title: Supracostal tubeless percutaneous nephrolithotomy: a retrospective cohort study.
abstract: OBJECTIVE
  To evaluate the safety of tubeless percutaneous nephrolithotomy in patients undergoing supracostal percutaneous renal access.
  
  
  METHODS
  Between October 1999 and October 2010, 302 patients underwent percutaneous nephrolithotomy via a supracostal access tract. Two hundred forty-eight (82.1%) patients had a nephrostomy tube placed at the end of the case and 54 (17.9%) did not. The medical records of both cohorts were compared regarding patient demographics (age, sex, body mass index, preoperative creatinine level), operative characteristics (estimated blood loss, length of stay, treatment efficacy), and complication rates (overall, thoracic, hemorrhage necessitating transfusion).
  
  
  RESULTS
  Patient demographics did not differ between the tubeless and nephrostomy tube groups. Estimated blood loss was significantly less in the tubeless patients (67 mL vs 123 mL; P=0.019). The tubeless group had a shorter mean length of stay than the nephrostomy tube group (2.5 vs 3.4 days, P<0.01). Treatment success was comparable between the two groups (tubeless 81.5% vs nephrostomy tube 77.8%; P=0.553). Overall complication (P=0.765) and blood transfusion (P=0.064) rates were equivalent. Chest complications were higher in the tubeless group (22.2%) compared with the nephrostomy tube patients (10.9%) (P=0.024). Nevertheless, chest complications necessitating intervention were not different (P=0.152).
  
  
  CONCLUSIONS
  Tubeless supracostal percutaneous nephrolithotomy was associated with less intraoperative blood loss and a shorter hospital stay. Although the tubeless group experienced more chest complications overall, the need for intervention was no different among the two cohorts. Tubeless supracostal percutaneous nephrolithotomy appears safe.
authors.affiliation: Department of Urology, Smith Institute for Urology, Hofstra University, North Shore-Long Island Jewish Health System, New Hyde Park, NY 11042, USA. bduty@nshs.edu
authors.forename: Brian
authors.initials: B
authors.lastname: Duty
authors.forename: Michael
authors.initials: M
authors.lastname: Conlin
authors.forename: Matthew
authors.initials: M
authors.lastname: Wagner
authors.forename: Aaron
authors.initials: A
authors.lastname: Bayne
authors.forename: Gregory
authors.initials: G
authors.lastname: Adams
authors.forename: Eugene
authors.initials: E
authors.lastname: Fuchs
mesh_terms: D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care; D012189:Retrospective Studies