Category: Clinical Stones: PCNL
Introduction & Objective : PCNL has become a standard minimally invasive treatment for renal stones. Tubeless PCNL is associated with less morbidity. Miniaturisation of instruments leads decrease morbidity of procedure. We compared standard tubeless PCNL to Miniperc tubeless PCNL for morbidity and stone free rates.
Methods : Afterinstitutional ethical and scientific committee approvalA Prospective randomised study conducted at BT savani kidney hospital, Rajkot, Gujarat India from January 2016 to January 2017 and included 80 patients, 40 patients in group 1 (standard tubeless PCNL) & 40 patients in group 2 (Miniperc tubeless PCNL), with single renal stone less than 2 cm. Patients with CKD, solitary kidney, ectopic kidney, pediatric age group and previous diversion were excluded. Tract was dilated upto 24Fr in group 1 & upto 16Fr in group 2. Neither percutaneous nephrostomy nor DJ stent was kept. Post operative pain score was monitored at 12 and 24 hours. Additional analgesia was given if pain score was more than 6 in form of tab. Tramadol 50mg. Hemoglobin was measured on 2nd post operative day. Stone clearance was checked with ultra-sonography & X-Ray KUB on 15th and 30th post operative day. Total Operative time, pain score, analgesic requirement, haemoglobin drop, complications (bleeding, fever, urinary leak & urosepsis) and stone free rate were compared.
Results : Miniperc operative time was longer than standard PCNL (45±10 vs 35±8mins. P<0.001). Median pain score at 12 and 24 hours and analgesic requirement was more in group 1 than in group 2 (6±1 VS 4±1, P<0.0001 and 3±1 vs 2±1, P<0.001). Post operative hemoglobin drop was more in group 1 than in group 2 (0.95±0.2 VS 0.6±0.1 , P<0.0001). Stone clearance in group 1 was 100% while in group 2 it was 95%. There was no significant difference in complications between the two groups.
Both Standard tubeless PCNL & tubeless Mini PCNL are effective for renal stones less than 2cm. Operative time is more in tubeless Mini PCNL, whereas pain score, analgesics requirement and hemoglobin drop are more in standard tubeless PCNL comparatively. Stone clearance in both groups is comparable and more than 95%.
Pratikkumar Shah– Senior resident , B.T. Savani kidney institute, Rajkot, Gujarat, India
Pankaj Dholaria– Senior resident , B.T. Savani kidney institute, Rajkot, Gujarat, India
Vivek Joshi– Senior resident , B.T. Savani kidney institute, Rajkot, Gujarat, India
Amish Mehta– Senior resident , B.T. Savani kidney institute, Rajkot, Gujarat, India
Sunil Moteria– Senior resident , B.T. Savani kidney institute, Rajkot, Gujarat, India