 2.00 (2.00, 3.00) h, P=0.017], the time of drinking water after operation [1.50 (1.00, 2.00) h vs. 2.00 (1.00, 3.00) h, P=0.005], and the heart rate (80.25±14.42 bpm vs. 91.07±15.08 bpm, P=0.002), the incidence of dizziness, nausea and other uncomfortable symptoms (5.6% vs. 25.0%, P=0.040) at 12 hours after operation were shorter or lower than those in the control group. There was no significant difference in blood oxygen saturation (non-inhaled oxygen state) 12 hours after the operation between the two groups [97.00% (95.25%, 98.00%) vs. 97.00% (96.00%, 98.00%), P=0.763]. Conclusion    Compared with conventional thoracoscopic thoracic sympathicotomy, tubeless 3 mm ultra-fine thoracoscopic electrocoagulation hook thoracic sympathicotomy can significantly shorten the operation time, reduce postoperative pain and promote postoperative recovery, in line with the concept of accelerated rehabilitation surgery and minimally invasive surgery, and is worth popularizing in clinical practice.

Nefrolitotricia percutánea ambulatoria: nuestra experiencia en 156 casos / Ambulatory Percutaneous Nephrolithotomy: Our experience in 156 cases

OBJETIVOS: analizar y presentar nuestros resultados en el tratamiento de la litiasis renal mediante Nefrolitotricia Percutánea (NLP) ambulatoria en un mismo centro. MATERIALES Y MÉTODOS: entre agosto de 2013 y mayo de 2017 se realizó una recolección prospectiva de datos de los pacientes sometidos a NLP ambulatoria tubeless con catéter doble J o totally tubeless por litiasis renal. Se excluyeron aquellos pacientes con score de ASA >3. Se analizaron los datos preoperatorios, intra- y posoperatorios. Se clasificaron las complicaciones de acuerdo con el sistema de Clavien modificado. Se compararon los valores de hematocrito, hemoglobina, creatininemia y uremia pre- y posoperatoria a las 48 horas. RESULTADOS: en total, se operaron 156 pacientes, a los cuales se les dio el alta el mismo día de la cirugía. La suma de los diámetros máximos de las litiasis, en promedio, fue de 26,6 mm, 32 casos de litiasis coraliforme. La posición más utilizada fue la ventral, con un tiempo promedio de cirugía de 50 minutos. Se realizó NLP tubeless en 125 pacientes y totally tubeless en 29 casos. A 40 pacientes se les colocó un tapón de Surgicel en el tracto de acceso percutáneo. La tasa libre de cálculos fue del 84%, y en pacientes con litiasis coraliforme fue del 53%. No hubo complicaciones intraoperatorias y el 80% de los pacientes no presentó complicaciones. La tasa de reinternación fue del 3%. Si bien se hallaron diferencias significativas entre los valores pre- y posoperatorios de hematocrito y hemoglobina (40% y 13,3 g/dl vs. 39% y 12,8 g/dl; p=0,0001 y 0,0001, respectivamente), estas no fueron clínicamente significativas y solamente un paciente requirió de transfusión de sangre (0,6%). CONCLUSIONES: en nuestra experiencia, la NLP ambulatoria fue segura, con tasas libres de cálculos y complicaciones similares a las realizadas con internación.

OBJECTIVES: To assess the safety and feasibility of ambulatory percutaneous nephrolithotomy (PCNL) at a single institution. METHODS: Data collected prospectively of patients submit for ambulatory PCNL tubeless or totally tubeless between August 2013 and May 2017 were review. Exclusion criteria were patients with ASA score >3. Preoperative, intraoperative, and postoperative data were collected. Complications were classified using the Clavien sistem modified for PCNL. Properative and 48hs postoperative value of hematocrit, hemoglobin, creatininemia and uremia were compare. RESULTS: One hundred and fifty five patients underwent ambulatory PCNL. All patients were discharge the same day of surgery. The median of the sum of the maximum stone diameter was 26,6mm, 32 patients had staghorn calculus. We performed the majority of the surgerys in ventral position with a median time of 50 minutes. One hundred and twenty five patients underwent tubeless PCNL and totally tubeless 29 patients. In 40 cases we used Surgicel for sealing the percutaneous tract. Overall stone-free rate was 84% and 53% in staghorn cases. There were no intraoperative complications and 80% of the patients did not have any complications. Readmission rate was 3%. There was a significant decrease in the postoperative hematocrit and hemoglobin level (40% y 13,3 g/dl vs. 39% y 12,8 g/dl; p=0,0001 y 0,0001), this was not clinically significant. Only one patient required blood transfusion (0,6%). CONCLUSION: Ambulatory PCNL is safe with a stone-free rate, readmisions and complications similar to standard PCNL.

