Totally tubeless percutaneous nephrolithotomy: A comparison with tubeless and standard methods

Abstract

Objectives: The study aimed to compare tubeless, totally tubeless, and standard percutaneous nephrolithotomy (PNL) in a tertiary center with selected patient population. Methods: Between September 2013 and March 2015, percutaneous nephrolithotomy was performed on 216 patients in our center. Patients without massive bleeding, calyceal perforation, and residual fragments smaller than 4mmwere enrolled in this study. The patients were divided into 3 groups. In the first group (n = 68), we placed nephrostomy and kept ureteral catheter for 24 hours (the standard group). In second the group (n = 69), no nephrostomy was inserted and ureteral catheter was removed in the operation room (the totally tubeless group) and in the third group (n = 79), no nephrostomy catheter was placed but antegrade DJ stent was inserted intraoperatively (the tubeless group). Three groups were compared with respect to age, analgesic requirement, BMI, length of stay, pain, and stone size. Results: No significant differences were found in the mean stone size, operation time, transfusion rates, and hemoglobin level change between the groups. However, hospitalization time, the amount of narcotic usage, and pain were significantly lower in the second group compared to the other groups (P < 0.05). Conclusions: In patients with no major intraoperative bleeding and calyceal perforation, the totally tubeless approach is safe with decreased pain, analgesia requirement, and hospital stay.