Tubeless percutaneous nephrolithotomy--should a stent be an integral part?

We compared the outcome of tubeless percutaneous nephrolithotomy with or without Double-J(R) stent.

From January 2004 to March 2006 patients with renal stones matched for age and stone size who underwent tubeless percutaneous nephrolithotomy were prospectively evaluated in 2 groups treated by 2 surgeons. Group 1 had a Double-J stent and group 2 did not. Inclusion criteria for tubeless percutaneous nephrolithotomy included contralateral normal kidney, intact pelvicaliceal system, complete stone clearance under fluoroscopy and single infracostal puncture. These groups were compared for analgesic requirement, hospital stay, and intraoperative and postoperative complications.

During a period of 27 months 52 patients (57 renal units) underwent tubeless percutaneous nephrolithotomy. Group 1 had 25 (28 renal units) and group 2 had 27 patients (29 renal units). Mean stone volume was 4.34 +/- 2.12 cm(3) in group 1 and 4.14 +/- 1.14 cm(3) in group 2. Mean pain score was 2.96 +/- 1.24 and 2.82 +/- 0.81 in groups 1 and 2, respectively. Analgesic (intramuscular or oral diclofenac sodium) requirement and mean hospital stay was comparable in groups 1 and 2, eg 170 +/- 110 vs 163.24 +/- 98.07 mg and 2.52 +/- 0.12 vs 2.35 +/- 0.12 days. Two patients in group 1 and 1 in group 2 had urinary leak from the percutaneous nephrolithotomy tract. Similarly 3 patients in group 1 had severe stent related problems and 1 required early removal of the Double-J stent.

Avoiding use of the Double-J stent may not compromise the safety of tubeless percutaneous nephrolithotomy.