Totally tubeless (tubeless and stentless) percutaneous nephrolithotomy in selected patients

Objective: The aim of this study is to evaluate the results of totally tubeless (tubeless and stentless) percutaneous nephrolithotomy (PNL) operations.

Materials and methods: A total of 18 patients (Group 1) who underwent totally tubeless PNL was compared with a control group of 18 age-, sex-, stone burden- and procedure-matched patients (Group 2) who had undergone PNL with placement of a nephrostomy tube in our clinic. The procedure was done with a single puncture and a single access. At the end of the surgery, we did not use a nephrostomy tube or a ureteral stent in selected patients. Operative findings, analgesia requirement, urinary extravasation, decrease in hematocrit, and duration of hospital stay were recorded in all patients.

Results: The mean stone size was 450 mm2 (160-1150) ve (180-1200) vs. 425 mm2, and stone-free rate was 100% vs. 94.5% for groups 1 and 2, respectively. In both groups PNL was performed successfully without any significant complications. The mean operation time was 42 min (21-70) vs. 40 min (25-65) and mean fluoroscopy time was 2.7 min (1-4) vs. 2.6 min (1-3), respectively. None of the patients demonstrated a urinoma in postoperative renal ultrasonography. There was no difference in terms of hemorrhage. Tranfusion was needed in one patient in each group. Three patients had subfebrile fever in both groups. The mean hospitalization time was 2 days for group 1 and 3.1 days for group 2 (p<0.05). All patients were evaluated with IVP at the 3rd postoperative month.

Conclusion: Our results suggest that tubeless PNL desicion should be made at the end of the operation. Tubeless PNL is a safe, less painful, and effective procedure in selected patients. Lowering hospitalization time postoperatively for well-chosen patients is possible and patient comfort is better.