Discussion
Urolithiasis, infection, staghorn calculi
UROLITHIASIS, INFECTION, URETER, URETERAL STONE, COMPLICATIONS
Urolithiasis is a common urological condition. With the development of technology, PCNL has become the preferred treatment for kidney and upper ureteral stones larger than 2 cm, particularly staghorn calculi [Regardless of traditional PCNL (placing both nephrostomy and ureteral stent) or tubeless PCNL (ureteral stent only), the ureteral stent needs to be removed by rigid or flexible cystoscope in the outpatient setting after surgery. To reduce the morbidity caused by cystoscopic extubation, Agrawal et al. and Shpall et al. tied a string to the proximal end of the double-J stent, and the string was fixed to the skin surface through the nephrostomy tract [Preserving the extraction string equipped on the ureteral stent could solve those problems. Some urologists are concerned that ureteral stent with extraction string may affect patients' quality of life, increase the incidence of infection, lead to premature migration or dislodgement of the stent. Nevertheless, ureteric stent placement with extraction string has been well-studied in URSL. In a prospective randomized controlled study, Barnes et al. demonstrated that ureteral stent with extraction string offered many advantages and did not increase stent-related urologic symptoms, complications, or postoperative morbidity [Similar studies have rarely been performed in PCNL. To assess the safety and efficacy of placing the ureteral stent with extraction string after PCNL in the prone position, we designed this study using the TJIU technique and obtained similar outcomes. The USSQ scores for each domain on POD 7 between the two groups of patients showed no significant difference in the results of our study. Before the ureteral stent removal, the scores were higher in the non-string group than the string group in most domains, although the difference between them was not statistically significant. Except that the score of the “sex” domain was significantly higher in the string group (4.34 vs 3.23; There are some limitations in our study. Firstly, the sample size was relatively small and it was a single-center prospective study. Secondly, we did not statistically analyze the cost differences between the two groups of patients in detail. Finally, the TJIU technique was only applied to PCNL in the prone position in the present trial. Because we could insert the ureteral stent with extraction string retrogradely into the ureter in several selected patients who underwent PCNL combined with retrograde flexible ureteroscopy in the supine lithotomy position.