Purpose: To assess bleeding complications in totally tubeless double-access percutaneous nephrolithotomy (PCNL) and compare it with the single-access method. Methods: One hundred and seven patients with large or scattered renal stones were enrolled in this cohort study. Totally tubeless PCNL with one access (group A, 70 cases) or two accesses (group B, 37 cases) was done and bleeding was assessed by measuring the hemoglobin drop of the patients, blood transfusion rate and need for performing angioembolization. Results: The mean (SD) hemoglobin drops in groups A and B were 1.97 (1.24) and 2.31 (1.24), respectively; p = 0.176. Blood transfusion rates in two groups were 7.1 and 10.8% (p = 0.716), respectively. None of our patients required angioembolization. The average hemoglobin drop and blood transfusion rate with double tracts were approximately near to those in single tract group and in acceptable ranges. The average hospital stay in groups A and B were 3.1 and 3.2 days (p = 0.074), respectively. There was no leakage from puncture site/s and stone free rates in the two groups were 85.7 and 97.3% (p = 0.093). Conclusion: Totally tubeless double-access PCNL is feasible and bleeding complications are comparable to single access totally tubeless PCNL making it an effective strategy to achieve more stone free rates.

Keywords:
Tubeless, Percutaneous nephrolithotomy, Hemorrhage, Complications
1.
Fernström I, Johansson B: Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol 1976;10:257-259.
2.
Mousavi-Bahar SH, Mehrabi S, Moslemi MK: Percutaneous nephrolithotomy complications in 671 consecutive patients: a single-center experience. Urol J 2011;8:271-276.
3.
Aghamir SM, Modaresi SS, Aloosh M, Tajik A: Totally tubeless percutaneous nephrolithotomy for upper pole renal stone using subcostal access. J Endourol 2011;25:583-586.
4.
Istanbulluoglu MO, Cicek T, Ozturk B, et al: Percutaneous nephrolithotomy: nephrostomy or tubeless or totally tubeless? Urology 2010;75:1043-1046.
5.
Aghamir SM, Hosseini SR, Gooran S: Totally tubeless percutaneous nephrolithotomy. J Endourol 2004;18:647-648.
6.
Aghamir SM, Salavati A, et al: Feasibility of totally tubeless percutaneous nephrolithotomy under the age of 14 years: a randomized clinical trial. J Endourol 2012;26:621-624.
7.
Stoller ML, Wolf JS Jr, St Lezin MA: Estimated blood loss and transfusion rates associated with percutaneous nephrolithotomy. J Urol 1994;152:1977-1981.
8.
Yamaguchi A, Skolarikos A, Buchholz NP, et al: Operating times and bleeding complications in percutaneous nephrolithotomy: a comparison of tract dilation methods in 5,537 patients in the clinical research office of the endourological society percutaneous nephrolithotomy global study. J Endourol 2011;25:933-939.
9.
Shah H, Khandkar A, Sodha H, et al: Tubeless percutaneous nephrolithotomy: 3 years of experience with 454 patients. BJU Int 2009; 104:840-846.
10.
Amer T, Ahmed K, Bultitude M, et al: Standard versus tubeless percutaneous nephrolithotomy: a systematic review. Urol Int 2012;88:373-382.
11.
Yuan H, Zheng S, Liu L, Han P, Wang J, Wei Q: The efficacy and safety of tubeless percutaneous nephrolithotomy: a systematic review and meta-analysis. Urol Res 2011;39:401-410.
12.
Hegarty NJ, Desai MM: Percutaneous nephrolithotomy requiring multiple tracts: comparison of morbidity with single-tract procedures. J Endourol 2006;20:753-760.
13.
Akman T, Sari E, Binbay M, et al: Comparison of outcomes after percutaneous nephrolithotomy of staghorn calculi in those with single and multiple accesses. J Endourol 2010;24:955-960.
14.
Mishra S, Sabnis RB, Kurien A, et al: Questioning the wisdom of tubeless percutaneous nephrolithotomy (PCNL): a prospective randomized controlled study of early tube removal vs tubeless PCNL. BJU Int 2010;106:1045-1049; discussion 1048-1049.
15.
Wang Y, Hou Y, Jiang F, Wang Y, Chen Q, Lu Z, Hu J, Wang X, et al: Standard-tract combined with mini-tract in percutaneous nephrolithotomy for renal staghorn calculi. Urol Int 2014;92:422-426.
16.
Fei X, Li J, Song Y, Wu B: Single-stage multiple-tract percutaneous nephrolithotomy in the treatment of staghorn stones under total ultrasonography guidance. Urol Int 2014;93:411-416.
17.
Bellman GC, Davidoff R, Candela J, et al: Tubeless percutaneous renal surgery. J Urol 1997;157:1578-1582.
18.
Wang J, Zhao C, Zhang C, Fan X, Lin Y, Jiang Q: Tubeless vs standard percutaneous nephrolithotomy: a meta-analysis. BJU Int 2012;109:918-924.
19.
Zhong W, Zeng G, Wu W, Chen W, Wu K: Minimally invasive percutaneous nephrolithotomy with multiple mini tracts in a single session in treating staghorn calculi. Urol Res 2011;39:117-122.
20.
Falahatkar S, Khosropanah I, Roshani A, et al: Safety and efficacy of tubeless percutaneous nephrolithotomy. Acta Medica Iranica 2008;46:383-385.
21.
Wang K, Zhang P, Xu X, Fan M: Ultrasonographic versus fluoroscopic access for percutaneous nephrolithotomy: a meta-analysis. Urol Int 2015, Epub ahead of print.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.