The Efficacy And Safety Of Tubeless MPCNL On The Treatment Of Upper Urinary Tract Stones

BackgroundCurrently,Percutaneous nephrolithotomy(PCNL)has become the optimal method to treat upper urinary tract stones(>2cm in diameter),especially,when it comes to the complex stones.Professor Wu Kaijun and Li Xun,famous urologic experts in our country,who put forward minimally invasive percutaneous nephrolithotomy(MPCNL)that combined with the actual situation of China.So far,PCNL has two development trends.The first one is miniaturization,that is,percutaneous renal access becoming smaller and smaller from the 1980's F30-F36 to F14-18 nowadays,which has been greatly reduced surgical complications and renal parenchymal damage.The basic requirement of minimally invasive concept is to achieve and keep the internal environment optimal with little trauma as far as possible[1].The second one is tubeless,that is to say,we don't indwell nephrostomy tube after PCNL,and some of them even without indwelling ureteral stent,in order to achieve totally tubeless,thereby reducing the postoperative pain and a lot of inconvenient for patients.Although PCNL has developed into a designed and improved precision surgical approach,it still has complications.EAU guidelines(2015)on urolithiasis reveal that the common postoperative complications are bleeding,fever and extravasation.Postoperative bleeding always draws more attention among these complications.Seitz et al.[2] recommended some methods for dealing with the postoperative bleeding: clamping the nephrostomy tube,balloon renal fistula can be inflated in the renal parenchyma to tamponade the venous bleeding and selective renal arterial embolization for severe bleeding cases.However,indwelling nephrostomy tube after PCNL will increase patients' postoperative discomfort,even pain,which can influence the health related quality of life(HRQo L)and the satisfaction of hospitalization.Currently,though some studies about the safety and feasibiltiy of tubeless PCNL have made,rarely focusing on postoperative discomfort and HRQoL.Some scholars overseas have already used 36-item short-form health survey to evaluate HRQo L of patients after PCNL,but studies about this aspect have been rarely reported domestic.Therefore,our study's aim is to evaluate the efficacy and safety of tubeless MPCNL(not indwelling nephrostomy tube,only indwelling double-J)on the treatment of urinary tract stones while 36-item short-form health survey will be used to evaluate HRQoL after MPCNL.ObjectivesTo evaluate the the efficacy and safety of tubeless MPCNL on the treatment of upper urinary tract stones and use 36-item short-form health survey to evaluate HRQo L of patients after MPCNL.MethodsWe performed a prospective study of 129 patients with upper urinary tract stones that underwent MPCNL in our center from July 2016 to February 2017.All of the patients were assigned into two groups(indwelling nephrostomy tube group and tubeless group).Operation time,HB drop,mean Scr drop,mean days of postoperative hospitalization,postoperative complications,VAS scores,the quantity of pain killer and SF-36 scores were compared routinely.ResultsAmong 129 patients,there are 10 people who remain residual calculus after MPCNL and are lost to follow up in tubeless group,while there are 11 people who remain residual calculus after the procedure,haemorrhage that needs super selective renal arterial embolization and are lost to follow up in another group.Finally 108 patients were put into this experiment.All of the 108 patients about demographic characteristics and preoperative laboratory examinations show no statistical significance.Among these two groups,operation time,mean HB drop and mean Scr drop are statistically insignificant;While postoperative pain and mean days of postoperative hospitalization show statistical significance in the both groups;The VAS scores of indwelling nephrostomy tube group are significantly higher than that of tubeless group(p<0.05);Patients needed more pain killer in indwelling nephrostomy tube group than that of tubeless group.There are obviously significant difference about complication Clavien?.Complications(Clavien?,Clavien ?)according to the modified Clavien systems shows no statistical significance between two groups.No complications of Clavien ? or Clavien ? occured.The mean PF SF-36 scores of the first postoperative day were 69.2±8.4 vs.79.2±8.5 while BP were 46.2±16.9 vs.71.2±16.5.They show statistical significance in the both groups(p<0.001).ConclusionsTubeless MPCNL can not only relieve postoperative pain,decrease the use of the quantity of pain killer,shorten the hospital stays,improve HRQo L of patients during hospitalization,but also do not increase the risk of postoperation complication.36-item short-form health survey that is worth popularizing has clinical value in evaluating HRQoL of patients after MPCNL.