title: Tubeless percutaneous nephrolithotomy: safe even in supracostal access.
abstract: OBJECTIVE
  This study was designed to determine the outcome and safety of tubeless percutaneous nephrolithotomy (PCNL) in the treatment of renal calculi.
  
  
  METHODS
  Between November 2005 and March 2006, 48 patients were randomized to either an 18F Re-entry nephrostomy tube (group 1) or a 6F Double-J stent (group 2). The two groups were well matched for age, sex, stone size, stone laterality, and number of previous renal procedures. All PCNL procedures were performed by the same surgeon. Postoperative visual analog pain scale (VAS) scores at 8 and 24 hours and 14 days after surgery, in-hospital analgesic use, length of hospital stay, success rate, blood transfusion rate, and postoperative complications were compared for the two groups.
  
  
  RESULTS
  The mean hospital stays in groups 1 and 2 were 3.1 and 1.6 days, respectively (P = 0.003). The mean VAS scores 8 and 24 hours after surgery were significantly lower in group 2 than in group 1 (P = 0.001). The postoperative analgesic requirement (diclofenac sodium) was significantly higher in group 1 (263 mg) than in group 2 (120 mg; P = 0.02). The rate of blood transfusion in the two groups was similar (P = NS). There was no difference between the groups in VAS scores on postoperative day 14. The number of supracostal accesses was significantly higher in group 2 than in group 1 (P = 0.02). The stone-free rates and the numbers of patients with insignificant residual fragments were similar in the two groups. There was no urine leakage or formation of urinoma in patients with Double-J stents.
  
  
  CONCLUSIONS
  Tubeless PCNL is safe and effective even after supracostal access and is associated with less postoperative pain and a shorter hospital stay.
authors.affiliation: Department of Urology, Erciyes University School of Medicine, Kayseri, Turkey. drmus42@hotmail.com
authors.forename: Mustafa
authors.initials: M
authors.lastname: Sofikerim
authors.forename: Deniz
authors.initials: D
authors.lastname: Demirci
authors.forename: Emre
authors.initials: E
authors.lastname: Huri
authors.forename: Erol
authors.initials: E
authors.lastname: Erşekerci
authors.forename: Mustafa
authors.initials: M
authors.lastname: Karacagil
mesh_terms: D000328:Adult; D000368:Aged; D000698:Analgesia; D004008:Diclofenac / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000379:methods; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation* / Q000379:methods*; D012449:Safety; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D004008:Diclofenac