Totally tubeless percutaneous nephrolithotomy

PURPOSE: We evaluated the requirement for routine placement of a ureteral stent and a nephrostomy tube following percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: A total of 43 patients underwent totally tubeless PCNL and was compared with a control group of 43 age-, sex-, weight-, and procedure-matched patients who had previously undergone PCNL with placement of a ureteral stent and a nephrostomy tube. Exclusion criteria for the tubeless approach were more than two percutaneous accesses, significant perforation of the collecting system, a large residual stone burden, significant postoperative bleeding, ureteral obstruction, and renal anomaly. The incidence of complications, length of hospitalization, analgesia requirements, and interval to return to normal activities were compared in the two groups. RESULTS: All 43 percutaneous procedures were performed without significant complications. None of the patients demonstrated urinoma in postoperative renal ultrasound scans. The average length of hospital stay was 1.6 days, with two-thirds of the patients staying <1 day for the study group, and 5.2 days for the controls (P < 0.001). The average analgesia requirement was 9.8 mg and 28.4 mg of morphine, respectively (P < 0.001). Patients returned to normal activities with 12.7 days v 24.6 days for the controls (P < 0.001). CONCLUSION: Totally tubeless PCNL is a safe and effective procedure. The hospitalization and analgesia requirements are less and the return to normal activities faster with this technique.