PROSPECTIVE RANDOMIZED STUDY COMPARING SAFETY AND EFFICACY OF STANDARD VERSUS TUBELESS PERCUTANEOUS NEPHROLITHOTOMY

Tubeless percutaneous nephrolithotomy (PCNL) is the non-placement of a nephrostomy tube at the end of the procedure. The benefits of a nephrostomy tube placement are numerous as it provides adequate renal drainage. It may also tamponade bleeding and allow for an easier second-look nephroscopy. However, majority of authors consider the nephrostomy tube as a source of morbidity. Tubeless PCNL is an effective and safe procedure for treatment of renal stones in selected cases. This procedure can even be chosen for patients with previous renal surgery, and hemorrhagic tendency. By using this method, less postoperative pain and a shorter hospital stay can be achieved, when compared with conventional PCNL. This study is to prospectively compare the feasibility and safety of tubeless percutaneous nephrolithotomy (PCNL) Vs standard PCNL. A 220 patients undergoing PCNL were randomized into two groups: Group A (tubeless PCNL) with antegrade placement of a Double-J stent without nephrostomy and group B (standard PCNL) with nephrostomy tube placement postoperatively with 110 patients in each group. Inclusion criteria were a stone size more than 2 cm, single tract puncture with complete clearance, less than three stones with a diameter <25mm and minimal bleeding at completion. The two groups were comparable in age and sex, operative time, access tract, stone size, stone disease in the opposite kidney and ureter, preoperative creatinine and associated comorbidities were recorded. Patients were followed up in the post-op period with a drop in Hb, need for blood transfusion, need for analgesia, hospital stay, complications and need for the ancillary procedure. There was no significant difference between the two groups for patient demographics and stone characteristics. There was no statistically significant difference between the two groups for the complications, stone clearance, need for ancillary procedure, mean postoperative drop in haemoglobin, need for blood transfusion. The mean postoperative ana;gesic requirement, operative time and hospital stay was statistically significantly higher in the tubeless PCNL group compared with the standard PCNL group with p values of 0.000, 0.040, 0.001 respectively. Inconclusion, Tubeless PCNL is considered a safe and efficient technique in any tract location (upper, middle, lower), in patients with bilateral disease and effective procedure if done in a selected group of patients.