The current study is a prospective randomized double blinded clinical trial (experimental study) that was conducted at our tertiary care center in the period between December 2019 and May 2020 to assess the role and effectiveness of alpha blockers (Tamsulosin) on the duration of urinary leakage post-percutaneous nephrolithotomy (PNL). The study included 62 patients with different configurations of renal stones.
Patients with the following criteria were included: age 16–65 years, patients admitted for a PNL procedure with renal stones of different configurations (pelvic, calyceal and PUJ stones) were included in the study (Fig. 1), while Exclusion criteria were: Patients who were expected to require an indwelling DJ stent post PNL (e.g.: solitary kidney), previous open renal stone surgery (due to possible adhesions that might impair healing), patient with renal impairment in addition to patients with marked hydronephrosis and decreased parenchymal thickness, and patients who had placement of an indwelling DJ stent due to an intraoperative complication, e.g.: perforation.
Patients were randomized into two equal groups (31 patients each). Randomization was done by closed envelopes method. Neither the surgeon nor the data collector knew the patient's group. Group A received tamsulosin 3 days before PNL and continued for 2 weeks post PNL, while Group B received the conventional treatment without receiving any tamsulosin.
Preoperatively, patients were evaluated by detailed history and physical examination. Radiological work up (plain urinary tract Xray “KUB”, and plain computed tomography of the urinary tract CTUT). Laboratory tests included complete blood count, coagulation profile, renal function tests, liver function tests, urine analysis and culture.
A standard technique of prone PNL was done in both groups.
Ureteric catheter 6F was initially placed in the lithotomy position; access obtained under fluoroscopy guidance.
Coaxial Alkan dilators with 32F Amplatz sheath with pneumatic lithotripter for stone fragmentation.
Intraoperative parameters were monitored including estimated blood loss, any encountered complications, operative time and number of percutaneous accesses,
The patients were followed up postoperatively for the presence and duration of urinary leakage post PNL. (The dressing was exposed every hour after removal of nephrostomy tube and endorsed).
Postoperatively on day 1, KUB was done for assessment of the presence of any residual stone fragments. This was replaced by CTUT in case of radiolucent stones. In addition, postoperative Hemoglobin and creatinine were checked.
Postoperatively the following were recorded: degree of pain, analgesic needs, fever, need for blood transfusion, time to open the PCN (if initially closed for tamponade effect) and time of PCN removal (removed once the output is clear) duration of ureteric catheterization, (removed on the morning after the nephrostomy site is dry) and hospital stay.
Follow-up of the patients was continued for 2–3 weeks for assessment of any delayed postoperative complications. Of main concern was urinary leakage post hospital discharge which could be caused by residual fragments that might obstruct the ureter, as well as late onset hematuria.