Prospective study comparing the safety and efficacy of totally tubeless percutaneous nephrolithotomy vs standard percutaneous nephrolithotomy

Mukta Vig, Vishal Vig, Gurinderjit S. Nagi, Suraj Suchak, Subhash Goyal


Background: To evaluate the feasibility and safety of totally tubeless percutaneous nephrolithotomy (PCNL) Vs standard PCNL.

Methods: From August 2014 to January 2016, 66 patients underwent PCNL in our institute. Of this group, 35 patients underwent traditional nephrostomy drainage following PCNL. A tubeless procedure was performed in the remaining 31 patients. TheseĀ  groups were compared with respect to age, stone burden, intraoperative events, postoperative pain, analgesic requirements, soakage, postoperative change in hemoglobin, hospitalization time and complication rates.

Results: Two groups were comparable with respect to age, stone burden (2.03 cm Vs. 2.12 cm) and intraoperative events. The mean pain score (day2 - 4.95 vs. 2.95) (day3 - 4.33 vs. 1.44) and analgesic requirement (mg diclofenac) (day2 - 140.22 vs. 65.31) (day3 - 124.44 vs. 43.89) was significantly less for group 2 on day 2 and 3. There was significant problem of soakage from nephrostomy tract in group 1. Patients in group 2 returned faster to normal activities but there was no difference found in drop in hemoglobin, complication rates even in subset of patients with large stone burden. No patient required readmission in the follow-up for pain, obstruction or infection in group 2. One patient developed urinoma which resolved conservatively

Conclusions: In selected cases totally tubeless PCNL is feasible and safe.


Tubeless, Nephrostomy, PCNL

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Bellman GC, Davidoff R, Candela J, Gerspach J, Kurtz S, Stout L. Tubeless percutaneous renal surgery. J Urol. 1997;157:1578-82.

Candela J, Davidoff R, Gerspach J, Bellman GC. Tubeless percutaneous surgery: a new advance in the technique of percutaneous renal surgery. Tech Urol. 1997;3:6-11.

Delnay KM, Wake RW. Safety and efficacy of tubeless percutaneous nephrolithotomy. World J Urol. 1998;16:375-7.

Limb J, Bellman GC. Tubeless percutaneous renal surgery: review of first 112 patients. Urology. 2002;59:527-30.

Mouracade P, Spie R, Lang H, Jacqmin D, Saussine C. Tubeless percutaneous nephrolithotomy: a series of 37 cases. Prog Urol. 2007;17:1351-4.

Singh I, Singh A, Mittal G. Tubeless percutaneous nephrolithotomy: Is it really less morbid? J Endourol. 2008;22:427-33.

Shah HN, Mahajan AP, Hegde SS, Bansal M. Tubeless percutaneous nephrolithotomy in patients with previous ipsilateral open renal surgery: a feasibility study with review of literature. J Endourol. 2008;22:19-24.

Wickham JE, Miller RA, Kellett MJ, Payne SR. Percutaneous nephrostolithotomy: one stage or two? Br J Urol. 1984;56:582-5.

Winfield HN, Weyman P, Clayman RV. Percutaneous nephrostolithotomy: complications of premature nephrostomy tube removal. J Urol. 1986;136:77-9.

Malcolm JB, Derweesh IH, Brightbill EK, Mehrazin R, Diblasio CJ, Wake RW. Tubeless percutaneous nephrolithotomy for complex renal stone disease: single center experience. Can J Urol. 2008;15:4072-6.

Bdesha AS, Jones CR, North EA, Pinfield J, Boyd PJ. Routine placement of nephrostomy tube is not nessary after pertutaneous nephrolithotomy. Br J Urol. 1997;79(Suppl 4):1.

Crook TJ, Lockyer CR, Keoghane SR, Walmsley BH. A randomized controlled trial of nephrostomy placement versus tubeless percutaneous nephrolithotomy. J Urol. 2008;180:612-4.

Lojanapiwat B, Soonthornphan S, Wudhikarn S. Tubeless percutaneous nephrolithotomy in selected patients. J Endourol. 2001;15:711-3.

Karami H, Gholamrezaie HR. Totally tubeless percutaneous nephrolithotomy in selected patients. J Endourol. 2004;18:475-6.

Desai MR, Kukreja RA, Desai MM, Mhaskar SS, Wani KA, Patel SH. A prospective randomized comparison of type of nephrostomy drainage following percutaneous nephrostolithotomy: large bore versus small bore versus tubeless. J Urol. 2004;172:565-7.

Aghamir SMK, Hosseini SR, Gooran S. Totally tubeless percutaneous nephrolithotomy. J endourol 2004;18:647-8.

Agrawal MS, Agrawal M, Gupta A, Bansal S, Yadav A, Goyal J. A randomized comparison of tubeless and standard percutaneous nephrolithotomy. J Endourol. 2008;22:439-42.

Shah HN, Kausik VB, Hegde SS, Shah JN, Bansal MB. Tubeless percutaneous nephrolithotomy: a prospective feasibility study and review of previous reports. BJU Int. 2005;96:879-83.

Malcolm JB, Derweesh IH, Brightbill EK, Mehrazin R, Diblasio CJ, Wake RW. Tubeless percutaneous nephrolithotomy for complex renal stone disease: Single center experience. Can J Urol. 2008;15:4072-6.

Tefekli A, Altunrende F, Tepeler K, Tas A, Aydin S, Muslumanoglu AY. Tubeless percutaneous nephrolithotomy in selected patients: a prospective randomized comparison. Int Urol Nephrol. 2007;39:57.

Falahatkar S, Khosropanah I, Roshani A, Neiroomand H, Nikpour S, Nadjafi-Semnani M et al. Tubeless percutaneous nephrolithotomy for staghorn stones. J Endourol. 2008;22:1447-52.

Sofer M, Beri A, Friedman A, Aviram G, Mabjeesh NJ, et al. Extending the application of tubeless percutaneous nephrolithotomy. Urology. 2007;70:412-7.

Rana AM, Mithani S. Tubeless percutaneous nephrolithotomy: Call of the day. J Endourol. 2007;21:169-72.

Feng MI, Tamaddon K, Mikhail A, Kaptein JS, Bellman GC. Prospective randomized study of various techniques of percutaneous nephrolithotomy. Urology. 2001;58:345-50.

Shah HN, Sodha HS, Khandkar AA, Kharodawala S, Hegde SS, Bansal MB. A randomized trial evaluating type of nephrostomy drainage after percutaneous nephrolithotomy: small bore v tubeless. J Endourol. 2008;22:1433-9.