Extending the application of tubeless percutaneous nephrolithotomy.
OBJECTIVE
Tubeless percutaneous nephrolithotomy (PCNL) has been successfully performed in selected patients. We assessed its applicability for use without imposing preoperative restrictions.


METHODS
The study consisted of a prospective and consecutive series of 126 patients. Tubeless PCNL was performed when perforation, residual stones, and significant bleeding had been intraoperatively excluded by fluoroscopy, nephroscopy, and hemodynamic assessment. Staghorn stones, supracostal and/or multiple access, anatomic anomalies, previously operated kidneys, solitary kidneys, and operative time were not considered contraindications. The demographic, clinical, and intraoperative and postoperative data were statistically analyzed.


RESULTS
Using this protocol, we performed 66 (52%) tubeless and 60 (48%) regular PCNLs. The average patient age (54 years versus 52 years), stone burden (924 versus 1044 mm2), operative time (116 versus 130 minutes), complication rate (9% versus 13%), hemoglobin decrease (1.2 versus 1.1 mg/dL), and immediate stone-free rate (92% versus 90%) were similar for the tubeless and regular PCNL groups, respectively (P >0.05). The reasons for performing standard PCNL were an expected second-look procedure (n = 35, 58%), an impression of active bleeding (n = 16, 27%), significant extravasation (n = 5, 8%), and suspected hydrothorax (n = 4, 7%). The overall transfusion rate was 3%. The average analgesia requirement (pethidine HCL) was 0.4 and 1.2 mg/kg (P <0.01), the median hospital stay was 1 and 4 days (P <0.0001), and the median back-to-work time was 7 and 15 days (P <0.001) for the tubeless and regular PCNL groups, respectively.


CONCLUSIONS
The results of our study have shown that tubeless PCNL can be safely and effectively performed based on intraoperative factors, without preoperative contraindications. Compared with the standard procedure, tubeless PCNL was associated with reduced postoperative pain, hospital stay, and recovery time.
Sofer
Mario
M
Department of Urology, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, Israel. mariosofer@hotmail.com
Beri
Avi
A
Friedman
Alan
A
Aviram
Galit
G
Mabjeesh
Nicola J
NJ
Chen
Juza
J
Ben-Chaim
Jacob
J
Greenstein
Alexander
A
Matzkin
Haim
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000295:instrumentation; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007902:Length of Stay / Q000706:statistics & numerical data; D017602:Lithotripsy, Laser / Q000379:methods; D008297:Male; D008875:Middle Aged; D053040:Nephrolithiasis / Q000601:surgery*; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control; D018579:Patient Selection; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D011446:Prospective Studies; D015641:Radiography, Interventional; D024162:Second-Look Surgery / Q000706:statistics & numerical data; D015607:Stents; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome