Nephroureterostomy-drained percutaneous nephrolithotomy: modification combining safety with decreased morbidity

Percutaneous nephrolithotomy (PCNL) has become well established as the standard procedure for the management of certain renal calculi. To minimize patient discomfort and reduce the hospital stay, a novel modification of our previous technique was evaluated. A smaller internal/external nephroureterostomy catheter (NUC) placed at the completion of the procedure was compared with the larger Malecot nephrostomy tube.

We conducted a 2:1 matched cohort study with historical controls. In 2002, a consecutive series of 30 PCNL procedures at a single teaching hospital were carried out in the conventional fashion. At the end of the procedure, an 8.5F/6.0F internal/external NUC was placed in the percutaneous tract instead of the traditional 24F Malecot tube. These patients were compared with a cohort of matched cases (60) performed between 1992 and 1997 on the basis of age, sex, and site of access (supracostal or infracostal). The endpoints were patient discomfort (morphine equivalents used), safety (postoperative hemoglobin drop), and length of hospital stay.

The mean morphine equivalents used in the first 24 postoperative hours were significantly different in the two groups (study 16.5 mg and controls 47.8 mg; P<0.001). The percentage difference between the preoperative and postoperative hemoglobin values was comparable in the two groups (mean study 12.8% and mean controls 13.4%; P=0.80). The median length of hospital stay was significantly shorter in the study group than in the control group, 1 v 4 days, respectively (P<0.001).

Our data suggest that the NUC diminishes postoperative pain while maintaining ureteral patency and nephrostomy access and decreases hospital stay.