Tubeless Percutaneous Nephrolithotomy Research Articles

Comparative Study between Outcome of Standard and Tubeless Percutaneous Nephrolithotomy (PCNL) at District Level Tertiary Hospitals in Bangladesh

Renal calculus is one of the commonest problems of the urinary tract. Surgical approach is more effective treatment option to remove it. Among all surgical procedures, Percutaneous Nephrolithotomy (PCNL) has gradually become a preferred option in last two decades for renal calculus that has largely replaced the open approach. Currently, it is the procedure of choice for renal calculus > 2 cm, or those are refractory to ESWL. The crucial step in Standard PCNL is placing a nephrostomy tube. In recent years, it has been reformed as 'Tubeless' PCNL with some modifications in which a Double-J (D-J) stent is placed without any nephrostomy tube for internal drainage. This study was done to compare the outcomes of Standard PCNL and Tubeless PCNL at district level tertiary hospitals in Bangladesh among 46 patients with renal calculus up to 3 cm size. Many authors agree that Tubeless PCNL or its modifications are effective as well as safe. Although, nephrostomy tube is responsible for an increase of post- operative morbidity, in our study, we did not find any statistically significant difference between these two procedures.

Total tubeless percutaneous nephrolithotomy without retrograde insertion of a ureteral catheter for the treatment of kidney stone patients without hydronephrosis: a randomized controlled trial.

To evaluate the safety and efficacy of total tubeless percutaneous nephrolithotomy (PCNL) without retrograde insertion of a ureteral catheter for the treatment of kidney stone patients without hydronephrosis. This prospective randomized controlled study at a tertiary care medical center was conducted from August 2019 to April 2023. Kidney stone patients diagnosed by computed tomography (CT) without significant hydronephrosis were randomly assigned to two groups: total tubeless PCNL without retrograde insertion of a ureteral catheter (group 1) and traditional PCNL (group 2). The primary endpoint was postoperative complications, while the secondary endpoints included the stone-free rate (SFR), operative time, length of postoperative hospital stay, and medical costs. A total of 99 patients were recruited, including 50 patients in group 1 and 49 patients in group 2. There were no significant differences in postoperative complications and SFR between the two groups (P > 0.05). However, relative to group 2, patients in group 1 had significantly shorter operative time (58.5 ± 25.39min vs. 82.98 ± 26.02min, P < 0.001) and length of postoperative hospital stay (1.98 ± 1.72days vs. 4.39 ± 2.95days, P < 0.001), as well as significantly lower medical costs (3190.30 ± 590.58 dollars vs. 3552.78 ± 967.79 dollars, P = 0.03). Total tubeless PCNL without retrograde insertion of a ureteral catheter for the treatment of kidney stone patients without hydronephrosis is safe and effective for urologists with extensive experience in PCNL. chictr.org.cn identifier, ChiCTR2000040884, date of registration: 13/12/2020, retrospectively registered.

Is double-J stent mandatory in complete supine percutaneous nephrolithotomy for adult patients with staghorn renal stones?

It is controversial whether double-J (DJ) stent insertion is necessary in tubeless percutaneous nephrolithotomy (PCNL) for patients with staghorn stones. We compared the outcomes of using ureteral catheters and double-J stents in tubeless complete supine PCNL (csPCNL) of staghorn stones. In this analytical cross-sectional study, from May 2008 to August 2022, 123 patients who underwent tubeless csPCNL were assessed. Patients were divided into two groups by either tubeless csPCNL with DJ stent (Group I; n = 23) or totally tubeless just with perioperative ureteral stent (Group II; n = 100). Demographic characteristics, stone-related factors, perioperative and postoperative parameters were compared in groups. Baseline characteristics were comparable in groups. The operative time in group I was significantly longer than group II (68.26 vs. 55.25min, P = 0.05). However, the duration of hospitalization in Group I was shorter than the other group (1.81 vs. 2.37 days, P = 0.03). Stone free rate was notably higher in Group I (90.5% vs. 79.8.0%) with no statistically significant difference. No significant differences were found in major complications. Patients in Group II had a significantly shorter time to return to normal life (6.48 vs. 7.91day; P = 0.043). Multivariable linear regression showed the preoperative creatinine level and stone size can affect the operative time (P = 0.02). In addition, stone number and underlying disease can affect the length of hospital stay (P = 0.007 & 0.030, respectively). Although not inserting a double J stent after csPCNL has acceptable results, because of higher residual rate in staghorn stone which cause more incidence of renal colic, longer time of hospital stay and return to normal life, inserting DJ stent is recommended.

