Tubeless percutaneous nephrolithotomy: first 200 cases in Israel.
BACKGROUND
Tubeless percutaneous nephrolithotomy is defined as PCNL without postoperative nephrostomy tubes. It is reported to reduce postoperative pain, hospital stay and recovery time. To date the procedure has been reserved for selected patients.


OBJECTIVE
To assess our initial experience in extending the implementation of tubeless PCNL without preoperative patient selection.


METHODS
All consecutive PCNLs performed during 2004-2008 were evaluated. Tubeless PCNL was performed when residual stones, bleeding and extravasation were excluded intraoperatively. Staghorn stones, stone burden, supracostal and multiple accesses, anatomic anomalies, solitary kidneys and operative time were not considered contraindications. We analyzed the clinical data and the choice of tubeless PCNL over time.


RESULTS
Of 281 PCNLs performed during the study period 200 (71%) were tubeless. The patients' average age was 53 years (range 28-82 years), the stone burden was 924 mm2 (400-3150 mm2), operative time was 99 minutes (45-210 min), complication rate was 14% and immediate stone-free rate 91%. There were 81 conversions to standard PCNL (29%) due to expected second-look (n = 47, 58%), impression of bleeding (n = 21,26%), suspected hydrothorax (n = 7, 9%) and extravasation (n = 6, 7%). The transfusion rate was 1%. The median hospital stay was 1 day (1-15 days) and recovery time 7 days (5-20 days). The rate of implementing the tubeless procedure increased steadily along time from 46% to 83% (P = 0.0001).


CONCLUSIONS
Tubeless PCNL can be safely and effectively performed based on intraoperative decisions, without preoperative contraindications. They are easily accommodated by experienced endourologists and provide real advantages.
Sofer
Mario
M
Endourology Service, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. marios@tasmc.health.gov.il
Lidawi
Ghalib
G
Keren-Paz
Gal
G
Yehiely
Ravit
R
Beri
Avi
A
Matzkin
Haim
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015331:Cohort Studies; D004240:Diverticulum / Q000150:complications; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006876:Hydrothorax / Q000209:etiology; D007557:Israel; D007668:Kidney / Q000002:abnormalities; D007669:Kidney Calculi / Q000601:surgery; D007670:Kidney Calices / Q000473:pathology; D007674:Kidney Diseases / Q000150:complications; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods / Q000706:statistics & numerical data*; D010149:Postoperative Pain / Q000517:prevention & control; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000209:etiology; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D014552:Urinary Tract Infections / Q000209:etiology