The double J tubeless misguided by zebra guidewire into ileum: a case report / 中华泌尿外科杂志

A case of severe complications is presented that replaced the double J tubeless misguided by zebra guidewire into ileum in a patient with ureteral dermostomy, causing a ureteral ileum fistula.The result suggests improper operation of zebra guidewire could have a risk of ureteral perforation when the ureter is distorted, narrow or with inflammatory lesions.Standardized diagnosis and treatment and correct selection of guidewire can reduce the risk of ureteral perforation.

The clinical application of tubeless video-assisted thoracoscopic surgery in the treatment of spontaneous pneumothorax / 中国胸心血管外科临床杂志

@#Objective    To explore the safety, feasibility and superiority of tubeless video-assisted thoracoscopic surgery (VATS) in the treatment of spontaneous pneumothorax. Methods    We retrospectively analyzed the clinical data of 38 patients with primary spontaneous pneumothorax treated in our hospital from February 2017 to July 2018. Tubeless bullectomy was performed in 18 patients, including 11 males and 7 females, aged 14.3±1.5 years. Twenty patients underwent conventional thoracoscopic bullae resection, including 12 males and 8 females, aged 14.5±1.7 years. The clinical effectiveness was compared. Results    All the 38 patients completed the operation successfully under the single-port thoracoscopy, without the transfer of intubation and secondary surgery. Operation time (67.3±13.3 min vs. 81.4±13.4 min, P=0.002), preoperative anesthesia time (14.2±2.6 min vs. 18.5±2.6 min, P=0.000), postoperative anesthesia recovery time (17.1±2.6 min vs. 26.5±5.0 min, P=0.000), visual simulation score of postoperative pain (2.3±0.9 vs. 5.2±1.0, P=0.000), postoperative activity time (1.3±0.4 d vs. 2.9±0.6 d, P=0.000), postoperative hospitalization time (2.9±0.8 d vs. 5.6±1.3 d, P=0.000), hospitalization cost (35.0±6.0 kyuan vs. 59.0±10.0 kyuan, P=0.000) were better in the control group. There was no significant difference in intraoperative blood loss (73.2±4.6 mL vs. 73.9±4.1 mL) and postoperative lung revascularization time (29.3±2.4 h vs. 29.7±2.5 h) between the two groups (P>0.05). Conclusion    Compared with traditional thoracoscopic bullectomy, tubeless VATS technique is safe and reliable in the treatment of spontaneous pneumothorax, with mild pain and quick recovery, in line with the concept of fast track surgery and worthy of clinical promotion.

Analysis of clinical outcomes of Tubeless Standard-Sized PCNL (TSPCNL) for large volume renal stones: A single center retrospective study

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.

Comparison of standard and tubeless percutaneous nephrolithotomy for renal calculi: a prospective randomized control trial

Background:In the current era of minimally invasive interventions, the mainstay of treatment of renal stones larger than 2cm is percutaneous nephrolithotomy (PCNL). PCNL underwent various evolutionary changes minimizing morbidity to the patients. We prospectively compared the outcome of tubeless PCNL (without nephrostomy drainage tube) to reduce the pain and discomfort caused by tube with standard PCNL in the treatment of renal stones.Methods:In this randomized control trial (RCT), we divided patients satisfying the inclusion criteria of consenting for trial, single access puncture, less than 3 stones each less than 3 cm, operative duration of less than 2 hours into two groups, standard PCNL (group 1) and tubeless PCNL (group 2) with 25 patients each. Randomization and group assignment were done after complete clearance of renal stones.Results:Patient‟s age, gender, sides of stone and stonesize were comparable between two groups (standard versus tubeless PCNL). Postoperative hemoglobin drop, bleeding, pyrexia, urine leak, and blood transfusion requirement did not show a statistically significant difference between the two groups. Analgesic requirement (190mg versus 80 mg of tramadol), operative duration (49.80 min versus 38.60 min), postoperative pain score (6/10 versus 3.64/10-visual analog scale) and duration of hospital stay (68.48 hours versus 41.12 hours) showed statistically significant difference favoring tubeless PCNL.Conclusions: Tubeless PCNL may be a safe, acceptable and effective modality of treatment for renal calculi in carefully selected patients comparing standard PCNL resulting in less operative duration, lower postoperative pain, reduced analgesic requirementand shorter hospital stay

Clinical study of flexible ureteroscope with tubeless in the treatment of middle or upper calyx renal calculi / 中华泌尿外科杂志

