title: Comparison one-step procedure with two-step procedure in percutaneous nephrolithotomy.
abstract: The aim of this study was to compare the effects of one-step percutaneous nephrolithotomy (PCNL) by the urologist alone and two-step PCNL by cooperating with the radiologist. We included 168 patients who underwent surgery by the same surgeon, 83 who underwent two-step PCNL, in which percutaneous nephrostomy insertion was performed by the radiologists on the day before endo-surgery, and 85 who underwent one-step PCNL, which involved the creation of a nephrostomy tract and performing the PCNL at the same time in the operating room, by a urologist. We compared the perioperative and postoperative parameters between these two groups. The result revealed that there were no significant differences between one-step and two-step PCNL in the decreases in haemoglobin level and blood transfusion volume, and the hospital stay was shorter in the one-step PCNL group. In addition, the one-step PCNL group was associated with significantly lower visual analogue score (VAS), which were 2.3, 1.1, and 0.4 on the post-operative days 1, 2, and 3, respectively, compared with 3.2, 1.7, and 1.0 in the two-step PCNL group. The number of parenteral analgesic prescriptions was fewer in the one-step PCNL group (0.8 ± 1.1 amps/vials) than in the two-step PCNL group (4.1 ± 2.4 amps/vials). Furthermore, different stone locations barely affected VAS and analgesic administrations. The results indicate that the one-step PCNL by the urologist alone, compared to two-step PCNL with the radiologist, has better wound pain outcome and shorter hospital stay with comparable successful rate and complication grade.
authors.affiliation: Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tzyou First Rd, Kaohsiung, 807, Taiwan.
authors.forename: Szu-Han
authors.initials: SH
authors.lastname: Chen
authors.forename: Wen-Jeng
authors.initials: WJ
authors.lastname: Wu
authors.forename: Yii-Her
authors.initials: YH
authors.lastname: Chou
authors.forename: Hsin-Chih
authors.initials: HC
authors.lastname: Yeh
authors.forename: Chia-Chun
authors.initials: CC
authors.lastname: Tsai
authors.forename: Kuang-Shun
authors.initials: KS
authors.lastname: Chueh
authors.forename: Nien-Ting
authors.initials: NT
authors.lastname: Hou
authors.forename: Siou-Jin
authors.initials: SJ
authors.lastname: Chiu
authors.forename: Hung-Pin
authors.initials: HP
authors.lastname: Tu
authors.forename: Ching-Chia
authors.initials: CC
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D064232:Visual Analog Scale