A Comparative Study of Standard PCNL vs Tubeless PCNL at a Tertiary Care Hospital

Abstract

Introduction The role of percutaneous nephrostomy tube for drainage after percutaneous nephrolithotomy (PCNL) procedure has come under scrutiny in recent years. The procedure has been modified to use of small diameter tubes and tubeless PCNL. Aim & Objectives This study was done to evaluate perioperative characteristics, postoperative analgesic requirement, length of hospital stay and post-surgical complications between standard PCNL and tubeless PCNL. Methodology This prospective comparative study was conducted in department of surgery and radiodiagnosis of Rama Medical College, Hapur from June 2017 to September 2018 on 80 patients of nephrourolithiasis, who were randomly divided into two groups of 40 patients each, group A underwent standard PCNL while group B underwent tubeless PCNL. Post operatively, the efficacy of the operative procedure was analyzed based on the outcome of the procedure, duration of patient stay and post-operative complications. Result Majority of patient who had underwent PCNL were in age group of 21–60 years (mean age- 36.78 years) with a male predominance (M:F= 69:11). Operative time for tubeless PCNL (mean time ± SD = 59.97 ± 26.40 minutes) was shorter than for standard PCNL (mean time ± SD = 67.55 ± 28.00 minutes) but it was statistically insignificant (p value = 0.73462). 26 patients (65%) of tubeless PCNL were discharged within 48 hours while 33 patients (82.5%) of standard PCNL had to stay in hospital for a longer duration of 3–4 days. Post-operative analgesia requirement (Inj. Diclofenac) was significantly high in standard PCNL group (mean dose ± SD = 136.84 mg ± 39.12 mg) than in tubeless PCNL group (mean dose ± SD = 119.74 mg ± 36.13 mg, p value = 0.0026). Post-operative complications such as hematuria, urosepsis and leakage were also much less in tubeless PCNL (n=11, 27.5%) than in standard PCNL (n= 17, 42.5%). Conclusion Tubeless PCNL is a safe and effective technique and is associated with decreased pain, low analgesic requirement, less operating time and faster recovery. However it has its own limitation that precludes secondary procedure for the treatment, removal of internal stent, dysuria and need to visit hospital for subsequent removal of internal stent.