Design And Clinic Application Of A New Kind Of Nephrostomy Tube With A Flexible Tail

BackgroundAs a common operation in the field of urology,percataneous nephrolithotomy(PCNL)has always been one of the main methods of dealing with the calculus of upper urinary track since its appearance because of it advantages of minor trauma?high rate of cure and large scope of application.The standard procedure of PCNL requires indwelling a nephrostomy tube and a ureteral stent(double J stent).Indwelling the nephrostomy tube in the renal fistula mainly plays a role of compressing the channel for stopping bleeding and secondary lithotripsy,which is also the most routine practice nowadays.So as for the patients who do not need the second-look procedure after the postoperative check,removing the nephrostomy tube early can drasticly reduce the length of hospital stay and promote the postoperative recovery.However,early removal of nephrostomy tube can also lead to an increasing risk of bleeding.What is more,the vitro nephrostomy tube is usually difficult to reinsert along the fistula pathway,so that doctors can do nothing about the bleeding,which is the main reason for many doctors why they are afraid of early tube removal.Similarly,the concept of tubeless percutaneous nephrolithotomy,that is,the nephrostomy tube is not retained after lithotripsy,has been widely reported,but this requires rich clinical experience and sound rescue equipments,especially the support of vascular interventional department,which is usually seen in large urology centers and is not suitable for extensive development.In view of this,in order to improve the safety of early tube removal and reduce the serious bleeding complications caused by channel loss,the urology department of Zhujiang hospital of southern medical university independently developed a new drainage tube with a flexible tube(patent no:201610640451.0),and tried to apply it to clinical work.ObjectiveTo introduce a new kind of nephrostomy tube with a flexible tail and initially explore the feasibility of using it in PCNL.MethodsWe retrospect 100 patients with PCNL during Mar.2018 to Oct.2018,including 50 patients(new tube group)with a new kind of nephrostomy tube with a flexible tail and 50 patients(standard tube group)with a standard nephrostomy tube.The following datas such as the duration of remaining nephrostomy tube and urinary tube,hospitalization time,bleeding situation during removing nephrostomy tube and after removing tube between the two groups were compared and the rate of success of reinserting tube in new tube group was verified.ResultIn new tube group and standard tube group,the duration of remaining nephrostomy tube was[(21.13± 2.12)h vs.(55.67 ± 18.52)h].The duration of urinary tube was[(40.40±4.75)h vs.(73.34 ± 20.12)h].The hospitalization time was[(48.48 ± 3.39)h vs.(87.36 ± 21.55)h].The VAS score of the first day after operation was[(3.08±1.00)points vs.(4.76 ± 1.41)points].The hemoglobin reduction for bleeding case after removing the nephrostomy tube(?HB)was[(4.60± 1.14)g/L vs.(20.00 ± 2.83)g/L].The duration of remaining nephrostomy tube and urinary tube,hospitalization time,VAS score of the first day after operation in new tube group and ? HB were obviously less than standard tube group(P<0.05).Comparing to the rate of stone clearance and retroperitoneal hematoma,there was no statistically significant difference(P>0.05).In new tube group,the rate of success of reinserting tube is 100%.ConclusionUsing the new kind of nephrostomy tube with a flexible tail in PCNL can reduce the hospitalization time,the discomfort of keeping the nephrostomy tube and improve medical safety.It is worth further clinical exploration and research.