Is it Necessary to Perform Nephrostography before Tube Removal after Percutaneous Nephrolithotomy

Document Type : Original Article


1 Department of Urology, Isfahan Kidney Transplantaion Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Urology, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Urology, Iran University of Medical Sciences, Tehran, Iran


Background: The aim of this study is the caparison of the complications rate among the patients which underwent nephrostomy removal with and without performing nephrostography. Materials and Methods: Between October 2010 and November 2011, 200 patients who underwent standard percutaneous nephrolithotomy (PCNL) procedures were included in this study. The patients were randomly assigned into two groups, Group A (n = 100) did not undergo the antegrade nephrostography on postoperative day 2 and the patients were discharged keeping the nephrostomy until postoperative day 3, while in Group B (n = 100) the nephrostomy tube was removed on postoperative day 3 after antegrade nephrostography demonstrating ureteral drainage down to the bladder. Postoperative complications in both groups were recorded and compared between two groups. Results: A total of 200 patients were treated with standard PCNL. The persistent leakage of urine after removal of the nephrostomy tube was encountered in 5 (5.0%) and 3 (3%) of patients in Groups 1 and 2, respectively. Urinary leakage was resolved with conservative management in 3 and 2 patients of Groups 1 and 2, respectively, but a double-J stent was inserted in 2 and 1 patients in each group because of persistent leakage of urine more than 1-week. The two groups show comparable complications such as prolonged urinary leakage which managed in a similar manner, however, postoperative hospital stay was lesser in Group 1. Conclusion: Our results revealed postoperative performing nephrostogramy before tube removal changed the planning of complications such as prolonged urinary leakage and could be omitted in cases.


Matlaga BR, Kim SC, Lingeman JE. Improving outcomes of percutaneousn ephrolithotomy access. Eur Urol EAU Update Ser 2005;3:37-43.  Back to cited text no. 1
Grasso M, Loisides P, Beaghler M, Bagley D. The case for primary endoscopic management of upper urinary tract calculi: I. A critical review of 121 extracorporeal shock-wave lithotripsy failures. Urology 1995;45:363-71.  Back to cited text no. 2
Pietrow PK, Auge BK, Zhong P, Preminger GM. Clinical efficacy of a combination pneumatic and ultrasonic lithotrite. J Urol 2003;169:1247-9.  Back to cited text no. 3
Lingeman JE, Coury TA, Newman DM, Kahnoski RJ, Mertz JH, Mosbaugh PG, et al. Comparison of results and morbidity of percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy. J Urol 1987;138:485-90.  Back to cited text no. 4
Michel MS, Trojan L, Rassweiler JJ. Complications in percutaneous nephrolithotomy. Eur Urol 2007;51:899-906.  Back to cited text no. 5
Tefekli A, Ali Karadag M, Tepeler K, Sari E, Berberoglu Y, Baykal M, et al. Classification of percutaneous nephrolithotomy complications using the modified clavien grading system: Looking for a standard. Eur Urol 2008;53:184-90.  Back to cited text no. 6
Stoller ML, Wolf JS Jr, St Lezin MA. Estimated blood loss and transfusion rates associated with percutaneous nephrolithotomy. J Urol 1994;152(6 Pt 1):1977-81.  Back to cited text no. 7
Andonian S, Okhunov Z, Shapiro EY, Smith AD, Okeke Z. Diagnostic utility and clinical value of postpercutaneous nephrolithotomy nephrostogram. J Endourol 2010;24:1427-30.  Back to cited text no. 8
Winfield HN, Weyman P, Clayman RV. Percutaneous nephrostolithotomy: Complications of premature nephrostomy tube removal. J Urol 1986;136:77-9.  Back to cited text no. 9
Maheshwari PN, Andankar MG, Bansal M. Nephrostomy tube after percutaneous nephrolithotomy: Large-bore or pigtail catheter? J Endourol 2000;14:735-7.  Back to cited text no. 10
Yu DS. Gelatin packing of intracortical tract after percutaneous nephrostomy lithotripsy for decreasing bleeding and urine leakage. J Chin Med Assoc 2006;69:162-5.  Back to cited text no. 11
Fernström I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol 1976;10:257-9.  Back to cited text no. 12
Agrawal MS, Agrawal M, Gupta A, Bansal S, Yadav A, Goyal J. A randomized comparison of tubeless and standard percutaneous nephrolithotomy. J Endourol 2008;22:439-42.  Back to cited text no. 13
Paul EM, Marcovich R, Lee BR, Smith AD. Choosing the ideal nephrostomy tube. BJU Int 2003;92:672-7.  Back to cited text no. 14
Lam HS, Lingeman JE, Mosbaugh PG, Steele RE, Knapp PM, Scott JW, et al. Evolution of the technique of combination therapy for staghorn calculi: A decreasing role for extracorporeal shock wave lithotripsy. J Urol 1992;148(3 Pt 2):1058-62.  Back to cited text no. 15
Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE, et al. Nephrolithiasis Clinical Guidelines Panel summary report on the management of staghorn calculi. The American Urological Association Nephrolithiasis Clinical Guidelines Panel. J Urol 1994;151:1648-51.  Back to cited text no. 16
Duvdevani M, Razvi H, Sofer M, Beiko DT, Nott L, Chew BH, et al. Third prize: Contemporary percutaneous nephrolithotripsy: 1585 procedures in 1338 consecutive patients. J Endourol 2007;21:824-9.  Back to cited text no. 17
Lee WJ, Smith AD, Cubelli V, Badlani GH, Lewin B, Vernace F, et al. Complications of percutaneous nephrolithotomy. AJR Am J Roentgenol 1987;148:177-80.  Back to cited text no. 18
Binbay M, Sari E, Tepeler A, Erbin A, Savas O, Muslumanoglu AY, et al. Characteristics of patients requiring Double-J placement because of urine leakage after percutaneous nephrolithotomy. J Endourol 2009;23:1945-9.  Back to cited text no. 19
Herroeder S, Durieux ME, Hollmann MW. Inflammatory responses after surgery. Hosp Med 2002;63:99-103.  Back to cited text no. 20
Marcovich R, Jacobson AI, Singh J, Shah D, El-Hakim A, Lee BR, et al. No panacea for drainage after percutaneous nephrolithotomy. J Endourol 2004;18:743-7.  Back to cited text no. 21
Shah HN, Sodha HS, Khandkar AA, Kharodawala S, Hegde SS, Bansal MB. A randomized trial evaluating type of nephrostomy drainage after percutaneous nephrolithotomy: Small bore v tubeless. J Endourol 2008;22:1433-9.  Back to cited text no. 22
Feng MI, Tamaddon K, Mikhail A, Kaptein JS, Bellman GC. Prospective randomized study of various techniques of percutaneous nephrolithotomy. Urology 2001;58:345-50.  Back to cited text no. 23
Srinivasan AK, Herati A, Okeke Z, Smith AD. Renal drainage after percutaneous nephrolithotomy. J Endourol 2009;23:1743-9.  Back to cited text no. 24