Objective To explore the feasibility and safety of flexible ureteroscope with tubeless in the treatment of middle or upper calyx renal calculi.Methods The clinical data of 107 patients with renal calculi treated from January 2015 to October 2018 were analyzed retrospectively.Age ranged from 18 to 55 years,with mean of (32.1 ± 5.2) years.Calculi was single,locating in the middle or upper calyx,with the diameter less than 2.0 cm,the CT value ≤ 800 HU,and mild renal hydronephrosis.All patients were routinely indwelling double-J tube using cystoscopy 2 weeks preoperatively,and ureteroscopic lithotripsy was performed.Fifty patients in group A were received tubeless treatment,and 57 patients in group B were given routinely indwelling double-J tube.The 50 patients in group A were (30.4 ± 5.9) years of age,including 33 males and 17 females,28 cases on the left and 22 cases on the right,24 cases locating in the upper calyx and 26 cases locating in the middle calyx,and calculi diameter of (1.3 ± 0.5) cm.The 57 patients in group B were (31.3 ± 5.4) years of age,including 35 males and 22 females,26 cases on the left and 31 cases on the right,27 cases locating in the upper calyx and 30 cases locating in the middle calyx,and diameter of (1.4 ± 0.4) cm.There were no significant difference in the demographics between the two groups (P ＞ 0.05).Results There were no obvious ureteral malformations,stenosis,polyps or tumors in the 107 cases intraoperatively,and the flexible ureteroscope sheath was placed smoothly.The operation time in group A [(48.2 ± 9.7) min] was significantly lower than that in group B [(51.7 ± 7.8) min,P ＜ 0.05].There was no significant difference in the calculi clearance rate between the two groups on the first day [92.0％ (46/50) vs.91.2％ (52/57)] and two weeks[96.0％ (48/50) vs.98.2％ (56/57)] after operation(P ＞ 0.05),and the calculi clearance rate reached 100％ at 1 month after operation.The incidence of hematuria in group A [24.0％ (12/50)] was significantly lower than that in group B [54.4％ (31/57),P =0.001].The incidence of bladder irritative symptoms in group A [14.0％ (7/50)] was significantly lower than that in group B [36.8％ (21/57),P =0.007].The incidence of lumbar and abdominal pain at 1 week,2 weeks and 1 month after operation was significantly lower in group A [32.0％ (16/50),8.0％ (4/50),2.0％ (1/50)] than that in group B [57.9％ (33/57),49.1％ (28/57),33.3％ (19/57),P ＜ 0.05].There was no significant difference between the two groups about the incidence of lumbar and abdominal pain at first day after operation [86.0％ (43/50) vs.84.2％ (48/57),P ＞ 0.05].Conclusions It was feasibility and safety to perform flexible ureteroscope with tubeless for the patients with renal primary and single calculi,ideal ureteral conditions (no malformations,stenosis,polyps or tumors),mild renal hydronephrosis,calculi,diameter ＜ 2.0 cm,CT value ≤ 800 HU,locating in the middle or upper calyx,and no history of urinary calculi.This procedure had not only similar calculi clearance rate compared with routinely indwelling double-J tube,but also has a lower incidence of complications (hematuria,bladder irritative symptoms,lumbar or abdominal pain).

Evaluation of super-mini-percutaneous nephrolithotomy(SMP) for upper urinary stone of adults and children / 中华泌尿外科杂志

