Nephrostomy in percutaneous nephrolithotomy (PCNL): does nephrostomy tube size matter? Results from The Global PCNL Study from The Clinical Research Office Endourology Society

Abstract

Purpose

To explore the relationships between nephrostomy tube (NT) size and outcome of percutaneous nephrolithotomy (PCNL).

Methods

The Clinical Research Office of the Endourological Society (CROES) prospectively collected data from consecutive patients treated with PCNL over a 1-year period at 96 participating centers worldwide. This report focuses on the 3,968 patients who received a NT of known size. Preoperative, surgical procedure and outcome data were analyzed according to NT size, dividing patients into two groups, namely small-bore (SB; nephrostomy size ≤ 18 Fr) and large-bore (LB; nephrostomy size > 18 Fr) NT.

Results

Patients who received a LB NT had a significantly lower rate of hemoglobin reduction (3.0 vs. 4.3 g/dL; P < 0.001), overall complications (15.8 vs. 21.4 %; P < 0.001) and a trend toward a lower rate of fever (9.1 vs. 10.7 %). Patients receiving a LB NT conversely had a statistically, though not clinically significant, longer postoperative hospital stay (4.4 vs. 4.2 days; P = 0.027). There were no differences in urinary leakage (0.9 vs. 1.3 %, P = 0.215) or stone-free rates (79.5 vs. 78.1 %, P = 0.281) between the two groups.

Conclusions

LB NTs seem to reduce bleeding and overall complication rate. These findings would suggest that if a NT has to be placed, it should better be a LB one.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

References

  1. 1.

    De Sio M, Autorino R, Quattrone C, Giugliano F, Balsamo R, D’Armiento M (2011) Choosing the nephrostomy size after percutaneous nephrolithotomy. World J Urol 29(6):707–711

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Fernström I, Johansson B (1976) Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol 10(3):257–259

    PubMed  Google Scholar 

  3. 3.

    Pietrow PK, Auge BK, Lallas CD, Santa-Cruz RW, Newman GE, Albala DM, Preminger GM (2003) Pain after percutaneous nephrolithotomy: impact of nephrostomy tube size. J Endourol 17(6):411–414

    PubMed  Article  Google Scholar 

  4. 4.

    Maheshwari PN, Andankar MG, Bansal M (2000) Nephrostomy tube after percutaneous nephrolithotomy: large-bore or pigtail catheter? J Endourol 14(9):735–737

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Borges CF, Fregonesi A, Silva D, Sasse AD (2010) Systematic review and meta-analysis of nephrostomy placement versus tubeless percutaneous nephrolithotomy. J Endourol 24(11):1738–1746

    Article  Google Scholar 

  6. 6.

    Ni S, Qiyin C, Tao W, Liu L, Jiang H, Hu H, Han R, Wang C (2011) Tubeless percutaneous nephrolithotomy is associated with less pain and shorter hospitalization compared with standard or small bore drainage: a meta-analysis of randomized, controlled trials. Urology 77(6):1293–1298

    PubMed  Article  Google Scholar 

  7. 7.

    Yuan H, Zheng S, Liu L, Han P, Wang J, Wei Q (2011) The efficacy and safety of tubeless percutaneous nephrolithotomy: a systematic review and meta-analysis. Urol Res 39(5):401–410

    PubMed  Article  Google Scholar 

  8. 8.

    Wang J, Zhao C, Zhang C, Fan X, Lin Y, Jiang Q (2012) Tubeless vs standard percutaneous nephrolithotomy: a meta-analysis. BJU Int 109(6):918–924

    PubMed  Article  Google Scholar 

  9. 9.

    Choi M, Brusky J, Weaver J, Amantia M, Bellman GC (2006) Randomized trial comparing modified tubeless percutaneous nephrolithotomy with tailed stent with percutaneous nephrostomy with small-bore tube. J Endourol 20(10):766–770

    PubMed  Article  Google Scholar 

  10. 10.

