Glenn M. Preminger, MD, a member of the Urology Times editorial council, is professor of urology and director of the Comprehensive Kidney Stone Center, Duke University Medical Center, Durham, NC.
The tubeless PNL approach provided the greatest comfort for the patient.
Two studies compared the configuration of different nephrostomy tubes used during PNL procedures in terms of patient comfort. The first study measured ease of placement and tracked pain management after the surgery, while the second was a retrospective study examining narcotic use, time to removal of the stent after surgery, and hospital stay (see "Tubeless PNL: Studies address ideal stents, candidates,"). A standard small-caliber nephrostomy tube appears to be more comfortable for the patient than is a nephroureteral stent.
These two studies complement a previous study that compared two different-sized nephrostomy tubes and the "tubeless" PNL approach (J Urol 2004; 172:565-7). As expected, the PNL tubeless approach provided the greatest comfort for the patient without increasing post-PNL complications.
A review of the PNL procedure in obese patients was also presented at the WCE. As obesity increases the risk of stone disease, we are all seeing more obese patients in our practice who require stone removal. The current study suggests that PNL is just as safe and effective in obese patients as it is in non-obese patients, and supports previous investigations documenting PNL as the optimal treatment for complex stones in obese individuals (J Urol 1998; 160:669-73; Urology 2004; 63:1036-41).
Finally, the anti-inflammatory agent ketorolac tromethamine was shown to be safe for managing pain following percutaneous stone removal (see "NSAID alleviates pain of PNL in select patients,"). Researchers found no increase in postoperative problems, such as a significant rise in creatinine levels or blood loss. Because ketorolac has been used so long for the management of renal colic, it is reassuring to see that this is a safe medication to use following PNL. Ideally, a randomized prospective trial comparing ketorolac to standard narcotics is needed.
Although percutaneous nephrolithotomy has been around for almost 30 years, it's good to see that we're still making advances in our technique and expanding the indications for this very effective and safe method to manage renal calculi.