Objective@#To compare the safety and efficiency of totally ultrasonography-guided super-mini-percutaneous nephrolithotomy(SMP) in the treatment of upper urinary stone in adults and children(<14years).@*Methods@#From May 2015 to July 2018, 81 cases of children(53%) and 71(47%) cases of adults with upper tract stones underwent the SMP by total ultrasound guidance. In the group of children, it’s including 53 male and 28 female with 85 channels in total, the patients age ranged from 10 months to 14 years, [mean (56.0±39.7) months], The stone size ranged from 0.8-3.5 cm, [mean (1.7±0.7)cm]. About stone distribution, 42 cases of pelvic stones, 25 cases of calyceal and pelvic stones, 5 cases of calyceal stones, 7 cases of upper uretaral stones, 1 case of upper ureteral and calyceal stones, 1 case of malformation with double renal pelvis and ureter. Urinary infection rate was 86.4%(70/81), positive rate of urinary culture was 39.5%(32/81). In the group of adults, it’s including 43 male and 28 female, the patients aged from 18 to 81 years, [mean (44.1±15.4)years], The stone size ranged from 1.0-3.0 cm, [mean (1.7±0.6)cm]. About Stone distribution, 19 cases of pelvic stones, 13 cases of calyceal and pelvic stones, 7 cases of calyceal stones, 24 cases of upper uretaral stones, 3 cases of upper ureteral and calyceal stones, 1 case of malformation with double renal pelvis and ureter. Urinary infection rate was 87.3%(62/71), positive rate of urinary culture was 26.8%(19/71). The patient was placed in the lithotomy position under general anesthesia. A 5F ureteric catheter was retrogradely inserted into the collecting system and urethral catheter was placed in the bladder. The patient was then turned prone. The selected calix was punctured under ultrasound guidance by 18G puncture needle and a 0.032 inch guidewire was inserted into the collecting system. Nephrostomy tract was established using Dilators(it was done in one step for 12F and in two steps for 14F). After the corresponding size of suction-evacuation sheath was placed, the sheath was connected to the specimen collection bottle via the oblique branch of a metal connector. The miniature endoscope was inserted into the sheath to observe the collecting system and stone fragmentation was completed by using YAG laser or pneumatic lithotripter. Stone free rate after surgery at 1day(SFR) and 1 month(1 month SFR), stone size, operative time(from starting fragmentation to the end of the surgery), hemoglobin drop and hematocrit drop in the first day after surgery, rate of surgecal complications, tubeless rate(totally tubless: no ureteric stent and nephrostomy tube; tubeless: no nephrostomy tube but ureteric stent), average length of hospital stay and urinary infection were recorded and compared.@*Results@#In children group, mean operative time was (27.7±13.0)min(range 5-60 min), SFR and SFR at 1 month were 96.3%(78/81)and 98.8%(80/81), mean hemoglobin drop was (8.0±9.1)g/L(range 0-41 g/L), mean hematocrit drop was 0.026±0.029(range 0-0.135), totally tubeless rate was 86.4%(71/81), mean hospital stay was (2.5±0.9)days(range 1-5 days). Complications were observed in 9 cases and classified using Calvien grading system, Grade Ⅰ in 8 cases: postoperative fever in 4, hematuresis in 1, perirenal hematoma, postoperative distal ureteral stone in 1 cases and delayed recovery of intestinal function in 1 case, all had a spontaneous recovery without special managements; Grade Ⅲb in 1 case, massive ascites was discovered during the surgery, and rcovered by puncture drainage.In adult group, mean operative time was (31.2±15.3)min(range 7-80 min), SFR and SFR at 1 month were 97.2%(69/71) and 98.6%(70/71), mean hemoglobin drop was (11.9±8.7)g/L(range 0-32 g/L), mean hematocrit drop was 0.030±0.027(range 0-0.106), totally tubeless rate was 87.3%(62/71), mean hospital stay was(2.4±1.1)days(range 1-8 days), urinary infection rate was 87.3%(62/71), positive rate of urinary culture was 26.8%(19/71). Complications were observed in 4 cases, Grade Ⅰ in 3 cases: hematuresis in 2 and delayed recovery of intestinal function in 1 case, all had a spontaneous recovery without special managements; Grade Ⅲb in 1 case, postoperative distal ureteral stone in 1 cases and cured by ureteroscopic lithotripsy. According to data about Hb drop, risk of hemorrhage is lower in children than adult significantly(P<0.05). There is not significant difference in stone free rate, stone size, operative time, hematocrit drop, surgery complications, totally tubeless rate, stone complexity, average length of hospital stay and urinary infection(P>0.05).@*Conclusions@#With the characteristics of safe, efficacious and rapid recovery, super-mini-percutaneous nephrolithotomy(SMP) can be used as the first choice of the treatment for upper urinary stone both in adults and children.

Evaluation of super-mini-percutaneous nephrolithotomy(SMP) for upper urinary stone of adults and children / 中华泌尿外科杂志

