Tubeless percutaneous nephrolithotomy: is it really less morbid?

PURPOSE

To prospectively evaluate and study the role, relative safety, and effectiveness of "tubeless" percutaneous nephrolithotomy (PCNL) and whether it is really less morbid vis-à-vis PCNL with a nephrostomy tube; to compare the postoperative pain, analgesia requirement, hospital stay, return to work time, and other parameters in patients undergoing tubeless PCNL and standard PCNL.

PATIENTS AND METHODS

Sixty selected patients underwent PCNL. A single urologist (IS) was the surgeon, and a resident administered random chit numbers, and recorded pain scores and results of all the chosen parameters. Patients who fulfilled the entry criteria for a tubeless PCNL protocol were randomized to either the omission of a nephrostomy tube (tubeless PCNL with Double-J stent) or to the placement of a 22F nephrostomy tube. The recorded data were analyzed with respect to several parameters.

RESULTS

The mean age, stone burden, and preoperative hemoglobin, blood urea, and serum creatinine values were not significantly different between the two groups. However, the operative time (P < 0.001), analgesia requirement (P < 0.001), and hospital stay and time to return to normal activity (P < 0.001) were significantly lower in the tubeless PCNL group.

CONCLUSIONS

Significantly less pain, lower analgesia requirement, and shorter hospital stay with early return to normal activities were observed in the tubeless PCNL group v the primary nephrostomy tube PCNL group. Tubeless PCNL in selected patients is a secure, effective, and less morbid procedure that does not compromise patient safety and concerns. We recommend that tubeless PCNL be the preferred procedure in selected patients for management of nephrolithiasis.