1891 PRELIMINARY RESULTS OF A PROSPECTIVE RANDOMIZED TRIAL OF TUBELESS FLOSEAL VS TUBELESS FASCIAL STITCH VS COPE LOOP NEPHROSTOMY PERCUTANEOUS NEPHROLITHOTOMY (PCNL) (2010)

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopic or Percutaneous Stone Removal IV1 Apr 20101891 PRELIMINARY RESULTS OF A PROSPECTIVE RANDOMIZED TRIAL OF TUBELESS FLOSEAL VS TUBELESS FASCIAL STITCH VS COPE LOOP NEPHROSTOMY PERCUTANEOUS NEPHROLITHOTOMY (PCNL) Roger Li, Jason Lee, Hak J. Lee, Donald Pick, Michael Louie, Rosanne T. Santos, Denise Wong, and Elspeth M. McDougall Roger LiRoger Li More articles by this author , Jason LeeJason Lee More articles by this author , Hak J. LeeHak J. Lee More articles by this author , Donald PickDonald Pick More articles by this author , Michael LouieMichael Louie More articles by this author , Rosanne T. SantosRosanne T. Santos More articles by this author , Denise WongDenise Wong More articles by this author , and Elspeth M. McDougallElspeth M. McDougall More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1845AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We present the preliminary results of a prospective randomized trial evaluating the safety and efficacy of various “tubeless” PCNL techniques in reducing post-operative (post-op) morbidity. We compared post-op hospital stay, analgesics use, changes in serum creatinine, changes in hemoglobin, SF-36 scores, as well as post-op pain analog scores among patients randomized to undergo nephrostomy tract closure with Floseal (hemostatic gelatin matrix), a deep fascial stitch, or a 10F Cope loop nephrostomy tube. METHODS A total of 31 patients undergoing PCNL met the inclusion criteria for the study and were randomized into one of the 3 aforementioned groups; 10 Floseal, 10 fascial stitch, 11 Cope loop. All patients underwent an uncomplicated endoscopic-guided PCNL, standard technique at our institution. A study questionnaire consisting of a SF-36 questionnaire and analog pain scales were given pre-operatively, on post-op day #1, and at 1 week, 1 month and 3 months after the procedure. Statistical analysis was performed using the ANOVA test. RESULTS The mean age, BMI, stone burden, pre-op labs, and complication rates were not significantly different among the three groups. The post-op hospital stay (p = 0.45), amount of opioid analgesia used in morphine equivalents (p = 0.79), changes in serum creatinine (p = 0.28) and hemoglobin (p = 0.09) were also not significantly different among the groups. The SF-36 total scores and pain analog scores were all comparable at each time-point, except at 1 week post-op, when there was a significantly higher pain analog score in the Floseal group compared to the Cope loop group (p = 0.02). CONCLUSIONS Nephrostomy tract closure with Floseal, deep fascial stitch and 10F Cope loop nephrostomy tube following PCNL result in similar peri-op bleeding, changes in serum creatinine and post-op discomfort. Patients had similar post-op hospital stays and analgesic use with no statistical difference in SF-36 and analog pain scale scores on the first post-op day, 1 month post-op, and 3 months post-op. In this preliminary study, the post PCNL placement of a fascial suture appears to be a reasonable way of managing PCNL patients, especially if a nephrostomy free approach is reasonable. Table 1. Floseal Fascial stitch Cope loop Test of significance Hospital stay (days) 1.7±1.16 1.5±0.71 2±0.77 P=0.4 Parenteral analgesics (Morphine equivalents) 28.42±41.3 19.5±15.2 24.3±26.9 P=0.8 Change in serum Cr 0.08±1.16 0.19±0.21 0.08±0.17 P=0.3 Change in hemoglobin -2.56±1.06 -2.49±1.16 -2.88±1.25 P=0.7 SF-36 total scores Pre-op 69.2±20.6 55.3±24.7 56±17.6 P=0.4 Post-op day #1 58.7±22.9 45.4±22.5 55±15.0 P=0.5 1 week 55±14.7 52.3±22.2 51.2±12.0 P=0.9 1 month 68.8±23.5 70.3±29.8 69.5±18.7 P=1.0 3 months 72.2±18.2 65±31.3 67±16.7 P=0.8 Analog pain scale Pre-op 8±12.6 14.4±19.0 16.1±14.5 P=0.7 Post-op day #1 16.2±14.9 23.8±17.0 25.1±14.9 P=0.6 1 week 22.6±11.3 15.6±13.3 4.6±4.5 P<0.05 1 month 15.8±11.3 16.7±23.0 9.4±11.6 P=0.7 3 months 9.8±11.4 12±19.1 8.6±12.0 P=0.9 Orange, CA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e735 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Roger Li More articles by this author Jason Lee More articles by this author Hak J. Lee More articles by this author Donald Pick More articles by this author Michael Louie More articles by this author Rosanne T. Santos More articles by this author Denise Wong More articles by this author Elspeth M. McDougall More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...