title: Does bleeding during percutaneous nephrolithotomy necessitate keeping the nephrostomy tube? A randomized controlled clinical trial.
abstract: OBJECTIVE
  To compare outcomes in two groups of patients with kept and discarded nephrostomy tube after percutaneous nephrolithotomy (PCNL) complicated with bleeding.
  
  
  METHODS
  Two hundred patients who had undergone PCNL complicated with hemorrhage were recruited in this study. Patients were randomly allocated to two groups: group A, who underwent tubeless PCNL and tract port was packed for 3 to 4 minutes after removing Amplatz sheath, and group B, for whom a 24-F nephrostomy tube was left in place at the end of the procedure. Patients were followed up for 3 months to check if bleeding occurred.
  
  
  RESULTS
  The mean operation time was 68 ± 4.3 minutes in group A and 74 ± 5.6 minutes in group B (P = .098). The mean stone size was similar in groups A and B (36.26 ± 5.3 mm versus 35.35 ± 5.85 mm; P = .613). The mean hemoglobin drop was 3.65 ± 1.20 g/dL in group A and 3.13 ± 1.06 g/dL in group B. There was no significant difference between the mean of stone free rate in groups A and B (92.58% ± 5.97 versus 89.60% ± 8.3; P = .210). Patients in group A experienced a significantly less duration of hospitalization than group B (2.42 ± 0.84 days versus 3.70 ± 0.80 days; P < .001).
  
  
  CONCLUSIONS
  In the absence of clear indication, nephrostomy tube insertion after PCNL does not seem to be beneficial, and its removal does not pose patients at any additional risk.
authors.affiliation: Department of Urology, Hasheminejad Kidney Center, Tehran University of Medical Sciences, Tehran, Iran. etemadian@hotmail.com
authors.forename: Masoud
authors.initials: M
authors.lastname: Etemadian
authors.forename: Mohammad Javad
authors.initials: MJ
authors.lastname: Soleimani
authors.forename: Ramin
authors.initials: R
authors.lastname: Haghighi
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Zeighami
authors.forename: Neda
authors.initials: N
authors.lastname: Najimi
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation*; D016037:Single-Blind Method; D055815:Young Adult