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Comparison one-step procedure with two-step procedure in percutaneous nephrolithotomy.

Szu-Han Chen1, Wen-Jeng Wu, Yii-Her Chou

  • 1Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tzyou First Rd, Kaohsiung, 807, Taiwan.

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One-step percutaneous nephrolithotomy (PCNL) performed by a urologist alone offers better pain outcomes and shorter hospital stays compared to two-step PCNL involving a radiologist. Both methods show comparable success rates and complication levels for kidney stone removal.

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Area of Science:

  • Urology
  • Minimally Invasive Surgery

Background:

  • Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stone management.
  • Current protocols often involve a two-step approach with radiologist assistance for nephrostomy placement.
  • The efficacy and patient outcomes of one-step versus two-step PCNL require further comparative analysis.

Purpose of the Study:

  • To compare the perioperative and postoperative outcomes of one-step PCNL performed by a urologist versus two-step PCNL involving a radiologist.
  • To evaluate differences in pain scores, analgesic requirements, hemoglobin levels, transfusion volumes, and hospital stay.

Main Methods:

  • A comparative study involving 168 patients undergoing PCNL.
  • 85 patients underwent one-step PCNL (urologist alone).
  • 83 patients underwent two-step PCNL (radiologist-assisted nephrostomy prior to urologist intervention).

Main Results:

  • One-step PCNL demonstrated a significantly shorter hospital stay.
  • Patients in the one-step PCNL group reported lower visual analogue scores (VAS) for pain on postoperative days 1, 2, and 3.
  • The one-step PCNL group required significantly fewer parenteral analgesic prescriptions.
  • No significant differences were observed in hemoglobin decrease or blood transfusion volume between the groups.

Conclusions:

  • One-step PCNL by a urologist alone provides superior wound pain outcomes and reduces hospital stay compared to the two-step approach with radiologist collaboration.
  • The one-step method achieves comparable stone-free rates and complication profiles.
  • This suggests one-step PCNL may be a more efficient and patient-friendly approach for kidney stone treatment.