Comparative Analysis of Mean Hospital Stay in Patients Undergoing Percutaneous Nephrolithotomy (PCNL) With Versus Without Nephrostomy Tube

Background: Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure for the removal of large renal calculi. The use of nephrostomy tubes postoperatively is common; however, they may increase hospital stay and patient discomfort. Tubeless PCNL has emerged as a potential alternative.Objective: To compare the mean hospital stay in patients undergoing PCNL with and without a nephrostomy tube.Methods: A prospective cohort study was conducted on 60 patients undergoing PCNL at the Armed Forces Institute of Urology, Rawalpindi, from June to December 2020. Patients were divided into two groups: Group A (PCNL with nephrostomy tube) and Group B (tubeless PCNL). Both groups were assessed for mean hospital stay, postoperative complications, and stone size using SPSS version 25. Inclusion criteria were age ≥18 years, stone size of 2-3 cm, and ASA I-II. Exclusion criteria included prior renal surgeries and comorbidities.Results: The mean hospital stay was significantly shorter in Group B (1.90 ± 0.80 days) compared to Group A (2.46 ± 0.81 days, p=0.0001).Conclusion: Tubeless PCNL significantly reduces hospital stay compared to standard PCNL.

Safety and Efficacy of Tubeless Percutaneous Nephrolithotomy: A Prospective Randomized Study

Background: Urinary lithiasis, or kidney stone disease, is a common and longstanding health issue characterized by significant morbidity and recurrence. Despite advancements in treatment modalities, managing large or complex renal stones continues to pose challenges. The evolution of surgical techniques, such as percutaneous nephrolithotomy (PCNL), has significantly impacted the management of kidney stones. This study aims to evaluate the safety and efficacy of tubeless PCNL compared to conventional PCNL in patients with renal and upper ureteric stones. Methods: A prospective randomized study was conducted at the Urology and Nephrology University Hospital, Assiut University, Egypt, from September 2016 to September 2019. The study included 60 patients who met the inclusion criteria and were randomly assigned into two groups: Group 1 (conventional PCNL) and Group 2 (tubeless PCNL). Postoperative outcomes, including pain scores, fever, blood loss, urinary leakage, length of hospitalization, need for re-hospitalization, and stone-free rates, were evaluated. Statistical analyses were performed using SPSS version 20.0, with a p-value of less than 0.05 considered statistically significant. Results: A total of 60 patients were included in the final analysis, equally divided into two groups. There were no statistically significant differences between the groups regarding demographic data, stone characteristics, hemoglobin levels, creatinine levels, or blood loss. However, the duration of surgery was significantly longer in the tubeless group (Group 2) compared to the conventional group (Group 1) (P-value = 0.034). Both groups achieved comparable stone-free rates with no significant differences in postoperative complications. Conclusion: Tubeless PCNL is a safe and effective alternative to conventional PCNL for managing renal and ureteral stones, with comparable outcomes in terms of blood loss, creatinine, and hemoglobin levels. The main advantage of tubeless PCNL is the potential for reduced postoperative discomfort and quicker recovery, although it requires a longer operative time. These findings support the use of tubeless PCNL as a viable option in appropriately selected patients, with implications for improving patient outcomes and reducing healthcare costs associated with kidney stone management.

Evaluating the safety of bipolar nephrostomy tract cauterization “BNTC” towards a safe tubeless percutaneous nephrolithotomy: a randomized controlled trial

To assess the safety and effectiveness of tubed versus tubeless percutaneous nephrolithotomy (PCNL) after tract inspection and bipolar cauterization of the significant bleeders. Patients who were scheduled for PCNL were screened for enrollment in this prospective randomized controlled trial. The patients were randomly assigned to one of two groups; Group 1 received tubeless PCNL with endoscopic inspection of the access tract using bipolar cauterization of the significant bleeders only, while Group 2 had a nephrostomy tube was inserted without tract inspection. We excluded patients with multiple tracts, stone clearance failure, and significant collecting system perforation. We recorded blood loss, hemoglobin drop after 6 h, postoperative analgesia requirements, hospital stay, and the need for angioembolization. A total of 110 patients completed the study. There were no significant differences between the two groups in in terms of demographic characteristics. Likewise, there was no significant difference in the mean decrease in hemoglobin after 6 h and the frequency of blood transfusion. However, the incidence of hematuria within the first 6 h (p = 0.008), postoperative pain scale (p = 0.0001), the rate of analgesia requirement (p = 0.0001) and prolonged hospital stay (p = 0.0001) were significantly higher in Group 2. Only 9 cases of tract screened patients (16% of group 1) required cauterization. Tubeless PCNL with tract inspection and cauterization of bleeders can provide a safer tubeless PCNL with less postoperative pain, analgesia requirement, and same-day discharge.

