Comparison of standard and tubeless percutaneous nephrolithotomy for renal calculi: a prospective randomized control trial

Abstract

pyrexia, incomplete stone removal, pleural injury, and adjacent organ injury. 2 After completion of stone removal, usually, a nephrostomy tube is placed which helps in tamponade of bleeding, drainage of urine, tract recovery, and a guide for second look nephroscopy if needed. 3,4 In various studies, the usage of small caliber nephrostomy tubes were found to be equivalent to large nephrostomy tubes. 5-7 Apart from the above-mentioned ABSTRACT Background: In the current era of minimally invasive interventions, the mainstay of treatment of renal stones larger than 2 cm is percutaneous nephrolithotomy (PCNL). PCNL underwent various evolutionary changes minimizing morbidity to the patients. We prospectively compared the outcome of tubeless PCNL (without nephrostomy drainage tube) to reduce the pain and discomfort caused by tube with standard PCNL in the treatment of renal stones. Methods: In this randomized control trial (RCT), we divided patients satisfying the inclusion criteria of consenting for trial, single access puncture, less than 3 stones each less than 3 cm, operative duration of less than 2 hours into two groups, standard PCNL (group 1) and tubeless PCNL (group 2) with 25 patients each. Randomization and group assignment were done after complete clearance of renal stones. Results: Patient"s age, gender, sides of stone and stone size were comparable between two groups (standard versus tubeless PCNL). Postoperative hemoglobin drop, bleeding, pyrexia, urine leak, and blood transfusion requirement did not show a statistically significant difference between the two groups. Analgesic requirement (190 mg versus 80 mg of tramadol), operative duration (49.80 min versus 38.60 min), postoperative pain score (6/10 versus 3.64/10-visual analog scale) and duration of hospital stay (68.48 hours versus 41.12 hours) showed statistically significant difference favoring tubeless PCNL. Conclusions: Tubeless PCNL may be a safe, acceptable and effective modality of treatment for renal calculi in carefully selected patients comparing standard PCNL resulting in less operative duration, lower postoperative pain, reduced analgesic requirement and shorter hospital stay.Cite this article as: Kamalakshi MM, Ramasamy V, Sadasivan D, Raveendran S, Paramasivam S, Ganapathy V. Comparison of standard and tubeless percutaneous nephrolithotomy for renal calculi: a prospective randomized control trial. Int J Clin Trials 2019;6(4):185-90.