    Shah HN, Sodha HS, Khandkar AA, Kharodawala S, Hegde SS, Bansal MB (2008) A randomized trial evaluating type of nephrostomy drainage after percutaneous nephrolithotomy: small bore v tubeless. J Endourol 22(7):1433–1439

    PubMed  Article  Google Scholar 

  11. 11.

    Türk C, Knoll T, Petrik A, Sarica K, Straub M, Seitz C (2010) EAU guidelines on urolithiasis 2010. http://www.uroweb.org/gls/pdf/18_Urolithiasis.pdf

  12. 12.

    de la Rosette J, Assimos D, Desai M, Gutierrez J, Lingeman J, Scarpa R, Tefekli A, CROES PCNL Study Group (2011) The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: indications, complications, and outcomes in 5803 patients. J Endourol 25(1):11–17

    PubMed  Article  Google Scholar 

  13. 13.

    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196

    PubMed  Article  Google Scholar 

  14. 14.

    Graefen M (2010) The modified Clavien system: a plea for a standardized reporting system for surgical complications. Eur Urol 57(3):387–389

    PubMed  Article  Google Scholar 

  15. 15.

    De la Rosette JJMCH, Opondo D, Daels FPJ, Giusti G, Serrano A, Kandasami SV, Wolf JS, Grabe M, Gravas S, on behalf of the CROES PCNL Study group (2012) Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy (PCNL). Eur Urol 62(2):246–255

    Google Scholar 

  16. 16.

    Tefekli A, Ali Karadag M, Tepeler K, Sari E, Berberoglu Y, Baykal M, Sarilar O, Muslumanoglu AY (2008) Classification of percutaneous nephrolithotomy complications using the modified clavien grading system: looking for a standard. Eur Urol 53(1):184–190

    PubMed  Article  Google Scholar 

  17. 17.

    Zuazu JR, Hruza M, Rassweiler JJ, de la Rosette JJ (2010) The Clavien classification system to optimize the documentation of PCNL morbidity. Arch Ital Urol Androl 82(1):20–22

    PubMed  Google Scholar 

  18. 18.

    Yamaguchi A, Skolarikos A, Buchholz N-P, Chomón GB, Grasso M, Saba P, Nakada S, de la Rosette J, Clinical Research Office Of The Endourological Society Percutaneous Nephrolithotomy Study Group (2011) Operating times and bleeding complications in percutaneous nephrolithotomy: a comparison of tract dilation methods in 5537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study. J Endourol 25(6):933–939

    PubMed  Article  Google Scholar 

  19. 19.

    Cormio L, Gonzalez GI, Tolley D, Sofer M, Muslumanoglu A, Klingler H-C, Stolzenburg J-U, de al Rosette J (2012) Exit strategies following percutaneous nephrolithotomy (PCNL): A comparison of surgical outcomes in The Clinical Research Office of The Endourological Society (CROES) PCNL Global Study. World J Urol (in press)

  20. 20.

    Cormio L, Perrone A, Di Fino G, Ruocco N, De Siati M, de la Rosette J, Carrieri G (2012) TachoSil® sealed tubeless percutaneous nephrolithotomy to reduce urine leakage and bleeding: outcome from a randomized controlled study. J Urol 188(1):145–150

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

The Global PCNL Study was supported by an unrestricted educational grant from Olympus.

Conflict of interest

No competing financial interests exist.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Jean de la Rosette.

Additional information

This study was conducted on behalf of the CROES PCNL Study Group.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Cormio, L., Preminger, G., Saussine, C. et al. Nephrostomy in percutaneous nephrolithotomy (PCNL): does nephrostomy tube size matter? Results from The Global PCNL Study from The Clinical Research Office Endourology Society. World J Urol 31, 1563–1568 (2013). https://doi.org/10.1007/s00345-012-0969-z

Download citation

Keywords

  • Exit strategy
  • Nephrostomy tube size
  • Renal access
  • Complications
  • PCNL