title: Totally tubeless versus standard percutaneous nephrolithotomy for renal stones: analysis of clinical outcomes and cost.
abstract: OBJECTIVE
  To evaluate the safety and cost-effectiveness of a totally tubeless percutaneous nephrolithotomy (PCNL) by comparing the clinical outcomes and cost analysis between standard PCNL and totally tubeless PCNL for renal stones.
  
  
  METHODS
  From June 2012 to September 2013, a total of 121 patients with renal stones who underwent totally tubeless or standard PCNL by two experienced surgeons were retrospectively evaluated by group. According to the surgeon's preference for the nephrostomy tube and/or ureteral stent, the present study was designed to be divided into Group 1 and Group 2. Group 1 was performed by one surgeon (H.J. Cho) who preferred a totally tubeless PCNL and Group 2 was performed by the other surgeon (S.H. Hong) who preferred a standard PCNL. We excluded bilateral renal stones, multiple approach, whole staghorn calculi, and previous renal surgery. Patient and stone characteristics, intraoperative and postoperative parameters, and cost analysis were compared between the two groups.
  
  
  RESULTS
  There were no significant differences in the patient demographics between groups. Mean stone burden was 501.5±361.1 mm(2) in Group 1 v 535.2±353.1 mm(2) in Group 2 (P=0.651). Length of hospital stay (1.72±0.58 v 4.10±1.88 days, P<0.001), postoperative pain scores using a visual analog scale (day 0: P<0.001, day 1: P=0.002), and analgesia requirements (33.2±21.3 v 45.2±19.5 mg, P=0.005) for Group 1 v Group 2 showed significant differences. The stone-free rate was 86.4% v 89.8% in Group 1 and Group 2, respectively (P=0.609). There were no significant differences in overall complications between groups (P=0.213). Mean total medical treatment costs in Groups 1 and 2 were 2398.22±549.1 USD and 2845.70±824.2 USD, respectively (P=0.002).
  
  
  CONCLUSIONS
  Many clinical outcomes in the totally tubeless PCNL showed comparable or better results than standard PCNL. We believe that totally tubeless PCNL is an acceptable, safe, and cost-effective alternative to standard PCNL for the treatment of renal stones.
authors.affiliation: Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul, Republic of Korea.
authors.forename: Sae Woong
authors.initials: SW
authors.lastname: Choi
authors.forename: Kang Sup
authors.initials: KS
authors.lastname: Kim
authors.forename: Jeong Ho
authors.initials: JH
authors.lastname: Kim
authors.forename: Yong Hyun
authors.initials: YH
authors.lastname: Park
authors.forename: Woong Jin
authors.initials: WJ
authors.lastname: Bae
authors.forename: Sung-Hoo
authors.initials: SH
authors.lastname: Hong
authors.forename: Ji Youl
authors.initials: JY
authors.lastname: Lee
authors.forename: Sae Woong
authors.initials: SW
authors.lastname: Kim
authors.forename: Tae-Kon
authors.initials: TK
authors.lastname: Hwang
authors.forename: Hyuk Jin
authors.initials: HJ
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*
chemical_list: D000700:Analgesics