Comparison of standard percutaneous nephrolithotomy and total tubeless percutaneous nephrolithotomy in the supine position.

To compare the efficacy, safety and advantages of the total tubeless (TT) percutaneous nephrolithotomy (PCNL) and standard PCNL in the supine position. This study was carried out at İzmir Tepecik Health Application and Research Center. A total of 87 patients were examined. Forty-three patients who underwent TT procedure were defined as Group 1, and 44 patients who underwent standard procedure with a nephrostomy tube were defined as Group 2. Two techniques were evaluated with demographic data and outcome parameters. Univariate regression analyses were performed in these data sets for the parameters that predicted the TT procedure. The demographic data of the groups and all characteristics of the stones were similar. When the results were examined, the stone-free rates detected by non-contrast computed tomography (CT) in the postoperative 1st month were similar between the groups. Complication rates and secondary intervention rates were similar. Operation and fluoroscopy times were shorter in group 1, which were not statistically significant. Postoperative hemoglobin decreased, and creatinine values were similar. In Group 1, mean postoperative visual analog scale (VAS) scores and the percentage of VAS reporting > 5 points for pain level measurement were lower and statistically significant. In the univariate analysis of the factors predicting the TT procedure, no significant results were found in any parameter. Performing TT PCNL in the supine position in selected patients reduces postoperative pain without affecting the complication rates as in prone PCNL. Our study is the first to compare TT and standard PCNL in supine position.

Is Totally Tubeless Percutaneous Nephrolithotomy a Safe and Efficacious Option for Complex Stone Disease?

Background: Percutaneous nephrolithotomy is the gold standard treatment for large, complex intrarenal stones. Historically, this was performed using a nephrostomy tube (PCN) and/or internalized ureteral stent at the end of the procedure. However, totally tubeless nephrolithotomy (tt-PCNL) is a novel technique where no tubes (no stent nor nephrostomy tube) are left post-operatively. We review the literature on this subject regarding peri-operative outcomes, post-operative outcomes, and potential complications of the procedure, discuss our technique, and make recommendations on implementation for centers not currently utilizing the procedure. Materials and methods: We performed a comprehensive search of the literature on totally tubeless nephrolithotomy using MEDLINE database search. Our search included prior review articles, meta-analyses, systematic reviews, primary research articles, case reports, and case studies. Results: In comparison to prior approaches where a stent or nephrostomy tube is placed, tt-PCNL has a similar complication rate and better post-operative outcomes. Totally tubeless PCNL has similar operative times and similar changes in hemoglobin. However, it had shorter length of stays across all studies. The mean difference in length of stay in the studies reviewed was 1.96 days. Additionally, tt-PCNL had decreased post-operative analgesic requirements and pain scores. Conclusions: This review highlights totally tubeless percutaneous nephrolithotomy as a safe and feasible surgical technique with improved outcomes in properly selected patients.

Comparison of Combined Guidance of Fluoroscopy and Ultrasonography in Total Tubeless Percutaneous Nephrolithotomy with the Standard Method: A Randomized Clinical Trial.

Utilizing the combination of fluoroscopy and ultrasonography during Percutaneous Nephrolithotomy (PCNL) to minimize radiation exposure. In this randomized clinical trial, 118 patients with urinary stones who were candidates for PCNL surgery in the prone position were selected and divided into two groups (with an allocation ratio of 1:1). Cases were grouped according to whether ultrasonography was used for renal tract dilation and Amplatz sheath placement. The number of attempts to establish proper renal access, the time interval between access to the targeted calyx and nephroscope entrance, and the Clavien-Dindo score were collected. The mean age of all patients was 46.12 ± 11.28 (45.6 ± 11.2 in the total fluoroscopy group and 46.5 ± 11.4 in the combined group) years (20-66). The intergroup differences in the baseline features were not significant. The mean duration of fluoroscopy time was significantly reduced in the combined guidance group (36.22 ± 10.73 vs. 23.05±8.94 seconds, (P-value = 0.001). Moreover, the difference in the distribution of Amplatz location on the nephroscopy time was meaningful (P-value = 0.016). However, intergroup differences in the number of attempts to successful puncture, length of hospitalization, recovery time, and postoperative complications, including gross hematuria duration, blood loss volume, pack cells requirement, pain score immediately and 6 hours after the surgery, and Clavien-Dindo score were not meaningful. It can be concluded that the use of ultrasound with X-ray in prone PCNL compared to the use of X-rays alone can significantly reduce the duration of radiation without increasing the risk of intra-operative and postoperative detrimental events.

