title: Modified totally tubeless percutaneous nephrolithotomy: Is it an effective and safe treatment option for renal and upper ureteral stones?
abstract: BACKGROUND
  We hypothesized that modified totally tubeless percutaneous nephrolithotomy (PNL) without indwelling ureteral stent would minimize postoperative discomfort without complications.
  
  
  OBJECTIVE
  To evaluate the safety, efficacy, and morbidity of standard, tubeless, and modified totally tubeless PNL as well as the usefulness of modified totally tubeless PNL.
  
  
  METHODS
  From November 2011 to February 2015, 211 patients who underwent PNL consecutively were enrolled in this study and divided into 3 groups (group 1: standard, group 2: tubeless, group 3: modified totally tubeless PNL). Patient and stone characteristics, operation time, hemoglobin change, length of hospitalization, stone-free rate, analgesic requirement, and perioperative complications were analyzed and compared among the 3 groups.
  
  
  RESULTS
  There were no significant differences in preoperative patient characteristics among the three groups. In the postoperative analysis, the three groups had similar operation time, stone-free rate, perioperative fever and transfusion rate, but group 2 showed superior results in terms of length of hospitalization (p = 0.001). Group 2 and group 3 had a lower analgesic requirement (p = 0.010). Immediate postoperative hemoglobin change (p = 0.001) and tube site complications (p = 0.001) were more common in group 1.
  
  
  CONCLUSIONS
  Modified totally tubeless PNL was not inferior in terms of postoperative outcomes and safety compared with the standard and tubeless PNL, and avoided the postoperative stent-related symptoms and cystoscopy for double-J stent removal. Modified totally tubeless PNL could be an alternative treatment of choice for management of renal or upper ureteral stones in selected patients.
authors.affiliation: Department of Urology, Medical School, Chonnam National University, Gwangju, Korea.
authors.forename: Ho Seok
authors.initials: HS
authors.lastname: Chung
authors.affiliation: Department of Urology, Medical School, Chonnam National University, Gwangju, Korea.
authors.forename: Seung Il
authors.initials: SI
authors.lastname: Jung
authors.affiliation: Department of Urology, Medical School, Chonnam National University, Gwangju, Korea.
authors.forename: Ho Song
authors.initials: HS
authors.lastname: Yu
authors.affiliation: Department of Urology, Medical School, Chonnam National University, Gwangju, Korea.
authors.forename: Eu Chang
authors.initials: EC
authors.lastname: Hwang
authors.affiliation: Department of Urology, Medical School, Chonnam National University, Gwangju, Korea.
authors.forename: Kyung Jin
authors.initials: KJ
authors.lastname: Oh
authors.affiliation: Department of Urology, Medical School, Chonnam National University, Gwangju, Korea.
authors.forename: Dong Deuk
authors.initials: DD
authors.lastname: Kwon
authors.affiliation: Department of Urology, Medical School, Chonnam National University, Gwangju, Korea.
authors.forename: Kwangsung
authors.initials: K
authors.lastname: Park
keywords: percutaneous nephrolithotomy; stone; tubeless