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Alpha-blockers, Urinary leakage, nephrocutaneous fistula, and percutaneous nephrolithotomy
Background: Post-removal urinary leakage subsequent to the percutaneous nephrolithotomy (PNL) procedure frequently presents as a notable complication. This can happen because of things like broken pieces of ureteral stones, edoema in the ureter, especially at the ureterovesical or ureteropelvic junction, blood clots, or even a ruptured calyx. This complication can significantly influence the patient's duration of hospitalization, leading to an extended stay, a postponed return to occupational activities, and consequent negative psychological repercussions.
The main goal of this study was to see if alpha-blockers, especially tamsulosin, could help shorten the time that urine leaks after PNL. This study sought to ascertain whether the utilization of alpha-blockers could serve as a practical intervention to alleviate the associated complications, thereby potentially reducing hospital stays and hastening the patient's recovery and reintegration into daily life.
Study design: randomized clinical trial
Place and Duration: This study was conducted in Bilawal Medical College LUMHS Jamshoro from september 2022 to March 2023.
Methodology: In this study, we enrolled a total of 110 individuals undergoing PNL. Physical exams, lab tests, and full radiological evaluations, such as kidney-ureter-bladder (KUB) imaging and plain computed tomography (CT), were all part of thorough assessments. The participants were randomly allocated into two evenly matched groups: Group A, consisting of 55 cases, received perioperative tamsulosin, whereas Group B, also comprising 55 cases, did not get tamsulosin treatment. Subsequent to the PNL procedure, a meticulous postoperative follow-up was conducted for both groups. The parameters under scrutiny included the DUL, instances of urinary catheterization, and the duration of the hospital stay.
Results: The DUL exhibited a statistically significant reduction in Group A (10.72±6.77 hours) in comparison to Group B (21.59±12.52 hours) (p-value < 0.001). Correspondingly, the length of hospitalization was markedly shorter in Group A (2.63±0.83 days) in contrast to Group B (3.21±1.12 days) (p-value 0.020). These findings underscore the impactful role of tamsulosin administration in Group A, which resulted in a marked decrease in the DUL post-PNL compared to the control Group B.
Conclusion: Among patients undergoing PNL for the management of renal stones, those who received tamsulosin experienced a notably reduced DUL, consequently leading to a shorter hospital stay in comparison to individuals who did not receive tamsulosin treatment. This observation points to a possible clinical benefit of giving tamsulosin to PNL patients with kidney stones: faster recovery after surgery and less time in the hospital.
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