Intraoperative patient selection for tubeless percutaneous nephrolithotomy

This study was conducted to report our experience of intraoperative patient selection for tubeless percutaneous nephrolithotomy (PCNL) based on a tentative decision-making algorithm. Thirty-four consecutive patients who were scheduled to undergo tubeless PCNL were included and medical records were obtained from a prospectively maintained database for these patients. After completion of PCNL, the nephrostomy site was observed with a safety guidewire in place. If there was no significant bleeding through the tract, tubeless PCNL was performed, and in cases with significant bleeding or other complications, nephrostomy catheter insertion was performed as usual. In 29 cases (85.3%), tubeless PCNL was performed according to our decision-making protocol. Mean stone size was 7.33 ± 9.35 cm(2). Mean hospital stay was 2.61 ± 1.01 days. The difference between preoperative and postoperative hemoglobin was 0.68 ± 1.22 g/dL (p > 0.05). Visual analog pain scale scores immediately post-operation, on postoperative day one and on the day of discharge were 4.62 ± 1.80, 3.25 ± 1.68 (postoperative day one vs. operative day; p = 0.001), and 1.87 ± 0.83 (the day of discharge vs. operative day; p = 0.001), respectively. The success rate with insignificant remnant stones was 85.2% and complete stone-free rate was 76.5%. In conclusion, tubeless PCNL was performed successfully with low complication rate and reduced pain score through our decision-making algorithm.