Tubeless percutaneous nephrolithotomy: is it really less morbid?

Objective: 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.

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.