Is Outpatient Totally Tubeless Standard Percutaneous Nephrolithotomy Safe and Efficacious?

Area of Science:

• Urology
• Minimally Invasive Surgery

Background:

• Percutaneous nephrolithotomy (PCNL) is standard for large kidney stones.
• Tubeless (t-PCNL) and totally tubeless (tt-PCNL) approaches have been described.
• Same-day discharge after tt-PCNL has not been studied.

Purpose of the Study:

• To evaluate the safety and efficacy of same-day discharge after totally tubeless PCNL (tt-PCNL).
• To compare outpatient tt-PCNL with no tubes/catheters/stents to outpatient t-PCNL with an indwelling stent.

Main Methods:

• Prospective data collection from 130 patients undergoing outpatient PCNL.
• Comparison of demographics, stone characteristics, operative data, post-op pain, stone-free rate (SFR), complications, and 30-day adverse events.
• Statistical analysis using Chi-square, Fisher's exact, and Mann-Whitney U tests.

Main Results:

• 53 patients underwent tt-PCNL and 50 had t-PCNL; groups were comparable in demographics and stone burden.
• No significant differences in post-op transfusion rates, SFR, 30-day complications, ED visits, or readmissions.
• tt-PCNL had shorter operative times and fewer Clavien-Dindo I complications than t-PCNL with stent.

Conclusions:

• Same-day discharge after outpatient tt-PCNL is safe and effective.
• Stent omission in tt-PCNL does not increase adverse events.
• Further multicenter trials are needed to confirm these findings.