Tubeless versus Standard Percutaneous Nephrolithotomy

Abstract

Background: Percutaneous nephrolithotomy (PCNL) is an established treatment for large renal calculi; however, conventional nephrostomy drainage may contribute to postoperative pain and prolonged hospitalization. Tubeless PCNL avoids routine nephrostomy tube placement and may facilitate postoperative recovery.

Objective: To compare the outcomes of tubeless versus standard PCNL in patients with renal stones.

Methods: A randomized controlled trial was conducted in the Department of Urology, Liaquat National Hospital, Karachi. A total of 104 patients aged 20–70 years with renal or upper ureteric stones measuring >2 cm were included and randomly allocated to tubeless PCNL (n=52) or standard PCNL (n=52). Outcomes included length of hospitalization, fluoroscopy duration, operative time, hematocrit decrease, and postoperative Visual Analog Scale pain scores at 1 and 6 hours.

Results: The tubeless PCNL group had a shorter mean hospital stay than the standard PCNL group (1.7 ± 0.8 vs. 3.1 ± 1.0 days; P<0.001). Mean fluoroscopy duration was 5.1 ± 1.6 versus 5.4 ± 1.8 minutes (P=0.371), while mean operative time was 76.2 ± 18.5 versus 82.1 ± 20.1 minutes (P=0.122). Hematocrit decrease was 2.5 ± 1.4% versus 3.4 ± 1.6% (P=0.003). VAS pain scores at 1 hour were 5.8 ± 1.6 versus 6.7 ± 1.2 (P=0.002), and at 6 hours were 3.4 ± 1.3 versus 4.7 ± 1.4 (P<0.001), respectively.

Conclusion: Tubeless PCNL was associated with shorter hospitalization and lower early postoperative pain compared with standard PCNL, while perioperative procedural outcomes remained comparable. Tubeless PCNL may therefore represent an effective alternative to standard nephrostomy drainage in appropriately selected patients.