Objective To compare the safety and efficiency of totally ultrasonography-guided super-mini-percutaneous nephrolithotomy(SMP) in the treatment of upper urinary stone in adults and children (＜ 14years).Methods From May 2015 to July 2018,81 cases of children(53％) and 71 (47％) cases of adults with upper tract stones underwent the SMP by total ultrasound guidance.In the group of children,it's including 53 male and 28 female with 85 channels in total,the patients age ranged from 10 months to 14 years,[mean (56.0 ± 39.7) months],The stone size ranged from 0.8-3.5 cm,[mean (1.7 ± 0.7) cm].About stone distribution,42 cases of pelvic stones,25 cases of calyceal and pelvic stones,5 cases of calyceal stones,7 cases of upper uretaral stones,1 case of upper ureteral and calyceal stones,1 case of malformation with double renal pelvis and ureter.Urinary infection rate was 86.4％ (70/81),positive rate of urinary culture was 39.5％ (32/81).In the group of adults,it's including 43 male and 28 female,the patients aged from 18 to 81 years,[mean (44.1 ± 15.4) years],The stone size ranged from 1.0-3.0 cm,[mean (1.7 ± 0.6) cm].About Stone distribution,19 cases of pelvic stones,13 cases of calyceal and pelvic stones,7 cases of calyceal stones,24 cases of upper uretaral stones,3 cases of upper ureteral and calyceal stones,1 case of malformation with double renal pelvis and ureter.Urinary infection rate was 87.3％ (62/71),positive rate of urinary culture was 26.8％ (19/71).The patient was placed in the lithotomy position under general anesthesia.A 5F ureteric catheter was retrogradely inserted into the collecting system and urethral catheter was placed in the bladder.The patient was then turned prone.The selected calix was punctured under ultrasound guidance by 18G puncture needle and a 0.032 inch guidewire was inserted into the collecting system.Nephrostomy tract was established using Dilators(it was done in one step for 12F and in two steps for 14F).After the corresponding size of suction-evacuation sheath was placed,the sheath was connected to the specimen collection bottle via the oblique branch of a metal connector.The miniature endoscope was inserted into the sheath to observe the collecting system and stone fragmentation was completed by using YAG laser or pneumatic lithotripter.Stone free rate after surgery at lday(SFR) and 1 month(1 month SFR),stone size,operative time(from starting fragmentation to the end of the surgery),hemoglobin drop and hematocrit drop in the first day after surgery,rate of surgecal complications,tubeless rate (totally tubless:no ureteric stent and nephrostomy tube;tubeless:no nephrostomy tube but ureteric stent),average length of hospital stay and urinary infection were recorded and compared.Results In children group,mean operative time was (27.7 ± 13.0)min(range 5-60 min),SFR and SFR at 1 month were 96.3％ (78/81)and 98.8％ (80/81),mean hemoglobin drop was (8.0 ± 9.1) g/L(range 0-41 g/L),mean hematocrit drop was 0.026 ±0.029(range 0-0.135),totally tubeless rate was 86.4％ (71/81),mean hospital stay was (2.5 ±0.9)days(range 1-5 days).Complications were observed in 9 cases and classified using Calvien grading system,Grade Ⅰ in 8 cases:postoperative fever in 4,hematuresis in 1,perirenal hematoma,postoperative distal ureteral stone in 1 cases and delayed recovery of intestinal function in 1 case,all had a spontaneous recovery without special managements;Grade Ⅲ b in 1 case,massive ascites was discovered during the surgery,and rcovered by puncture drainage.In adult group,mean operative time was (31.2 ± 15.3) min(range 7-80 min),SFR and SFR at 1 month were 97.2％ (69/71) and 98.6％ (70/71),mean hemoglobin drop was (11.9 ± 8.7) g/L (range 0-32 g/L),mean hematocrit drop was 0.030 ± 0.027 (range 0-0.106),totally tubeless rate was 87.3％ (62/71),mean hospital stay was (2.4 ± 1.1) days (range 1-8 days),urinary infection rate was 87.3％ (62./71),positive rate of urinary culture was 26.8％ (19/71).Complications were observed in 4 cases,Grade Ⅰ in 3 cases:hematuresis in 2 and delayed recovery of intestinal function in 1 case,all had a spontaneous recovery without special managements;Grade Ⅲ b in 1 case,postoperative distal ureteral stone in 1 cases and cured by ureteroscopic lithotripsy.According to data about Hb drop,risk of hemorrhage is lower in children than adult significantly (P ＜ 0.05).There is not significant difference in stone free rate,stone size,operative time,hematocrit drop,surgery complications,totally tubeless rate,stone complexity,average length of hospital stay and urinary infection (P ＞ 0.05).Conclusions With the characteristics of safe,efficacious and rapid recovery,super-mini-percutaneous nephrolithotomy (SMP) can be used as the first choice of the treatment for upper urinary stone both in adults and children.

Experiencia en nefrolitotomía percutánea modificada en un centro urológico / Experience in modified percutaneous nephrolithotomy in a urology centre

Introducción Recientemente se ha descrito la técnica quirúrgica para la realización de nefrolitotomías percutáneas modificadas que permite obtener punciones de diámetro reducido, con buena visibilidad y éxito sin la necesidad de adquirir nuevos instrumentos. Objetivo Establecer el comportamiento de los pacientes tratados con nefrolitotomía percutánea modificada en un centro urológico de Pereira (Colombia), 2015­2016. Métodos Estudio observacional descriptivo de un grupo de pacientes que han sido tratados con nefrolitotomía percutánea modificada, donde se eliminó la camisa metálica del nefroscopio estándar para permitir menor diámetro del tracto de entrada (22-F). Se revisaron datos de registros clínicos incluyendo variables sociodemográficas, de comorbilidades, quirúrgicas y complicaciones. Se realizó seguimiento de variables adicionales del postoperatorio. Estadística descriptiva empleando STATA 11. Resultados En total se revisaron datos de 21 pacientes intervenidos con nefrolitotomía percutánea modificada. La edad media fue de 51,5 años y el 57,1% fueron hombres. El tamaño promedio de las litiasis fue de 32,8 mm y el 57,1% de las punciones fueron en cáliz inferior. La duración promedio del procedimiento fue de 91 min con una mediana de sangrado de 50 mL. La tasa libre de cálculos fue del 90,5% y ningún paciente tuvo sonda de nefrostomía (tubeless). La mayoría de los pacientes (95,2%) fueron manejados de manera ambulatoria, sin mayores complicaciones intra- o posquirúrgicas, aunque el nivel de dolor a la semana siguiente del procedimiento fue en promedio de 4,1. Conclusiones La técnica de nefrolitotomía percutánea modificada descrita mostró ser segura, efectiva y factible de realizar, incluso en pacientes con grandes litiasis y tubeless ambulatoria.

