Tubeless versus common minimally invasive percutaneous nephrolithotomy for renal stones under local anesthesia: analysis of clinical outcomes

Abstract

Background: To compare the clinical outcomes of tubeless minimally invasive percutaneous nephrolithotomy（mPCNL）and common minimally invasive percutaneous nephrolithotomy under local anesthesia, and to explore the feasibility, safety and clinical efficacy of tubeless mPCNL under local anesthesia. Methods: Patients with PCNL who underwent local anesthesia from January 1, 2018 to November 30, 2018. The patients were divided into Group 1 (tubeless mPCNL: indwelling double J tube, no indwelling nephrostomy tube) and group 2 (common mPCNL: indwelling double J tube and nephrostomy tube). The intraoperative and postoperative parameters of the two groups were compared, including operation time, average postoperative hospital stay, puncture position, postoperative hemoglobin decline, postoperative visual analogue scale (VAS), analgesic use, postoperative fever and stone removal rate. Results: In group1,the VAS scores of 6 hours after surgery was 4.07±1.79 significantly lower than that for group 2 (4.07±1.79 vs 6.24±1.33, P<0.05). and There was a statistically significant difference in the use of analgesics between the two groups（P<0.05）. The VAS scores of day 1 after surgery (2.50±1.76 vs 3.83±2.22 in group1 and group2) was significantly lower in the tubeless mPCNL (P<0.05). The hospital stay for group 1 was significantly shorter than group 2(3.15±1.42 vs 6.48±1.88 days, P<0.01)). There were no significant differences in the operation time, puncture position, postoperative hemoglobin decline rate, VAS score on the day of discharge, postoperative fever, and stone removal rate between the two groups (P>0.05). Conclusion: Tubeless mPCNL is a simple, safe and effective technique under local anesthesia. It is worthy of clinical application. Tubeless mPCNL treatment for renal stones can significantly reduce postoperative pain and shorten hospital stays compared with common m PCNL.