Tubeless percutaneous nephrolithotomy: 3 years of experience with 454 patients

Abstract

OBJECTIVE To present our experience with 454 patients who had tubeless percutaneous nephrolithotomy (TPCNL) over last 3 years. PATIENTS AND METHODS From September 2004 to August 2007, all patients aged >14 years and undergoing PCNL were considered for TPCNL. Exclusion criteria were the presence of pyonephrosis, matrix calculi, significant bleeding or residual stone burden and need for three of more percutaneous accesses. These patients had a nephrostomy tube placed after PCNL (control group). The remaining patients undergoing TPCNL (study group) had antegrade ureteric stenting. Demographic and perioperative data were compared retrospectively. RESULTS Of 840 patients who had PCNL during the study period, 454 had TPCNL. The two groups had comparable demographic data except for a smaller stone burden (322.8 vs 832.2 mm2) and fewer staghorn calculi (94 vs 154) in patients undergoing TPCNL (P < 0.001). The mean number of tracts per renal unit and operative duration were statistically higher in patients undergoing standard PCNL (1.5 vs 1.1, and 68.8 vs 52.2 min, respectively). The decrease in haemoglobin, complication and stone‐free rates were comparable. TPCNL was associated with less postoperative pain, analgesia requirement and earlier discharge (P < 0.001). CONCLUSIONS TPCNL can be used with a favourable outcome and no increase in complications in selected patients, with the potential advantages of decreased postoperative pain, analgesia requirement and hospital stay. Its application can be extended to patients with a solitary kidney, previous ipsilateral open surgery, raised serum creatinine level, in the presence of three renal accesses or supracostal access, and in patients undergoing bilateral synchronous PCNL or contralateral endourological stone treatment.

Comparison of retrograde intrarenal surgery and percutaneous nephrolithotomy for the treatment of renal stones greater than 2 cm

“…Recent studies showed that PCNL procedures performed without tubes decreased the hospital stay significantly. [26,27] In our study, the mean hospital stay was 4.57±2.1 days in the PCNL group and 1.56±0.8 days in the RIRS group. Similar to the literature results, hospital stay was significantly shorter in the RIRS group compared with the PCNL group (p<0.001).…”

Comparison Between Retrograde Intrarenal Surgery (Rirs) and Percutaneous Nephrolithotomy (Pcnl) in the Treatment of Single Renal Stone 2 - 3cm

“…Recent studies have shown that tubeless PCNL is the most important factor in decreasing hospital stay. 18,19 However, the decision to position a tubeless PCNL is surgeon's choice and intraoperative findings. It can be applied in the absence of a significant residual stone, pelvicaliceal system perforation, and significant bleeding.…”

Comparison of outcomes of tubed versus tubeless percutaneous nephrolithotomy in children: A single center study

“…Tubeless PCNL has been a successful procedure even in advanced aged patients. [13,14] Shah et al [15] documented superiority of percutaneous nephrolithotomy in terms of patient's satisfaction. They reached a conclusion that PCNL was a safe technique even in solitary kidney, past history of any ipsilateral renal surgical procedure, elevated serum creatinine levels, with an advantage of bilateral simultaneous use of PCNL or contralateral endourological removal of stones.…”