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Year : 2019  |  Volume : 30  |  Issue : 5  |  Page : 226-231

Presence of residual stones is not a contraindication for tubeless percutaneous nephrolithotomy

Department of Urology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan

Correspondence Address:
Yeong-Chin Jou
Department of Urology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Chung-Hsiao Road, Chiayi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/UROS.UROS_137_18

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Objective: The objective of this study was to evaluate the safety of performing tubeless percutaneous nephrolithotomy (PCNL) for patients with residual stones. Materials and Methods: This study was conducted between 2007 and 2015, and a total of 815 patients were included in this study who underwent tubeless PCNL. Postoperatively, 591 patients were found to be stone free (Group 1), whereas residual stones were noted in 224 patients (Group 2). The hospital course and postoperative complications up to 3 months were analyzed by retrospective review. The complications were analyzed by Clavien–Dindo classification and grouped to severe/life-threatening complications (≥Grade 4) and none or nonsevere complications (≤3). All the demographic variables were scrutinized by regression analysis. Results: The mean days of hospital stay were 3.15 and 3.70 in Group 1 and Group 2, respectively (P < 0.001). Sixty-seven patients from Group 1 (11.3%) and 65 patients from Group 2 (29%) suffered postoperative complication (P < 0.001). A multivariate logistic regression model confirmed a higher risk of complications for the residual stone group versus the stone-free stone group (odds ratio [OR]: 2.37,P < 0.001). However, life-threatening complication rate reveals no difference between the two groups (1.4% vs. 3.1%,P = 0.093). Sixteen patients (2.7%) from Group 1 and 12 patients (5.4%) from Group 2 were rehospitalized in 3 months; however, the difference was not statistically significant (P = 0.064). The adjusted logistic regression model also established a nonelevated risk of rehospitalization (OR: 1.11, P = 0.823). Ninety-seven patients in the residual stone group received secondary stone managements in 3 months, but none of them underwent secondary PCNL. Conclusion: Patients from the residual stone group had remarkably longer hospital stay and higher postoperative complication rate because of more complicated stone nature. However, there was no significant difference in the incidence of severe complication and rehospitalization in both the groups. Tubeless PCNL is a relatively safe procedure and not contraindicated for patients with residual stones.

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