title: Tubeless percutaneous nephrolithotomy: outcomes with expanded indications.
abstract: BACKGROUND
  Tubeless PCNL has been utilized to shorten hospital stay and improve patient postoperative pain control. Prior studies have excluded those patients with significant bleeding or other complications. Our objective was to evaluate the utility of tubeless PCNL in all patients irrespective of intraoperative outcome.
  
  
  METHODS
  A retrospective review of the charts of patients who underwent PCNL at our institute was performed. Patients were assigned to one endourologist Who routinely performed tubeless PCNL and to a second endourologist who routinely left a small-bore pigtail nephrostomy. Preoperative demographics operative and postoperative outcomes were compared.
  
  
  RESULTS
  Out of 159 patients included, 83 patients had tubeless PCNL while 76 patients had standard PCNL. There was no difference between groups regarding age, gender, ASA score, number, maximum diameter of stones, number of calyces involved, Stone density (HU), laterality and use of preoperative narcotics. While staghorn stones were more common in patients who underwent standard PCNL (p = 0.008). Tubeless patients had less number of access tracts (p ≤ 0.001), shorter hospital stay (1.7 vs. 3.0 days, p = 0.001) when compared to standard PCNL group. Multivariable analysis controlling for confounding factors including staghorn calculi and number of accesses confirmed that tubeless PCNL was associated with shorter hospital stay and less postoperative pain. There was no significant difference in complication rates between the two groups.
  
  
  CONCLUSIONS
  Our report confirms the previous reports of shorter hospital stay, less pain and analgesia as compared to standard PCNL, and establishes its safety irrespective of bleeding, perforation, extravasation or other intraoperative issues that have previously been utilized as exclusionary criteria for this approach.
authors.affiliation: Glickman Urological & Kidney Institute, The Cleveland Clinic, Cleveland, USA.
authors.forename: Wahib
authors.initials: W
authors.lastname: Isac
authors.affiliation: Glickman Urological & Kidney Institute, The Cleveland Clinic, Cleveland, USA.
authors.forename: Emad
authors.initials: E
authors.lastname: Rizkala
authors.affiliation: Glickman Urological & Kidney Institute, The Cleveland Clinic, Cleveland, USA.
authors.forename: Xiaobo
authors.initials: X
authors.lastname: Liu
authors.affiliation: Glickman Urological & Kidney Institute, The Cleveland Clinic, Cleveland, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Noble
authors.affiliation: Glickman Urological & Kidney Institute, The Cleveland Clinic, Cleveland, USA.
authors.forename: Manoj
authors.initials: M
authors.lastname: Monga
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007669:Kidney Calculi / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome