DURATION OF POST-OPERATIVE NEPHROSTOMY TUBE DRAINAGE AFTER PERCUTANEOUS NEPHROLITHOTOMY
1
Vol. 179, No. 4, Supplement, Tuesday, May 20, 2008 THE JOURNAL OF UROLOGY ® 503 caliceal locations of stones is more effective on stone free rates for staghorn stones. And increasing access number is related with more blood transfusion , long operative duration , more complications and more opioid needs. Source of Funding: None 1474 DURATION OF POST-OPERATIVE NEPHROSTOMY TUBE DRAINAGE AFTER PERCUTANEOUS NEPHROLITHOTOMY Aaron D Berger*, Thomas Chi, Marshall L Stoller. San Francisco, CA. INTRODUCTION AND OBJECTIVE: In recent years, there has been a purported improvement in percutaneous nephrolithotomy (PNL) with the advent of a “tubeless” technique. With this approach, a double-J ureteral stent is placed antegrade and the nephrostomy tube is removed at the conclusion of the procedure. This technique, however, often requires post-operative outpatient cystoscopic stent removal. The goal of this study was to evaluate the average duration of a post-operative nephrostomy tube after routine PNL to determine if METHODS: We performed a retrospective review of 108 consecutive percutaneous nephrolithotomies performed over a 2 year period by a single surgeon at a single institution. Patients routinely undergo an antegrade nephrostogram on post-operative day one or two and if there are no residual stones and good drainage of contrast down the ureter into the bladder, the nephrostomy tube is removed and the patient discharged home tube free. RESULTS: Of the 108 patients in this series, 85 (78.7%) patients had their nephrostomy tubes removed prior to discharge from the hospital. Our patients were commonly referred to our tertiary stone dimension. The average length of NT duration for those who had their tubes removed prior to discharge was 2.2 days compared to 19.9 days for those who were discharged home with the nephrostomy tube in place. No patient in the group sent home tube free required urgent ureteral stenting for obstruction. Those requiring PNT drainage at time of discharge were secondary to marked UPJ/ureteral edema, evidence of infection, or need for second stage. The overall stone free rate for the group was 84.2% based on post-operative antegrade pyelography. CONCLUSIONS: Nearly 80% of patients were discharged home with no indwelling tubes or stents after percutaneous nephrolithotomy and thus did not have to undergo an unnecessary outpatient cystoscopic stent removal. We feel that this data demonstrates that a tubeless technique results in an unnecessary outpatient procedure in the majority of cases. Source of Funding: None 1475 PERCUTANEOUS NEPHROLITHOTOMY (PCNL) FOR RENAL MATRIX CALCULI: SINGLE CENTRE EXPERIENCE WITH 12 PATIENTS Hemendra N Shah*, Shabbir S Kharodawala, Amit A Khandkar, Hiren S Sodha, Sunil S Hegde, Manish B Bansal. Mumbai, India. INTRODUCTION AND OBJECTIVE: We report our experience of percutaneous nephrolithotomy (PCNL) in 12 patients with matrix calculi, which to our knowledge is a largest single centre experience in managing this relatively rare entity. METHODS: We retrospectively reviewed records of all PCNL’s performed at our institute from April 2003 to September 2007 to identify patients having matrix calculi. Patient’s demographic data, mode of presentation and radiological investigations were studied. A 28 Fr. Nephrostomy tube was placed at the end of procedure and nephrostogram done in all patients on 2 nd postoperative day. When in and were given antibiotic for 4-6 weeks after surgery. A retrograde pyelography and ultrasonography were done at the time of stent removal to document stone free status. Patient’s peri-operative outcome and RESULTS: There were 7 females and 5 men with mean age of 43.8 yrs. Flank pain was commonest mode of presentation (n=10) and recurrent UTI was present in 4 patients. Urinalysis revealed pyuria in 10 in 3 patients and was normal in 3 patients. Intravenous urography Noncontrast CT scan and MR urogram diagnosed calculi in 2 patients on maintenance hemodialysis. Renal scan revealed < 20% differential function in 4 patients. All except 2 patients needed single access tract. Initial procedure was abandoned in 3 patients due to pyonephrosis. Average hospital stay was 3.1 days (range 2-13 days) and postoperative hemoglobin drop was 0.83 g/dl. No patients needed blood transfusion composed entirely of proteins and remaining 6 patients had crystalline components in their