title: Tubeless percutaneous neprolithotomy: the new gold standard.
abstract: OBJECTIVE
  We present our experience with tubeless percutaneous nephrolithotomy (PCNL).
  
  
  METHODS
  Between July 2004 and December 2006, 121 patients (82 males and 39 females) with 18-70 mm (mean 31.19 mm) renal stones underwent tubeless PCNL leaving only a 6 Fr externalized ureteric catheter. Their ages ranged between 4 and 80 years (mean 37.27). Two patients had bilateral disease, so a total of 123 renal units are included. The procedure was performed under general anesthesia in the prone (110 units) or supine position (13 units). A total of 133 punctures were performed. The punctures were single (114 units), double (8 units), or triple (1 unit). The approach was subcostal through the lower calyx (n=110) or middle calyx (n=10), or supracostal through the middle calyx (n=8) or upper calyx (n=5).
  
  
  RESULTS
  Mean operative time was 46.30 min (range 15-100). Mean reduction in hemoglobin level was 1.57 g (range 0.3-4) with blood transfusion rate 4.13%. Complication rate was 9.9% in the form of perirenal collection (five patients), urinary leakage (two patients), fever (four patients), and hydrothorax (one patient). The ureteric catheter was left for 7-72 h (mean 45.67). Postoperative analgesia was required in 22 patients (18.2%) with mean 22.9 mg diclofenac sodium per patient. Mean hospital stay was 50.69 h (range 12-96) with 106 units (86.18%) rendered stone free, 13 (10.57%) with insignificant residuals, and four units (3.25%) were left with significant residual stones.
  
  
  CONCLUSIONS
  Tubeless PCNL is a good option in non-complicated PCNL with the advantages of reduced hospital stay, low postoperative pain, and little need for postoperative analgesia.
authors: Urology Department, Urology and Nephrology Center, Al-Thawra Modern General Teaching Hospital, Medical College-Sana'a University, P.O. Box 18682 Sana'a, Yemen. drtowfik@hotmail.com
authors: Tawfik H
authors: TH
authors: Al-Ba'adani
authors: Khaled M
authors: KM
authors: Al-Kohlany
authors: Abdulelah
authors: A
authors: Al-Adimi
authors: Mansour
authors: M
authors: Al-Towaity
authors: Taher
authors: T
authors: Al-Baadani
authors: Mohammed
authors: M
authors: Alwan
authors: Mohammed
authors: M
authors: Al-Hussieni
authors: Shehab
authors: S
authors: Al-Germozi
authors: Mokhtar
authors: M
authors: Al-Masani
authors: Khalid
authors: K
authors: Al-Badwy
authors: Ibrahiem H
authors: IH
authors: El-Nono
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D011183:Postoperative Complications; D011677:Punctures; D016896:Treatment Outcome