A Prospective Observational Study of Tubeless Percutaneous Nephrolithotomy Procedure for Renal Stones.

Background: Standard procedure for large renal stones (>1.5cm) is percutaneous nephrolithotomy. This standard procedure of doing percutaneous nephrolithotomy incudes placing of nephrostomy and DJ Stent and has significant pain and morbidity, which are related to these tubes. Various modifications were done to PCNL to decrease the morbidity. We report an observational study of PCNL without placing nephrostomy tubes. Aim and objectives: Aim was to study the outcomes of tubeless PCNL, evaluate the outcomes and complications with tubeless PCNL and to compare the outcomes of tubeless percutaneous nephrolithotomy (PCNL) with standard PCNL. Materials and methods: A total of 90 cases were included initially in this study with following inclusion criteria on patients with renal and/or upper ureteric calculi of greater than 1.5cm, less than equal to 3.0cm, negative urine culture and no coagulopathy. Further selection of cases was done after the PCNL procedure depending on whether procedure went uneventful. Finally 72 cases were included and 18 cases were excluded at the time of the procedure. The 18 patients who were excluded, required more than 2 tracts and had significant perforation of the collecting system and significant intra operative bleeding. The outcomes measured were the Hb drop, septic complications, pain score and analgesic need and hospital stay. G Ravi Chander, N Rama Murthy, Saptagiri Prasad, K Gopikanth, Anna Manikantanan Suresh. A Prospective Observational Study of Tubeless Percutaneous Nephrolithotomy Procedure for Renal Stones. IAIM, 2020; 7(10): 51-60. Page 52 Results: There was no significant difference in mean operative time between standard and tubeless PCNL groups. Post-operative analgesic requirement was significantly low in our study group compared to Standard PCNL. No difference was found in the incidence of Sepsis, Hb drop. The incidence of urinary leak is significantly lower in our group. Hospital stay is shorter in our study which was statistically significant. Conclusions: Tubeless PCNL can be adopted in majority of patients especially when the procedure went uneventful without much bleeding, without PCS injury and where complete clearance of the stone done with single tract. Tubeless PCNL is equally safer procedure with bleeding and sepsis complications comparable to Standard PCNL, but it has definite advantage of less post-operative pain requiring less analgesic, less post op urinary leak and most important shorter hospital stay. [ABSTRACT FROM AUTHOR]