Comparison of standard with tubeless percutaneous nephrolithotomy

To assess the efficacy, safety, and morbidity of tubeless percutaneous nephrolithotomy (PCNL) and compare it with standard PCNL.

A total of 135 patients (140 renal units) undergoing tubeless PCNL (group 1) from June 2000 to September 2007 were compared with a similar group of 185 (194 renal units) patients undergoing standard PCNL (group 2) in the same period. Patients who needed more than two percutaneous tracts; who had significant intraoperative bleeding, intraoperative perforation of the pelvicaliceal system, excessive manipulation at the ureteropelvic junction, or a residual stone after the procedure; and who had a solitary kidney or azotemia were excluded from the study. The chi-square test was performed for statistical analysis of qualitative variables and the student's t test for quantitative variables. A P value < 0.05 was considered significant.

The mean age in group 1 was 34.4 years (range 9-66 yrs) and in group 2 was 32.6 years (range 6-74 yrs). Male/female ratio was 1.7 and 1.6 respectively. The average stone size in group 1 was 3.2 cm (range 2-5.5 cm) v 3.6 cm (range 2.2-6.0 cm). Sixteen patients in group 1 and 24 patients in group 2 were in the pediatric age group. Simultaneous bilateral PCNL was performed in 6 patients in group 1 and 10 patients in group 2. Both the groups were comparable in age, sex ratio, side ratio, stone size, location, preoperative incidence of urinary tract infection, method of tract dilatation, and mean operative time. The incidence of single tract (95 v 98 in group 1 and group 2) for complete stone clearance was significantly more in the tubeless group. Mean hospital stay (1.8 v 2.9 days) and the analgesic requirement (68 mg v 210.5 mg of pethidine) was also significantly less in the tubeless group. Blood loss and mean operative time were also less in the tubeless group but were not statistically significant.

Tubeless PCNL is safe and effective. It has significantly less morbidity, a shorter hospital stay, and less postoperative analgesic requirement in comparison with standard PCNL.