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Trans-tract electrocoagulation can decrease the need for postoperative nephrostomy tube after endoscopic combined

Masashi Takeda1, Hideyasu Iwamoto2, Nao Miyake2

  • 1Department of Urology, Miyazaki University Graduate School of Medicine, Miyazaki, Japan.

International Journal of Urology : Official Journal of the Japanese Urological Association
|October 2, 2019
PubMed
Summary

Trans-tract electrocoagulation during endoscopic combined intrarenal surgery improves stone-free rates and reduces complications. This safe and efficient procedure minimizes the need for post-operative nephrostomy tubes, shortening hospital stays.

Keywords:
electrocoagulationendoscopic combined intrarenal surgeryhemostasisnephrostomyurinary stone

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Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Endourology

Background:

  • Endoscopic combined intrarenal surgery (ECIRS) is a key procedure for managing complex renal and ureteral stones.
  • Bleeding during ECIRS can complicate the post-operative recovery and necessitate interventions like nephrostomy tube placement.

Purpose of the Study:

  • To evaluate the efficacy and safety of trans-tract electrocoagulation (TTEC) as an adjunct to ECIRS for renal or ureteral stones.
  • To compare surgical outcomes between patients who underwent ECIRS with and without TTEC.

Main Methods:

  • A retrospective study comparing patients undergoing ECIRS between May 2010 and March 2018.
  • TTEC using a resectoscope was implemented in June 2013 to control bleeding from the access tract post-ECIRS.
  • Patient demographics and surgical outcomes were analyzed for groups with and without TTEC.

Main Results:

  • The TTEC group (n=225) showed significantly higher initial stone-free rates (80% vs. 72%) compared to the non-TTEC group (n=72).
  • Patients receiving TTEC had a significantly higher nephrostomy tube-free rate (67% vs. 26%), shorter catheterization time (2.8 vs. 5.4 days), and shorter hospital stay (6.5 vs. 8.8 days).
  • The TTEC group also had a significantly smaller stone burden (P=0.001).

Conclusions:

  • Trans-tract electrocoagulation is a safe and effective addition to ECIRS for renal and ureteral stones.
  • TTEC significantly reduces the requirement for post-operative nephrostomy tubes.
  • This technique contributes to improved patient outcomes, including shorter recovery times and hospital stays.