Outcomes of tubeless and totally-tubeless percutaneous nephrolithotomy (PCNL) in a tertiary urology centre.

Introduction Traditional practice following percutaneous nephrolithotomy (PCNL) is to leave a nephrostomy drain in situ. 'Tubeless' PCNL involves placement of a ureteric stent in lieu of nephrostomy drain. In 'totally-tubeless' PCNL, no drainage is left. The purpose of this study was to demonstrate that standard and miniaturised PCNL can be performed tubeless or totally tubeless with excellent safety and clinical outcomes. Patients and methods Fifty-two tubeless or totally-tubeless PCNLs were performed between 2013 and 2018 (the majority between 2016 and 2018 following introduction of miniaturised PCNL equipment). PCNLs were performed in the Galdakao-modified supine Valdivia position. Data on outcomes and complications were collected prospectively. Decision to omit nephrostomy drain or ureteric catheter/ stent was made at time of surgery in cases that were deemed suitable (e.g. no solitary kidney, minimal bleeding and fluoroscopic/visual complete stone clearance at operation completion). Stone clearance rates, length of hospital stay and complications were determined. Results 13 tubeless and 39 totally tubeless PCNLs were performed. Miniaturised equipment was utilised in 11 of the totally tubeless group. Overall stone-free rate was 86%. Median length of stay was 1 day. The rate of complications (Clavien-Dindo grade 3 and above) was 8%. Conclusions Omitting a nephrostomy drain or ureteric stent is a safe option in suitable patients. We have demonstrated excellent stone free rates with minimal complications and length of hospital stay. We plan to conduct a pilot trial assessing the clinical outcomes, feasibility and acceptability of tubeless miniaturised vs tubeless conventional PCNL using validated pain scores and PROMs.