Totally tubeless percutaneous nephrolithotomy: a prospective randomized controlled study.

Area of Science:

• Urology
• Nephrology

Background:

• Percutaneous nephrolithotomy (PCNL) is a standard procedure for kidney stone removal.
• Conventional PCNL often involves a nephrostomy tube or ureteral stent, potentially increasing morbidity.

Purpose of the Study:

• To evaluate the safety, effectiveness, and morbidity of totally tubeless PCNL compared to conventional PCNL.
• To assess differences in pain, analgesic requirements, complications, and recovery time.

Main Methods:

• A randomized controlled trial involving 131 patients with large renal pelvic or impacted ureteropelvic junction stones.
• Patients were randomized to undergo either conventional or totally tubeless PCNL.
• Kidney function was assessed pre- and post-operatively using Tc 99m DTPA clearance, ultrasonography, and IV urography.

Main Results:

• No significant differences were observed in serum creatinine, hemoglobin decrease, morphology, activity resumption, or complication grading between groups.
• The totally tubeless PCNL group showed statistically significant reductions in length of hospital stay, pain visual analog scale scores, and analgesic requirements.
• Relative perfusion rates demonstrated significant differences between pre- and post-operative states in both groups.

Conclusions:

• Totally tubeless PCNL is a safe and well-tolerated alternative for selected patients undergoing kidney stone removal.
• This approach leads to decreased hospital stays, reduced postoperative pain, and lower analgesic demands.
• Nephrostomy tubes or ureteral stents may not be necessary for all patients undergoing uncomplicated PCNL.