A comparative analysis of treatment of patients after percutaneous nephrolithotripsy with various methods of upper urinary tract drainage
Patients and methods. The study consisted of a prospective analysis of 120 patients, who underwent percutaneous nephrolithotripsy in the urology clinic of I.M.Sechenov First Moscow State Medical University from March 2013 to December 2014. All patients were divided into two groups: group 1 (n = 63) included patients with placement of nephrostomy drainage, group 2 (n = 57) included all patients with internal drainages. The method of drainage was chosen during the pre-operative period based on data of pre-operative examination. The choice of the drainage method of the upper urinary tract and its effectiveness were assessed by the results of calculation of the time of operative intervention, assessment of intraoperational blood loss. In the post-operative period, we assessed the number of bed-days, terms of removal of drainages and also pain intensity at different stages of the post-operative period based on data of the pain visual analogue scale (VAS).
Results. The average duration of operative intervention in group 1 was 98 ± 16 min, and in group 2 the average time of surgery was 71 ± 19 min. The average haemoglobin levels before surgery in groups 1 and 2 were approximately comparable amounting to 141.5 ± 13 and 143.6 ± 18 g/l. Haemoglobin levels in the early post-operative period differed strikingly: 121 ± 13 and 128 ± g/l. Assessment of objective pain intensity by VAS showed that in the early post-operative period pain intensity in both groups was approximately comparable: 6.29 and 6.05 scores, respectively, but beginning with the second day, namely, from the moment of activation of patients, pain intensity values in both groups began to differ. In group 1: second day – 5.33 ± 1.5 scores, third day – 3.25 ± 1.8 scores, fifth day – 2.5 ± 1.6 scores. In a further elucidation of the pain source 56 (88%) patients related pain to the nephrostomy proper and to pain in the nephrostomy area during moving, and only 7 (11%) patients related pain directly to the operated kidney itself. In group 2: second day – 3.5 ± 1.2 scores, third day – 2.9 ± 1.4 scores, fifth day – 1.22 ± 0.8 scores.
Conclusion. Modern preoperative examination including multislice spiral computed tomography with contrast, and 3D multiplanar modelling permit to obtain all necessary information with respect to the size, number and localisation of stones, vascular architectonics of the kidney, interlocation of nearby organs and the kidney at the pre-operative stage. This makes possible for an experienced endoscopic surgeon at the prehospital stage to make a surgery plan, and on completion of the latter – method of drainage of the P-C system. In its turn, tubeless completion of PCNL in correct assessment of an intraoperational situation and careful selection of patients is effective and safe. Draining of the upper urinary tract with internal drainages permits to reduce the intensity of postsurgical pain, which improves the quality of life of patients in the post-operative period and to reduce the number of post-operative bed-days.
Key words: upper urinary tract, catheter stent, nephrostomy drainage, percutaneous nephrolithotripsy.
Publisher's imprint: Urology and Andrology, 2016, volume 4, No 1, p. 19–23. The article was received 26.10.2015.