Nephrostomy tube placement prior to percutaneous nephrolithotomy does not impact outcomes

This study aims to compare outcomes of percutaneous nephrolithotomy (PCNL) performed with a nephrostomy tube placed prior to surgery versus access at the time of surgery.

Between March 2005 and August 2014, 233 PCNLs were performed. One hundred and nine of those cases underwent placement of nephrostomy tubes at least 1 day prior to surgery (Group A), and the remaining 124 cases were performed in which access was obtained at the time of PCNL (Group B). Patient demographics, comorbidities, stone size, sepsis rates, and additional complication rates including bleeding and inability to access stone were compared.

There were no significant differences in patient demographics, stone size, or comorbidities when comparing the two groups. Success rates were not significantly different, 92.7% in Group A compared to 94.4% in Group B. Similarly, there was no significant difference in complication rates or ICU admissions. The rate of sepsis in Group A was 1.83% compared to 2.42% in Group B, which showed no statistical significance. Notably, there were more patients with neurogenic bladders in the pre-placement group (p = 0.05).

Pre-placement of a nephrostomy tube prior to PCNL did not result in a decreased incidence of complications or sepsis and did not demonstrate increased success rates. Patients with neurogenic bladders may be more vulnerable to suffering from sepsis and therefore role of timing of nephrostomy tube placement must be further studied.