RESUMEN
BACKGROUND: Percutaneous nephrolithotomy (PCNL) is the gold-standard for treatment of renal stones larger than 20 mm. Traditionally, a nephrostomy tube (NT) is placed, causing discomfort and prolonged hospitalization but some surgeons prefer the tubeless technique (TL). Simultaneously, the effectiveness of ureteral stents after PNCL is doubtful. We investigated the safety of the TL technique as well as that of the single loop (SL) over double loop (DL) stents. METHODS: Three hundred and twenty-one individuals submitted to PCNL in a single center were retrospectively reviewed. Statistical analysis was performed to compare procedures regarding safety and effectiveness (stone size, residual stones, operative time, peri- and post-operative complications, need for blood transfusion and length of hospital stay) between two groups regarding presence or absence of NT placement (NT [N.=198] vs. TL [N.=123]); and according to the type of stent used (SL [N.=74] vs. DL [N.=247]). RESULTS: NT was associated with a higher complications rate compared to the TL (30.3% and 13%, respectively; P=0.001) and longer hospitalization (4 vs. 2 days; P=0.001). Regarding ureteral stents, they cause similar morbidities (20.7% and 24.4%; P=0.881), and median length of stay (3 days; P=0.947). NT and DL were more frequent in patients with higher stone burden. CONCLUSIONS: Tubeless PCNL encompasses lower morbidity and should be considered as an option for select patients, particularly with less stone burden and uncomplicated procedures. Regarding ureteral stents, SL is a safe option and does not require further procedures for removal.
Asunto(s)
Drenaje/efectos adversos , Drenaje/métodos , Nefrolitotomía Percutánea/métodos , Cálculos Urinarios/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Nefrolitotomía Percutánea/efectos adversos , Complicaciones Posoperatorias , Estudios Retrospectivos , Stents , Resultado del Tratamiento , Uréter/cirugía , Cateterismo Urinario/estadística & datos numéricos , Adulto JovenRESUMEN
Lower urinary tract symptoms (LUTS) are a common complaint in the general population with great impact on the quality of life. Besides the classical pathologies, there are less common causes that must be considered in the treatment approach for patients with LUTS. We present the case of a 30-year-old patient with multiple emergency department episodes with dysuria, urinary frequency, suprapubic pain and an episode of acute urinary retention. The blood and urine tests only revealed increased systemic inflammatory parameters. The ultrasound examination showed thickening of the bladder wall, and the CT scan revealed a retropubic abscess originating from a pubic symphysis osteomyelitis. A percutaneous drainage was performed and, after empirical antibiotic therapy, there was complete resolution of the clinical picture.