stones. At an average follow-up of 9.1 months, no patients had stone recurrence. CONCLUSIONS: Matrix calculi are rare renal calculi seen in 1.2 % patients undergoing PCNL. Percutaneous removal is the primary treatment modality to render patient’s stone free. Postoperative nephrostogram and check nephroscopy assures complete stone clearance and a 4-6 weeks antibiotic course possibly prevents stone recurrence. Source of Funding: None Stone Disease: Research (I) Moderated Poster Session 52 Tuesday, May 20, 2008 1:00 - 3:00 pm 1476 ARTERIOSCLEROTIC DISEASES INCREASE THE RISK FOR URIC ACID STONES Akinori Iba*, Yasuo Kohjimoto, Yasuyo Shintani, Takeshi Inagaki, Isao Hara. Wakayama, Japan. INTRODUCTION AND OBJECTIVE: An increased prevalence of urinary stone disease has been reported in patients with obesity, type 2 diabetes and hypertension, collectively termed metabolic syndrome (MetS). Since insulin resistance, characteristic of MetS, is reported to result in low urine pH through impaired renal ammoniagenesis, (UA) stones. The aim of the present study is to clarify the distribution of the stone composition in patients with MetS and determine which components of MetS might favor UA stone formation. METHODS: We retrospectively reviewed the charts of 467 Calcium oxalate and calcium phosphate were grouped into the single category of calcium (Ca) stones (n=384), and stones containing uric cystine stones were excluded form the study. The distribution of Ca and presence of the diseases related to MetS (lipid disorders, hyperuricemia, type 2 diabetes, arteriosclerotic diseases). RESULTS: Of 432 patients with Ca and UA stones, mild obese (39.6%), hyperuricemia in 112 (25.9%), type 2 diabetes in 75 (17.4%), arteriosclerotic diseases in 175 (40.5%). Overall, 335 patients (77.5%) had at least one of these disorders. The distribution of stone composition was not associated with BMI, lipid disorders and type 2 diabetes. While, patients with hyperuricemia and arteriosclerotic diseases (table). CONCLUSIONS: The results indicate that MetS is strongly associated with urinary stone disease and that arteriosclerotic diseases
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Transcript of DURATION OF POST-OPERATIVE NEPHROSTOMY TUBE DRAINAGE AFTER PERCUTANEOUS NEPHROLITHOTOMY
Vol. 179, No. 4, Supplement, Tuesday, May 20, 2008 THE JOURNAL OF UROLOGY® 503
caliceal locations of stones is more effective on stone free rates for staghorn stones. And increasing access number is related with more blood transfusion , long operative duration , more complications and more opioid needs.
Source of Funding: None
1474DURATION OF POST-OPERATIVE NEPHROSTOMY TUBE DRAINAGE AFTER PERCUTANEOUS NEPHROLITHOTOMYAaron D Berger*, Thomas Chi, Marshall L Stoller. San Francisco, CA.
INTRODUCTION AND OBJECTIVE: In recent years, there has been a purported improvement in percutaneous nephrolithotomy (PNL) with the advent of a “tubeless” technique. With this approach, a double-J ureteral stent is placed antegrade and the nephrostomy tube is removed at the conclusion of the procedure. This technique, however, often requires post-operative outpatient cystoscopic stent removal. The goal of this study was to evaluate the average duration of a post-operative nephrostomy tube after routine PNL to determine if
METHODS: We performed a retrospective review of 108 consecutive percutaneous nephrolithotomies performed over a 2 year period by a single surgeon at a single institution. Patients routinely undergo an antegrade nephrostogram on post-operative day one or two and if there are no residual stones and good drainage of contrast down the ureter into the bladder, the nephrostomy tube is removed and the patient discharged home tube free.
RESULTS: Of the 108 patients in this series, 85 (78.7%) patients had their nephrostomy tubes removed prior to discharge from the hospital. Our patients were commonly referred to our tertiary stone
dimension. The average length of NT duration for those who had their tubes removed prior to discharge was 2.2 days compared to 19.9 days for those who were discharged home with the nephrostomy tube in place. No patient in the group sent home tube free required urgent ureteral stenting for obstruction. Those requiring PNT drainage at time of discharge were secondary to marked UPJ/ureteral edema, evidence of infection, or need for second stage. The overall stone free rate for the group was 84.2% based on post-operative antegrade pyelography.
