Safety and feasibility of tubeless percutaneous nephrolithotomy with expanded indication

Objective: The aims of this study were to compare perioperative outcomes of expanded indications of tubeless PCNL versus tubed PCNL. Material and Method: Between May 2011 and August 2014, 192 PCNL cases (118 tubeless/74 tubed) in Siriraj Hospital were reviewed. There were no any specific criteria for selecting patients to tubeless group. Patient demographics data, operative and perioperative outcomes were evaluated and complications were classified by using Clavien score system. Results: Baseline characteristics were well balanced between both groups. The operative time was shorter in tubeless PCNL (75 vs. 120 min; p = 0.001) even though the puncture approaches were similar between two techniques. Pain score, morphine usage, hematocrit change and stone-free rate were comparable in both groups. In tubeless PCNL group, there were significantly lower incidence of fever (53% vs. 75%; p = 0.002) and Clavien score (1.4±0.9 vs. 1.8±0.8; p = 0.005), and shorter length of hospital stay (4 vs. 7 days; p = 0.001). Clavien scores of tubeless and tubed PCNL according to clinical factors (Age ≥60 years, previous kidney surgery, BMI ≥30 kg/m², staghorn stone and supracostal approach) were not statistically significant between two groups. Conclusion: Tubeless PCNL with ureteric stent in all patients had favorable outcomes with no increasing complications when compared with tubed PCNL. It is a safe and effective procedure for management of nephrolithiasis in experienced surgeon.