title: Postoperative morbidity of tubeless versus conventional percutaneous nephrolithotomy: a prospective comparative study.
abstract: Percutaneous Nephrolithotomy (PNL) is an established technique for the treatment of renal calculi. Some reports have challenged the need for a nephrostomy tube at the end of the procedure, arguing that it accounts for a longer hospital stay and increased postoperative pain. During the last years, several series have addressed the feasibility and safety of tubeless PNL, where a double-J ureteral stent is left in place after the end of intervention instead of a nephrostomy tube. The aim of our study was to compare conventional versus tubeless PNL in terms of postoperative morbidity. Eighty-five patients who underwent PNL at a single center met the inclusion criteria (complete intraoperative stone clearance, no evidence of active intraoperative bleeding, single percutaneous access, and operative time shorter than 2 h) and were randomized at the end of the procedure to have placed either a nephrostomy tube (group 1) or a double-J ureteral stent (group 2). Outcomes assessed were postoperative pain, bleeding complications, leakage complications, and length of hospital stay. The patients in the tubeless group had a shorter hospital stay (3.7 vs. 5.8 days; P < 0.001), and less postoperative pain at postoperative days 2 and 3 (P < 0.001). No significant difference in bleeding or leakage complications was observed. This study supports the feasibility and safety of tubeless PNL in a selected group of the patients, suggesting some intraoperative criteria to be considered when performing it. However, further controlled studies will have to determine its impact on stone-free rates prior to be considered the standard technique in these selected cases.
authors.affiliation: Department of Urology, Hospital Clínico Universidad de Chile, Santiago, Chile.
authors.forename: Fernando
authors.initials: F
authors.lastname: Marchant
authors.forename: Pedro
authors.initials: P
authors.lastname: Recabal
authors.forename: Mario I
authors.initials: MI
authors.lastname: Fernández
authors.forename: Francisco
authors.initials: F
authors.lastname: Osorio
authors.forename: Javiera
authors.initials: J
authors.lastname: Benavides
mesh_terms: D000328:Adult; D005240:Feasibility Studies; D006801:Humans; D015994:Incidence; D007669:Kidney Calculi / Q000628:therapy*; D007902:Length of Stay; D008875:Middle Aged; D009017:Morbidity; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation* / Q000379:methods*; D010149:Postoperative Pain / Q000453:epidemiology; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology*; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies