Tubeless percutaneous neprolithotomy: the new gold standard.
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.
Al-Ba'adani
Tawfik H
TH
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
Al-Kohlany
Khaled M
KM
Al-Adimi
Abdulelah
A
Al-Towaity
Mansour
M
Al-Baadani
Taher
T
Alwan
Mohammed
M
Al-Hussieni
Mohammed
M
Al-Germozi
Shehab
S
Al-Masani
Mokhtar
M
Al-Badwy
Khalid
K
El-Nono
Ibrahiem H
IH
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