A retrospective cohort study: evaluating the efficacy of standard versus tubeless percutaneous nephrolithotomy (PCNL) in pediatric patients up to 18 years old.

Percutaneous nephrolithotomy (PCNL) is an endourological method applied as the standard or tubeless method for kidney stone treatment. In a retrospective cohort study, 88 surgery units involving 75 children up to 18years old with kidney stones who underwent the surgery for 8years in Shahid Beheshti and Boo-ali hospitals in Hamadan with one of the two methods of standard or tubeless PCNL were evaluated and compared considering the success rate of operation, hemoglobin, hematocrit drop, need for medications, need for blood transfusion, duration of surgery, and the length of hospital stay. Among the 88 units studied, 47 cases were operated with the standard PCNL and 41 cases by tubeless method. In children operated by standard and tubeless PCNL, the complete success rate of operation was 87.2% and 100% (P = 0.006), the need for blood transfusion was 2.1% and 0% (P = 1.00), the need for opioids was 27.7% and 14.6% (P = 0.134), the decrease in hemoglobin was -1.82 ± 0.94 and -1.30 ± 0.98mg/dl (P = 0.024), the decrease in hematocrit was -5.40 ± 2.66 and -3.52 ± 3.11mg/dL (P = 0.003), the mean surgery duration was 109.30 ± 53.27 and 101.46 ± 31.92min (P = 0.414), the duration of postoperative hospitalization was 3.38 ± 1.76 and 2.46 ± 1.27days (P = 0.007), and the frequency of fever was 23.4% and 7.3% (P = 0.04), respectively. The success rate of kidney stone surgery in children with the tubeless PCNL is higher than the standard method, and its complications are lower.

Comparison of safety and efficacy of tubeless vs. conventional mini percutaneous nephrolithotomy in patients with Escherichia coli bacteriuria.

To evaluate the safety and efficacy of tubeless percutaneous nephrolithotomy (PCNL) in patients with Escherichia coli (E. coli) bacteriuria. We conducted a retrospective review of 84 patients with E. coli bacteriuria who underwent PCNL. Patients were divided into two groups according to whether a nephrostomy tube is placed at the end of the procedure. Preoperative clinical data, surgical outcomes, and postoperative complications were compared. Then, regression analysis of factors predicting success rate of PCNL in patients with E. coli bacteriuria was performed. After PCNL, residual fragments ≤ 4mm were considered as success. At baseline, the two groups were similar with regard to age, gender, BMI, underlying disease, hydronephrosis, stone characteristics, and urinalysis. Postoperative fever occurred in 1 patient (3.8%) in the tubeless PCNL group, and in 5 patients (8.6%) in the conventional PCNL group (p > 0.05). There were no significant differences in terms of successful rate, decrease in hemoglobin, pain scores, blood transfusion, and hospitalization expenses. However, the tubeless PCNL group had significantly shorter operative time (60 vs. 70min, p = 0.033), indwelling time of catheter (2 vs. 4 days, p < 0.001), and hospital stays (3 vs. 5 days, p < 0.001) than the conventional PCNL group. In the analysis of factors predicting success, the stone diameter, stone burden, and operative time were associated with success rate of PCNL. It is safe and effective to perform tubeless PCNL in patients with E. coli bacteriuria. Compared to conventional PCNL, tubeless PCNL accelerates patient recovery and shortens hospital stays.

