Randomized trial comparing modified tubeless percutaneous nephrolithotomy with tailed stent with percutaneous nephrostomy with small-bore tube.
OBJECTIVE
Recent trials using smaller percutaneous catheters as well as "tubeless" percutaneous technique have attempted to reduce postoperative analgesia requirements and the morbidity of a traditional large-bore nephrostomy tube after percutaneous nephrolithotomy (PCNL). We performed a randomized trial comparing tubeless procedures and use of small catheters to elucidate any differences in perioperative parameters, postoperative discomfort, complications, convalescence, and CT scan findings.


METHODS
Twenty-four consecutive patients underwent randomization into tubeless (using a tailed 6F double-J stent) and small tube (using an 8.2 pigtail nephrostomy tube) (N = 12 each). A CT scan of the abdomen and pelvis without contrast was obtained the morning of the first postoperative day. Morphine equivalents and a visual analog pain score, as well as questionnaires for convalescence at the postoperative check, postoperative day 1, time of tube removal (3-5 days), and 1-week follow-up were recorded.


RESULTS
The mean pain scores and morphine requirements for the tubeless and small-tube groups at postoperative day 0, postoperative day 1, time of stent removal, and 10 days were not significantly different. Convalescence significantly favored stented patients. The CT findings were equivalent. Three patients had inadvertent dislodgment of their stents.


CONCLUSIONS
Tubeless and small-bore procedures cause similar postoperative discomfort, with indwelling stents appearing to quicken return to normal activities. Tailed stents may not be appropriate for all patients.
Choi
Michael
M
Department of Urology, Kaiser Permanente Medical Center, Los Angeles, California, USA.
Brusky
John
J
Weaver
John
J
Amantia
Monica
M
Bellman
Gary C
GC
D000700:Analgesics / Q000627:therapeutic use; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D011182:Postoperative Care; D011183:Postoperative Complications; D015607:Stents; D016896:Treatment Outcome
D000700:Analgesics