Introduction A surgical technique has been recently described for performing modified percutaneous nephrolithotomy that enables small diameter punctures to be made, with good visibility and success and without the need to purchase new instruments. Objective To establish the outcomes of patients treated with modified percutaneous nephrolithotomy in a Urology Centre in Pereira (Colombia), 2015­2016. Methods Observational study of a group of patients who were treated with modified percutaneous nephrolithotomy, where the outer sheath of the standard nephroscope was removed to give a smaller tract diameter (22-F). The data from clinical records were recorded, including socio-demographics, comorbidities, and surgical and other complications. Additional post-operative variables were monitored during follow-up. Descriptive statistics were performed using STATA 11. Results The data from a total of 21 patients who underwent modified percutaneous nephrolithotomy were reviewed. The mean age was 51.5 years, and 57.1% were men. The mean size of the stones was 32.8 mm, and 57.1% of punctures were in lower calyx. The mean duration of the procedure was 91 minutes, with a median bleeding of 50 mL. The stone-free rate was 90.5%, and no patient had a nephrostomy tube (tubeless). Most patients (95.2%) were managed on an outpatient basis, without major intra- or post-operative complications, although the mean pain level was 4.1 in the week following the procedure. Conclusions The modified percutaneous nephrolithotomy technique showed to be safe, effective, and feasible to perform, as well as tubeless in ambulatory patients and with large stones.

Comparison of standard percutaneous nephrolithotomy and tubeless percutaneous nephrolithotomy / 中华泌尿外科杂志

Objective Using Wisconsin Stone Quality of Life questionnaire (WISQOL) to compare standard percutaneous nephrolithotomy(PCNL) and tubeless PCNL.Methods From January 2017 to June 2017,patients who met the criteria (no urinary tract infection,stones between 1-3 cm,hydronephrosis larger than 3cm,renal cortex thickness ＞ 2 cm and without serious heart,lung,liver and kidney dysfunction and coagulation dysfunction) and underwent PCNL were prospectively enrolled and randomized into 2 groups,standard PCNL group and tubeless PCNL group.Diclofenac sodium suppositories were used to relieve pain in all patients with obvious pain.The quality of life of these patients were estimated and compared by using WISQOL.Safety and efficacy were also estimated.Result At the end of the study,a total of 50 patients were included in the analysis.There were 24 patients in the standard PCNL group and 26 patients in the tubeless PCNL group.There were 9 male patients in the standard PCNL group and 17 male patients in the tubeless PCNL group.There was no significant difference in gender between the two groups.The differences between the standard PCNL group and tubeless PCNL group in mean age (yrs.) [(53.21 ±13.35) vs.(51.1 ± 11.5),P =0.55],stone diameter (mm) [(18.46 ± 5.58) vs.(18.75 ± 5.39),P =0.85],stone-free rate (23/24 vs.24/26,P =0.60),mean hemoglobin decline (g/L) [(11.87 ± 9.20)vs.(10.43 ± 8.49),P =0.56] were not significant.Mean dosage of acesodyne(pcs) in tubeless PCNL group (4.07 ± 1.49) was significantly less than that in standard PCNL group (7.54 ± 2.23).There were no patient need transfusion or postoperative fever management.The influence of perioperative quality of life of patients treated with tubeless PCNL is significantly better than those treated with standard PCNL in 16 items which includ energy,sleep,work and family,physical symptoms,concerns related to intimacy and travel,and general emotional well-being.Conclusion Tubeless PCNL can improve patients' quality of life compared with standard PCNL.

Efficacy and Safety of Tubeless Percutaneous Nephrolithotomy versus Standard Percutaneous Nephrolithotomy.

Introduction: We conducted a prospective study of tubeless percutaneous nephrolithotomy (PCNL) in selected patients and compared it with standard PCNL among patients with similar inclusion criteria and evaluated the efficacy and safety of tubeless PCNL over the standard PCNL. Methods: Between December 2009 and December 2011, a total of 298 patients underwent PCNL. 40 patients with stone size <2 cm underwent PCNL. In 20 patients, nephrostomy tube (N) was placed, and in another 20 patients, a exteriorized ureteral stent was placed and did not undergo nephrostomy (NN) (tubeless). These two groups were compared regarding the duration of hospital stay, post-operative pain, analgesic duration, complications, and estimated blood loss - hemoglobin (Hb) drop in g% (before and after PCNL). Results: Out of the 40 patients in the study, there were 13 (32.5%) females and 27 (67.5%) males. 7 patients (17.5%) had stones in calyx, 18 (45%) in pelvis, 3 (7.5%) in pelvi-ureteric junction, and 12 (30%) ureter. The mean age of patients was 41.3 year (7-55 years). The average size of stone was 14.38 ± 4.02 mm. The duration of procedure of all patients was 50.13 ± 15.34 min. The duration of the procedure, visual analog pain score, duration of analgesia use, the length of hospital stay, and drop in Hb and found that in patients who underwent tubeless nephrolithotomy it was 38.5 ± 7.8 min, 2.3 ± 0.5 cm, 2.6 ± 0.5 days, 3.5 ± 0.8 days, and 0.3 ± 0.4 g%, respectively. Whereas it was 61.8 ± 11.7 (P < 0.0001), 3.7 ± 1.1 (P < 0.0001), 4.4 ± 0.9 (P < 0.0001), 0.3 ± 0.4, and 0.5 ± 0.5 (P = 0.13), respectively, in patients undergoing standard nephrolithotomy. One patient developed fever in each group. Conclusion: In properly selected patients, tubeless PCNL with only an externalized ureteral catheter demonstrates significant advantages over standard PCNL regarding post-operative discomfort, morbidity, hospital stay, and period of analgesia requirement. In near future, tubeless PCNL with externalized ureteral catheter can be recommended as a standard of care in the management of selected cases of renal calculi.

