Tubeless with Tract Screening ± Bipolar Cauterization

COURSE DESCRIPTION

Introduction and Objectives: To evaluate the safety and effectiveness of tubed vs tubeless with tract screening and bipolar coagulation for bleeders in percutaneous nephrolithotomy (PCNL) for the management of renal calculi.

Methods: We prospectively randomized 110 patients undergoing PCNL for either endoscopically screening the access tract with bipolar tract coagulation whenever there was a significant tract bleeder using bipolar ball electrode (Karl Storz Tuttlingen, Germany) followed by tubeless exit (Group 1) or nephrostomy tube insertion only without screening (Group 2) with antegrade Double-J stenting in both groups. We excluded patients with multiple tracts, failure of stone clearance, and significant perforation of the collecting system. We recorded blood loss, 6 hours hemoglobin drop, postoperative need for analgesia, hospital stay, and incidence of angioembolization.

Results: There were no significant differences between either group in terms of demographic characteristics (Table 1). Mean hemoglobin drop after 6 hours was 0.7 ± 0.8 g/dL vs 1 ± 0.9 g/dL in Groups 1 and 2 (p = 0.07), respectively, and the blood transfusion rate (p = 0.08). The incidence of hematuria in the first 6 hours (p = 0.008), nonsteroidal anti-inflammatory drugs administration (p = 0.0001), and postoperative pain scale (p = 0.0001) were significantly higher in the tubed Group 2 (Table 2). Only nine cases of tract screened patients (16% of Group1) necessitated cauterization (Table 3).

LEARNING OUTCOMES

Conclusion: Tubeless PCNL with tract screening ± cauterization could provide a safer solution for generalization of tubeless PCNL with same-day discharge plus less postoperative pain and fewer nonsteroidal anti-inflammatory drugs administration in patients undergoing PCNL for renal stones.

Patient Consent Statement: Corresponding author has received and archived patient consent for video recording/publication in advance of video recording of procedure.