Objective: To evaluate the feasibility and efficacy of tubeless 24 F (1 F=0.33 mm)tract percutaneous nephrolithotomy (PCNL) in the treatment of renal and proximal ureteral stones in Chinese patients.
Methods: In the study, 108 patients treated with tubless 24 F tract PCNLs during September 2009 and April 2013 in our department were retrospectively analyzed, of whom, 42 were with renal calculi (the max diameter of calculi 2-4 cm, including 4 with simple staghorn stones), 41 with upper ureteral stones (the max diameter of calculi more than 1.5 cm or failure treated with extracorporeal shock wave lithotripsy), and 25 with upper ureteral stones combined with simple renal stones. Tubeless 24 F tract PCNL was performed when serious renal infection, obstraction in the distal of stone, the thickness of cortex less than 5 mm, operation time more than 90 min, residual stones needing second PCNL, severe bleeding during operation, pelvic perforation and obvious urinous infiltration were excluded.
Results: All the 108 patients were treated successfully with tubeless 24 F tract PCNL. Residual stone(about 5 mm in diameter)was found only 1 patient's lower calyces. The stone clearance rate was 99.1%, the average operation time was (40.5±9.1) min, the mean VAS on the first day postoperation was 3.0±1.6, the preoperative and postoperative hemoglobin decrease was (4.8±2.7) g/L, no blood transfusion and angiography and embolization needed, no pleural and other adjacent organ injury occurred. One patient got fever postoperatively (>38.5 °C). No perirenal hematoma and urine leakage were found. The average postoperative hospital stay was (2.4±0.6) days. All the patients were followed up for 1 month, and no other complication occurred.
Conclusion: Tubeless 24 F tract PCNL can be a feasible way for renal stones and upper ureteral stones treatment, based on the severity candidate, perfect operative procedures and precise judgment at the end of the operation.