Comparison of totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for kidney stones: a randomized, clinical trial

This study aimed to compare the totally tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy techniques regarding their rates of success and complications in patients with kidney stones. Patients were randomly assigned to two groups. Forty-four patients (24 men; mean age: 50.40±2.02 years) received totally tubeless percutaneous nephrolithotomy (PCNL; no nephrostomy catheter or ureteral catheter after PCNL) and 40 patients (18 men; mean age: 49.95±13.38 years) underwent standard PCNL (a nephrostomy catheter and ureteral catheter were used after PCNL). All surgeries were performed by one surgeon. Postoperative changes in hemoglobin, the blood transfusion rate, changes in creatinine levels, operation time, analgesic need, hospitalization time, and complication rate were compared between the groups. No significant differences were observed in age, gender, stone size, and surgery side between the groups (P<0.05). The operation time was significantly lower in the totally tubeless PCNL group than in the standard PCNL group (P=0.005). Pethidine requirements were significantly higher in the standard PCNL group than the totally tubeless PCNL group (P=0.007). Hospitalization time was significantly higher in the standard PCNL group than in the totally tubeless PCNL group (P<0.0001). The complication rate was 15% in the standard PCNL group and 9.1% in the totally tubeless PCNL group (P=0.73). The totally tubeless PCNL technique is safe and effective, even for patients with staghorn stones. This technique is associated with decreased pain, analgesic needs, and operative and hospitalization time. We believe that a normal peristaltic ureter is the best drainage tube.

Advances in tubeless percutaneous neprolithotomy / 中国综合临床

Percutaneous neprolithotomy (PCNL) is the preferred method for the treatment of the majority of urinary calculi, especially for the calculi lies in the renal and upper ureteral.Recently, a number of trials were applied into TPCNL, such as, decrease the nephrostomy and indwelling externally grooved ureteral stent, internal ureteral catheter and not aiming replace the preventive use of renal tube.TCNL has its advantages in postoperative pain, hospitalization time and postoperative recovery than standard percutaneous neprolithotomy.

Treatment of tubeless transurethral ureteroscopic 2 μm laser vaporesection for ureter cyst in pediatrics (33 cases) / 中国内镜杂志

Objective To explore the feasibility of tubeless 2 μm laser vaporesection in treating pediatric ureter cysts by ureteroscopy.MethodsClinical data of 33 ureter cysts patients who received tubeless 2 μm laser vaporesections by ureteroscopy were reviewed. The median age of patients was 4 years with a range from 1 to 7 years. The operations were carried out by RevoLix 2 μm laser through ureteroscopy without ureter stents and catheters indwelling.ResultsAll operations were successfully performed. And no serious complications occurred after the operations.ConclusionsTubeless transurethral 2 μm laser treatment by ureteroscopy was a superior micro-invasive surgery method for pediatrics with ureter cysts, with advantages of little blood loss, high safety, convenient operation and infrequent complications.

Clinical curative effect comparison of partial tubeless and traditional percutaneous nephrolithotomy for the treatment of upper urinary calculus / 局解手术学杂志

Objective To compare the clinical curative effect of partial tubeless and traditional percutaneous nephrolithotomy ( PCNL) in treatment of upper urinary calculus and to evaluate the clinical feasibility and value. Methods 206 patients with upper urinary calculus were enrolled in a randomized clinical trial from May 2013 to May 2014 according to the inclusion and exclusion criteria. These patients were randomized into the observation group (tubeless PCNL group) and the control group (traditional PCNL group). The operation time,stone clearance rate,visual analogue scale (VAS) pain score,usage of analgesic drugs,hemoglobin decrease,blood transfusion,bleeding,fever, leakage of urine,postoperative hospital stay,hospitalization expenses and the time of patients return to normal life were compared. Results All the operations were successfully finished. There were no statistically significant difference in operation time,stone clearance rate,hemoglo-bin decrease,bleeding,blood transfusion and fever (P>0. 05),but the visual analogue scale (VAS) pain score,usage of analgesic drugs, leakage of urine,postoperative hospital stay,hospitalization expenses and the time of patients return to normal life of the observation group were evidently lower than those of the control group (P<0. 05). Conclusion As partial tubeless PCNL have a great advantage on ease post-operative pain,shorten postoperative hospital stay,reduce hospitalization expenses and accelerate patients return to normal life,it is safe and effective for the treatment of upper urinary calculus,and it should be popularized and applied.