A Cross-Sectional Study Comparing Tubed PCNL And Tubeless PCNL: An Experience at the Institute of Kidney Diseases (IKD), Peshawar

Background: Percutaneous Nephrolithotomy (PCNL) has revolutionized the treatment of large renal and proximal ureteric stones, offering a minimally invasive alternative to open surgery. The introduction of tubeless PCNL, which omits the placement of a nephrostomy drainage tube, has generated discussion regarding its efficacy and safety compared to the traditional tubed PCNL. Objective: This study aims to compare the outcomes of tubed versus tubeless PCNL in terms of post-operative complications, recovery time, and efficacy in stone removal. Methods: A retrospective cross-sectional analysis was conducted on 110 patients who underwent PCNL at the Institute of Kidney Disease, Peshawar, from January 2017 to December 2020. Patients were allocated into two groups, tubed PCNL (n=50) and tubeless PCNL (n=50), based on 1:1 sequential randomization. The inclusion criteria were ASA I and ASA II classification, age between 5 to 70 years, and single tract procedure with complete clearance without the need for a second look nephrostomy. Exclusion criteria included patients with a solitary kidney, active urinary tract infections, and congenital malformations. Data on age, gender, co-morbidities, history of ESWL, stone size, location, quantity, and post-operative outcomes were collected and analyzed using SPSS version 25. Results: No significant differences were found in patient demographics or stone characteristics between the two groups. The tubeless PCNL group demonstrated a significantly lower rate of post-operative ESWL sessions (4% vs. 22%, p=0.02) and a trend towards shorter hospital stays, although not statistically significant. The drop in hemoglobin levels post-operation was less in the tubeless group (0.84 ± 1.87 mg/dl) compared to the tubed group (1.56 ± 0.91 mg/dl), but this was not statistically significant (p=0.17). Conclusion: Tubeless PCNL offers a viable alternative to traditional tubed PCNL, particularly for patients with smaller renal stones. It is associated with a lower need for post-operative ESWL sessions and potentially shorter hospital stays, suggesting an advantage in terms of recovery and post-operative comfort. Further prospective studies are warranted to confirm these findings and explore the long-term outcomes of the tubeless technique.

A Comparative Analysis between Flexible Ureteroscopic Lithotripsy and Tubeless Percutaneous Nephrolithotomy in the Treatment of >15 mm Non-Obstructing Proximal Ureteral Stones.

The proper surgical modality for large non-obstructing proximal ureteral stones is disputed. We compare effectiveness and safety of flexible ureteroscopic lithotripsy (FURL) and tubeless percutaneous nephrolithotomy (TPNL) in treatment of upper ureteral stones larger than 1.5 cm. We reviewed the medical records of patients who performed FURL or TPNL for upper ureteral stones between June 2016 and November 2018. Comparative analysis was conducted regarding demographic parameters, stone free rate, postoperative pain and complications. This study included 58 patients treated with FURL and 60 patients treated with TPNL owing to upper ureteral stones larger than 1.5 cm. Stone size was similar in the FURL and TPNL groups (17.6 ± 2.6 vs. 18.0 ± 2.1 mm, p = 0.194). The overall 3-month stone clearance rate was 95.8% for FURL versus 96.0% for TPNL (p = 0.575). There was no difference between the FURL and TPNL groups for hospital stay (p = 0.280) and postoperative complications. On the other hand, patients treated with FURL had longer operative time (p = 0.012) and less postoperative pain (p = 0.008). Both surgical techniques were considered feasible and effective surgical procedures in the treatment of large upper ureteral stones.

Tubeless PCNL versus standard PCNL for the treatment of upper urinary tract stones: a propensity score matching analysis

PurposeIn this study, the feasibility of tubeless percutaneous nephrolithotomy (PCNL) for the treatment of upper urinary tract stones was investigated.MethodsFrom January 2021 to December 2022, the clinical data of 273 patients who received tubeless PCNL (Group A) were studied. The control group includes clinical data from 302 patients (from January 2019 to October 2022) who received standard PCNL (Group B). The baseline characteristics were consistent between the two groups after using the propensity score matching (PSM) method. Compare the preoperative clinical characteristics, postoperative complications, residual stones, catheterization time, and hospital stay between the two groups.Results146 pairs of patients were successfully paired through PSM. There was no statistically significant difference in operative time, blood leukocyte counts, haemoglobin decrease, fever, urinary extravasation, sepsis, bleeding, blood transfusion rates, embolism, and residual stones after surgery between the two groups; Postoperative day 1 and discharge day, the VAS pain score in Group A was significantly lower than that in Group B. The catheterization time and hospitalization time of patients in Group A were significantly lower than those in Group B.ConclusionAccording to the inclusion and exclusion criteria, selecting suitable patients for tubeless PCNL is safe and effective, while significantly alleviating pain and reducing catheterization time and hospital stay.

