V6-11: THE CIRCLE NEPHROSTOMY TUBE: AN ATTRACTIVE NEPHROSTOMY DRAINAGE SYSTEM FOLLOWING COMPLEX PERCUTANEOUS NEPHROLITHOTOMY
VideoIntroductions and Objectives
Percutaneous nephrolithotomy (PNL) is the preferred approach for managing large and/or complex kidney stones. Multiple accesses is sometimes necessary to achieve complete stone clearance. Nephrostomy tube (NT) placement is crucial for drainage, as well as for maintaining an access for a secondary stone procedure. NT available are Cope loop, reentry Malecot catheters, Foley catheters, and circle NT. Despite being very useful in draining the multiple access PNL, the circle NT is an underutilized drainage system. The aim of this study is to demonstrate the use of the circle nephrostomy tube (Cook® Medical) following complex PNL and the method of its insertion.
A retrospective review of 1317 consecutive patients who had 1599 PNL by multiple surgeons at IU Health Methodist Hospital was performed. Renal units (RU) which required multiple access, as well as circle NT, were reviewed and analyzed. The method of insertion of circle NT both primarily and during secondary PNL procedures is demonstrated.
A total of 1843 accesses were created in 1317 RU: 380 upper, 129 mid, and 1334 lower. Multiple accesses in this series were done in 233 RU (17.69%). Following multiple access PNL, circle NT were inserted in 91 RU (39.06%), Cope loop NT and tubeless upper pole puncture in 105 RU (45.06%), and Cope loop NT and non-dilated puncture for stone localization in 37 RU (15.8%). The overall transfusion rate was 3.49%. None of the patients who had Circle NT experienced clogging, dislodgement, or obstruction of the tube. The cost of circle NT and Cope loop is 121.73 USD and 95.20 USD, respectively.
Circle NT are easy to insert, secure, and cost effective compared to inserting two Cope loop tubes. Circle NT provide excellent drainage and facilitate secondary procedures.