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Prospective randomized trial of three different methods of nephrostomy tract closure after percutaneous nephrolithotripsy
Author(s) -
Li Roger,
Louie Michael K.,
Lee Hak J.,
Osann Kathryn,
Pick Donald L.,
Santos Rosanne,
McDougall Elspeth M.,
Clayman Ralph V.
Publication year - 2011
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2010.09676.x
Subject(s) - medicine , percutaneous nephrostomy , nephrostomy , randomized controlled trial , surgery , percutaneous , percutaneous nephrolithotomy , urology
Study Type – Therapy (RCT)
Level of Evidence 1b What's known on the subject? and What does the study add? Percutaneous nephrolithotripsy is a common procedure throughout the world, but the optimal technique for closure of the percutaneous tract is unknown. This is important for two reasons, the first is that the access tract may bleed after removal of the instruments and access sheath, the second is that several randomized studies have shown improved patient comfort by not having any nephrostomy tubes after the procedure. Our study is the first to compare three common methods of access tract closure in a randomized study. OBJECTIVE• To evaluate the safety and efficacy of ‘tubeless’ nephrostomy tract closure in reducing postoperative morbidity after percutaneous nephrolithotomy (PCNL).MATERIALS AND METHODS• In all, 31 patients undergoing PCNL were randomized into three groups, each with a different method of nephrostomy tract closure: using either a gelatin matrix haemostatic sealant (FloSeal), fascial stitch or Cope loop nephrostomy tube. • We compared operative time, estimated blood loss (EBL), postoperative stay, analgaesics use, changes in creatinine and haemoglobin levels, and stone clearance rate, as well as postoperative short‐form (SF)‐36 quality‐of‐life and pain analogue scores at five different time points after surgery. • All data were analysed using a one‐way anova test. • A repeated measures anova test was used selectively to assess the progression of SF‐36 and pain analogue scores.RESULTS• The preoperative variables operative time, EBL, postoperative stay ( P = 0.45), analgaesia use ( P = 0.79), changes in creatinine ( P = 0.28) and haemoglobin ( P = 0.09) levels, and postoperative SF‐36 scores were not significantly different. • In contrast, the differences in analogue pain scales at 1 week after surgery ( P = 0.02) and the trends of analogue pain score progression ( P = 0.03) were statistically significant. • Three patients underwent second‐look procedures for residual stones and there was one case of postoperative pyelonephritis in a multiple sclerosis patient.CONCLUSIONS• The Cope loop closure patients recovered fastest, while FloSeal closure patients experienced initial increase in pain followed by resolution at 1 month. • As a result of the small study group sizes, it is difficult to show any significant difference in postoperative pain, especially in long‐term follow‐up; further clinical evaluation is necessary.