Comparison of Two Centers' Experience in Pediatric Supine and Prone Miniaturized Percutaneous Nephrolithotomy with Propensity Match Analysis.

Introduction: Percutaneous nephrolithotomy (PNL) is the treatment of choice in children with complex and large stones. With the experience gained from adult practice, supine PNL is increasingly performed in children as well. We aimed to evaluate the comparative results of prone and supine mini-PNL (m-PNL) performed for large/complex stones in children. Patients and Methods: The study included children who underwent supine and prone m-PNL at two centers between September 2019 and 2022. Patients were divided into two groups with a 1:1 ratio to index supine m-PNL and prone m-PNL cases for the size, number, location of the stones, degree of hydronephrosis, and age. Operative related parameters, success, and complication rates are being discussed on a procedure-based manner. Results: Forty-two patients (21 supine and 21 prone) were included. The mean age was 9.6 ± 4 years and mean stone size was 28.8 ± 13.6 mm. Regarding the operative data, the mean duration of procedure time was 65.7 ± 17.8 minutes in supine group, whereas 86.9 ± 19.0 minutes in prone group (p = 0.001). Fluoroscopy time was shorter in supine group (p = 0.027). Tubeless PNL was performed in 11 cases of prone group (52%), whereas this number was 18 (86.7%) in supine group (p = 0.019). Stone-free rates were similar in both groups (supine m-PNL: 90.5%, prone m-PNL: 85.7%, p = 0.634). Complications were minor in nature in most of the cases of both groups, which resolved with supportive measures in a short period of time. However, there was a statistically significant difference regarding the location and number accesses between two groups (p = 0.008). Simultaneous flexible ureterorenoscopy was performed in eight patients in the supine PNL group (<0.001). Conclusions: Our current findings and the highly limited data reported in the literature indicate that as an established minimal invasive treatment alternative m-PNL procedure in supine position can also be performed with similar success and complication rates in pediatric population.

Camposampiero tubeless percutaneous nephrolithotomy (tPCNL): Easy, quick, effective, safe.

To describe our technique to perform tubeless percutaneous nephrolithotomy (tPCNL) using hemostatic matrix (i.e. Floseal®) for the closure of the percutaneous tract, developed through the experience gained in our endourology specialized center. To evaluate the procedure efficacy and safety. tPCNL performed in our center with Floseal® application from February 2017 to December 2019 were retrospectively reviewed. Clinical and surgical data were collected in order to evaluate the success of the procedure and possible complications. Camposampiero technique is reported in detail. Sixty-nine patients (45 males, mean age 58 years old) were included. In all patients the procedure was completed successfully and in 88% of subjects no further treatments were necessary; a low complication rate (6.9%) was reported. In our experience, tPCNL with Floseal application is feasible, safe, and effective.

Complications of tubeless versus standard percutaneous nephrolithotomy.

The necessity of nephrostomy tube after percutaneous nephrolithotomy (PCNL) has been called into question in modern series. We sought to examine differences in postoperative complications and outcomes of tubeless PCNL versus standard PCNL at our institution. A retrospective review of our institutional stone database was conducted from January 2016 to December 2021 for patients who had undergone either tubeless PCNL, defined by placement of only an internal ureteral stent, or standard PCNL, which involved placement of an externalized nephrostomy tube. Patients were excluded if they underwent totally tubeless PCNL. A total of 438 patients were included for analysis: 329 patients underwent tubeless PCNL and 109 patients underwent standard PCNL. Between tubeless and standard groups, there was no difference in readmission rates 6.1% vs. 9.2% (p = 0.268), Clavien 2 or > complications 18.5% vs. 19.3% (p = 0.923), and Clavien 3 or > complications 4.0% vs. 7.3% (p = 0.151). The tubeless group experienced shorter operative duration 121.5 vs. 144.8 min (p = 0.012), shorter length of stay 2.5 vs. 3.8 days (p = 0.002), and higher stone-free rates 72.3% vs. 60.2% (p = 0.014), but also increased blood transfusion rates 6.4% vs. 0.9% (p = 0.022). In comparing tubeless with standard PCNL, there was no difference in readmission rates, or significant Clavien complication rates. Patients undergoing tubeless PCNL experienced higher stone-free rates, but more number of patients required postoperative blood transfusion. The decision to leave a nephrostomy tube after PCNL appears unlikely to impact overall complication rates and can be left to surgeon experience and case-based discretion.