CONCLUSIONS: Nearly 80% of patients were discharged home with no indwelling tubes or stents after percutaneous nephrolithotomy and thus did not have to undergo an unnecessary outpatient cystoscopic stent removal. We feel that this data demonstrates that a tubeless technique results in an unnecessary outpatient procedure in the majority of cases.
Source of Funding: None
1475PERCUTANEOUS NEPHROLITHOTOMY (PCNL) FOR RENAL MATRIX CALCULI: SINGLE CENTRE EXPERIENCE WITH 12 PATIENTSHemendra N Shah*, Shabbir S Kharodawala, Amit A Khandkar, Hiren S Sodha, Sunil S Hegde, Manish B Bansal. Mumbai, India.
INTRODUCTION AND OBJECTIVE: We report our experience of percutaneous nephrolithotomy (PCNL) in 12 patients with matrix calculi, which to our knowledge is a largest single centre experience in managing this relatively rare entity.
METHODS: We retrospectively reviewed records of all PCNL’s performed at our institute from April 2003 to September 2007 to identify patients having matrix calculi. Patient’s demographic data, mode of presentation and radiological investigations were studied. A 28 Fr. Nephrostomy tube was placed at the end of procedure and nephrostogram done in all patients on 2nd postoperative day. When in
and were given antibiotic for 4-6 weeks after surgery. A retrograde pyelography and ultrasonography were done at the time of stent removal to document stone free status. Patient’s peri-operative outcome and
RESULTS: There were 7 females and 5 men with mean age of 43.8 yrs. Flank pain was commonest mode of presentation (n=10) and
recurrent UTI was present in 4 patients. Urinalysis revealed pyuria in 10
in 3 patients and was normal in 3 patients. Intravenous urography
Noncontrast CT scan and MR urogram diagnosed calculi in 2 patients on maintenance hemodialysis. Renal scan revealed < 20% differential function in 4 patients. All except 2 patients needed single access tract. Initial procedure was abandoned in 3 patients due to pyonephrosis. Average hospital stay was 3.1 days (range 2-13 days) and postoperative hemoglobin drop was 0.83 g/dl. No patients needed blood transfusion
composed entirely of proteins and remaining 6 patients had crystalline components in their stones. At an average follow-up of 9.1 months, no patients had stone recurrence.
CONCLUSIONS: Matrix calculi are rare renal calculi seen in 1.2 % patients undergoing PCNL. Percutaneous removal is the primary treatment modality to render patient’s stone free. Postoperative nephrostogram and check nephroscopy assures complete stone clearance and a 4-6 weeks antibiotic course possibly prevents stone recurrence.
Source of Funding: None
Stone Disease: Research (I)
Moderated Poster Session 52
Tuesday, May 20, 2008 1:00 - 3:00 pm
1476ARTERIOSCLEROTIC DISEASES INCREASE THE RISK FOR URIC ACID STONESAkinori Iba*, Yasuo Kohjimoto, Yasuyo Shintani, Takeshi Inagaki, Isao Hara. Wakayama, Japan.
INTRODUCTION AND OBJECTIVE: An increased prevalence of urinary stone disease has been reported in patients with obesity, type 2 diabetes and hypertension, collectively termed metabolic syndrome (MetS). Since insulin resistance, characteristic of MetS, is reported to result in low urine pH through impaired renal ammoniagenesis,
(UA) stones. The aim of the present study is to clarify the distribution of the stone composition in patients with MetS and determine which components of MetS might favor UA stone formation.
METHODS: We retrospectively reviewed the charts of 467
Calcium oxalate and calcium phosphate were grouped into the single category of calcium (Ca) stones (n=384), and stones containing uric
cystine stones were excluded form the study. The distribution of Ca and
presence of the diseases related to MetS (lipid disorders, hyperuricemia, type 2 diabetes, arteriosclerotic diseases).
RESULTS: Of 432 patients with Ca and UA stones, mild obese
(39.6%), hyperuricemia in 112 (25.9%), type 2 diabetes in 75 (17.4%), arteriosclerotic diseases in 175 (40.5%). Overall, 335 patients (77.5%) had at least one of these disorders. The distribution of stone composition was not associated with BMI, lipid disorders and type 2 diabetes. While,
patients with hyperuricemia and arteriosclerotic diseases (table). CONCLUSIONS: The results indicate that MetS is strongly
associated with urinary stone disease and that arteriosclerotic diseases
