Changing practice to stented percutaneous nephrolithotomy (PCNL): a 2 year experience

Introduction: Stented PCNL is an increasingly practiced technique in which PCNL is performed without leaving a post-operative nephrostomy tube. We present our results from one of the biggest UK series to assess the impact of this technique on the safety, efficacy, length of hospital stay and analgesic requirement, to guide our future practice in terms of patient selection. Patients and methods: Case notes of 56 stented PCNLs between October 2005 and 2007 were reviewed retrospectively and compared to a similar group of 50 conventional PCNLs (only a nephrostomy post-operatively) in terms of co-morbidities (ASA grade), stone burden, intra-operative details, complications, length of stay (LOS) and analgesic requirement. The stented technique was employed in complex stones and in anatomical abnormalities (e.g. horseshoe, solitary, and duplex systems). The use of a stent rather than a nephrostomy was decided at the time of surgery when satisfactory haemostasis and stone clearance were achieved at the end of the procedure. Results: Co-morbidities, anatomical abnormalities, stone burden, operative time, number of punctures, access and infection rates were comparable. The stented technique was employed in complex stones (staghorn n = 13, multiple stones n = 11) and in patients with anatomical abnormalities (n = 9). Overall stone free rate was 92.8% and 82% for the stented and the conventional groups, respectively. No haemorrhage or ureteric obstruction was reported in the stented group. All stent removals were uneventful. Mean LOS and analgesic requirement of diclofenac were markedly less in stented group. The number of stented procedures tripled from year 1 (n = 14) to year 2 (n = 42). Mean LOS dropped steadily from 68.6 h in the first 6 months (n = 5) to 47.4 h in the last 6 months (n = 22) with increased experience. Twenty-four patients (42%) were fit for discharge within 35 h. Conclusion: In our experience, the stented technique was well tolerated and has reduced the length of hospital stay with no evidence of loss of efficacy or increased morbidity even in complex stones or patients with anatomical abnormalities. (C) 2009 British Association of Urological Surgeons. Published by Elsevier Ltd. All rights reserved.