A Comparative Study of Tubeless versus Standard Percutaneous Nephrolithotomy (PCNL) – A Randomized Controlled Study

Abstract

Introduction: The tubeless percutaneous nephrolithotomy (PCNL) procedure is defined as non-placement of double-J stent at the end of procedure. There are numerous advantages of placement of nephrostomy tube as in standard PCNL like adequate renal drainage, tamponade effect for bleeding and relook PCNL. Aim: This study aims to determine the effectiveness, safety, and morbidity of tubeless PCNL by comparing it to the standard PCNL technique. Methodology: It was a randomized controlled study conducted over a period of two years from (October 2019 to November 2021). All the patients aged 18-65 years of age with stone size of 1- 2.5cm who underwent PCNL in our department were included. The patients were allocated into two groups Group A (Tubeless PCNL) and group B (Standard PCNL). The randomization was done by block randomization method with sealed envelope system. Results: The mean age in Group A was 37.94±12.7 years and group B 39.38±11.91 years. The mean stone size in (Group A20.56±2.87mm, Group B- 21.54±2.63) and both were comparable. The mean operative time in (Group A was 47.68 min±5.27, Group B 49.72min±5.18) with insignificant result. The mean drop in haemoglobin was (Group A- 0.70gm% and Group B- 0.79 gm %) and requirement of blood transfusion was in (Group A- 5(10%) & Group B- 8(16%) patients. The mean analgesia requirement (inj. Tramadol (mg) was 113 mg ±29.68 in Group A and 172 mg ±31.87 in Group B) with significant p value <0.0001. The mean hospital stay was (Group A-3.42±0.72 & Group B-4.2±0.49 days) and the comparison shows significant result p value <0.0001. The stone clearance was more than 90% in both the groups with insignificant result, P value 0.7281. Conclusion: Tubeless PCNL is an effective alternative procedure with the potential advantages of decreased postoperative pain, analgesia requirement, and hospital stay.