Outcome of Tubeless Percutaneous Nephrolithotomy in Patients with Single Kidney; A Cross-Sectional Study

Background: While tubeless Percutaneous Nephrolithotomy (PCNL) is becoming more popular, there might still be doubt in performing it on single kidney patients. This study is performed to assess outcomes and complications of tubeless PCNL in patients with single kidney.&#x0D; Methods: In this cross-sectional study, 134 single kidney patients who underwent tubeless PCNL for renal stones, were assessed for outcomes including stone-free rate, duration of operation, length of hospital stay, changes in serum creatinine and hemoglobin levels, bleeding, infectious complications, damage to adjacent organs, and mortality. These outcomes were compared based on age, sex, history of comorbidities, history of interventions for kidney stones and the number of accesses during the operation.&#x0D; Results: Mean duration of operation was 139.14 minutes. Mean length of hospital stay was 2.59 days. In total, 11.9% of patients required intraoperative blood transfusion and 3.7% required ICU admission due to complications. The most common postoperative complications included fever, hematuria and UTI. Initial stone-free rate after surgery was 67.2% and two weeks later 76.9%. No mortality was reported. Postoperative serum creatinine levels increased slightly in short term, however, improved significantly in long-term. Comorbidities such as diabetes mellitus, hypertension, ischemic heart disease, and chronic kidney disease were associated with a higher incidence of minor and major complications of tubeless PCNL and a lower rate of stone-free rate.&#x0D; Conclusion: Tubeless PCNL is a relatively safe, feasible and efficient method with acceptable complications in single kidney patients.

Current advances in pain regimens for percutaneous nephrolithotomy A comprehensive review.

Percutaneous nephrolithotomy (PCNL) causes pain and discomfort after surgery. The primary causes of immediate postoperative pain after PCNL are visceral pain from the ureters and kidneys, and body surface discomfort from incisions. Acute, untreated pain has the potential to develop into chronic pain, which remains a considerable burden for the rehabilitation of patients. The goal of this review was to describe the current options for treating pain post-PCNL. We conducted a literature review of all published manuscripts on pain protocols for patients undergoing PCNL and related topics; 50 published manuscripts were identified and reviewed. PCNL morbidity must be reduced by an appropriate management of postoperative pain. Opioids, multimodal therapy, tubeless PCNL, reduced size of nephrostomy tube, and regional anesthesia are currently available for reducing postoperative pain. Implementing successful treatment strategies for postoperative pain after PCNL is key in reducing the morbidity and mortality of PCNL.

Percutaneous nephrolithotomy in supine position with less than 24-hour hospital stay; a single-center experience

ABSTRACT Objectives To report our initial experience of day care percutaneous nephrolithotomy (PCNL) with early hospital discharge within less than 24 hours of the procedure. Patients and Methods The files of patients treated with PCNL between 1st January 2020 till 31st December 2022 were retrospectively reviewed. Day care PCNL was defined as the discharge of patients either on the same day or within 24 hours after surgery. Patient age, ASA score, body mass index, stone diameter, laterality, stone burden, Hounsfield unit, and Guy’s score were analyzed. Operative time, size of the access tract, method of lithotripsy, estimated blood loss, and length of hospital stay were also recorded. Postoperative complications were stratified according to the Dindo-Clavien classification. The primary outcome was to evaluate the feasibility and safety of early discharge within 24 hours after PCNL compared to the in-patients who were kept in hospital for at least 2 days after surgery. Results A total of 85 patients underwent PCNL at our center of whom 36 patients were discharged within 24 hours (day care PCNL) of the procedure and 49 patients were kept for at least 2 days (in-patient PCNL). In the day care group, median stone burden was 465 mm2 (360-980) and 18 patients (50%) had Guy’s stone score ≥ III. The median tract size was 24 (13-30) and endoscopic combined intrarenal surgery (ECIRS) was performed in 7 cases in the day care group. Tubeless PCNL was carried out in 88.8% of the day care surgery group compared to 37.5% in the in-patient group (p < 0.0001). The postoperative complication rate was comparable between both groups (13.8% vs 22.4% for day care vs in-patient group, respectively, p = 0.08). Conclusions Day care PCNL is feasible and safe for selected patients including those having large stone burden without increasing the risk of complications or readmission rate.