Safety and efficacy of bilateral simultaneous tubeless percutaneous nephrolithotomy

To evaluate the feasibility and safety of bilateral simultaneous tubeless percutaneous nephrolithotomy (PCNL).

From August 2004 to January 2005, 10 patients underwent bilateral simultaneous tubeless PCNL. Patients needing more than two percutaneous tracts, having significant intraoperative bleeding, or a residual stone burden were excluded from the study group. The outcome of these 10 patients was compared with a control group of 10 patients who had previously undergone bilateral simultaneous PCNL with routine placement of a nephrostomy tube.

The two groups had comparable demographic data, except for a greater stone burden in the right renal units in patients undergoing standard PCNL. The study and control groups needed a total of 22 and 23 tracts, respectively. The difference in the mean drop in hemoglobin, transfusion requirement, and complication rate between the two groups was not statistically significant. Patients undergoing tubeless PCNL required less analgesia (P = 0.001) and were discharged 20 hours earlier (40 versus 60 hours) than those in the control group. However, the difference in mean hospital stay was not statistically significant owing to the small sample size. Complete stone clearance was achieved in 80% of the renal units in the study group and 75% of the renal units in the control group. Three renal units in the tubeless group and four in the standard PCNL group had less than 5-mm residual fragments.

Bilateral simultaneous tubeless PCNL appears to be a feasible, safe, and effective procedure offering potential advantages of decreased analgesic requirement and hospital stay without increasing the complications. Additional clinical studies with a larger number of patients are required to confirm these potential benefits.