Nefrolitectomía percutánea "Tubeless" con catéter pigtail versus catéter ureteral externalizado por una noche: estudio comparativo, prospectivo y randomizado / Comparison of tubuless percutaneous nephrolithothotomy with pigtail catheter versus one nigth externalized ureteral catheter: comparative, prospective and randomized study

La nefrolitectomía percutánea (NLP) es una técnica establecida para el tratamiento de nefrolitiasis de gran tamaño que finaliza dejando una nefrostomía para hemostasia, drenaje y facilitar una eventual revisión. Nuestro grupo publicó recientemente un estudio prospectivo y randomizado que demostró la factibilidad y seguridad de realizar NLP “tubeless” (sin nefrostomía y con catéter pigtail) en un grupo seleccionado de pacientes (sin litiasis residual ni sangrado intra operatorio significativo, con acceso percutáneo único y tiempo operatorio menor a 2 horas).Objetivo: Comparar el uso de catéter ureteral tipo pigtail versus catéter ureteral externalizado por 24 horas en pacientes sometidos a NLP “tubeless”. Métodos: Sesenta y ocho pacientes sometidos a NLP ¨tubeless” fueron prospectivamente randomizados para el uso de catéter pigtail (Grupo 1) o catéter ureteral externalizado por una noche (Grupo 2). Se evaluó el dolor pos operatorio, estadía hospitalaria, caída del hematocrito y desarrollo de hematomas perirrenales objetivados por tomografía axial computarizada no contrastada. Para el análisis estadístico un p value <0,05 fue considerado significativo. Resultados: Los grupos fueron comparables en edad, distribución de sexo, índice de masa corporal y carga litiásica. No difirieron en dolor pos operatorio ni incidencia de hematomas. El Grupo 1 tuvo una estadía hospitalaria y una caída del hematocrito significativamente mayor. Conclusión: Los resultados sugieren que ambas conductas son factibles y seguras. La mayor estadía hospitalaria del Grupo 1 y la posterior necesidad de cistoscopia para retirar el catéter pigtail favorecen el uso de catéteres ureterales externalizados. Además se validan los criterios utilizados para la aplicación de la técnica tubeless en NLP...

Percutaneous nephrolithotomy (PNL) is an established technique for the management of big renal calculi that finishes leaving a nephrostomy tube to provide hemostasia, drainage and access for a second look when needed. We have recently published a prospective and randomized study demonstrating the feasibility and safety of performing “tubeless” PNL (without nephrostomy and leaving a pigtail catheter) in a selected group of patients (no significant residual lithiasis nor significant intraoperative bleeding, single access and less of 2 hours of surgery).Objective: Compare the use of pigtail catheter versus night-externalized ureteral catheter in patients subjected to “tubeless” PNL. Methods: Sixty eight patients undergoing “tubeless” PNL were prospectively randomized for the use of pigtail catheter (Group 1) or 24 hours-externalized ureteral catheter (Group 2).Postoperative pain, hospital stay length, hematocrit drop and evidence of peri-renal hematomas in non-enhanced computarized tomography were evaluated. For statistical analysis a p value <0.05 was considered significant. Results: Groups were similar in age, sex distribution, body mass index and stone burden. No differences in postoperative pain or incidence of hematomas were observed. Group 1 had a longer hospital stay and a greater hematocrit drop. Conclusion: These results suggest that both alternatives are feasible and safe. The longer hospital stay in Group 1 and the further need of cystoscopy to remove the pigtail catheter favors the use of 24 hours-externalized ureteral catheter. In addition, we validate our intraoperative criteria for performing “tubeless” PNL...

Comparison of improvement effect of nursing satisfaction degree by tubeless versus standard percutaneous nephrostolithotomy / 中国实用护理杂志

Objective To analyze the nursing interventions of two kinds of percutaneous nephrolithotomy (PCNL),so that we can provide personalized service for patients with PCNL and improved quality of nursing. Methods 140 cases of patients undergoing PCNL were chosen from January 2010 to January 2012.70 of them received standard PCNL,another 70 cases were given tubeless PCNL.The same nursing method was given before the operation,and personalized nursing was given according to difference in operation method.A self-designed questionnaire was conducted for satisfaction degree with nursing service of all patients on discharge. Results Satisfaction degree with psychological care,catheter nursing and complication nursing of tubeless PCNL was higher than standard PCNL. Conclusions Two methods of PCNL have become conventional therapy for upper urinary calculus,and careful nursing is very important,especially for tubeless PCNL.