Tubeless per cutaneous nephrolithotomy: is it the present standard of care?

Background: Since the time standard per cutaneous nephrolithotomy (PCNL) was introduced in 1976, it has undergone changes in techniques, instrumentation and post-operative management for better patient care. Standard PCNL involves placement of nephrostomy tube and DJ stent/ureteric catheter after stone retrieval. Now the trend is towards tubeless PCNL and totally tubeless PCNL as to minimize pain, infection and hospital stay. Our objective was to compare the outcome of standard PCNL with tubeless PCNL. Methods: This was a randomized study of patients who underwent standard PCNL and tubeless PCNL in our institute from August 2013 to August 2015 for renal calculi >2 cms. Patients with residual calculi needing further ancillary treatment and patients who had major collecting system tear were excluded from the study. A total of 257 patients who had undergone PCNL during the study period for renal calculi >2 cm were included in the study. 27 patients were excluded due to presence of residual calculi or major collecting system tear. Of these 115 underwent standard PCNL and remaining 115 tubeless PCNL. Post-operative visual analog pain score, need for analgesics, infection rate, post-operative hospital stay were analyzed. Results: No significant differences were noted in patient demographics, age, sex, stone size and stone burden. There were no significant complications seen in tubeless group as compared to standard PCNL group. Post-operative pain and hospital stay was significantly reduced in tubeless PCNL group. Conclusions: Tubeless PCNL is a relatively safe and effective modification of standard PCNL. It increases patient compliance of PCNL by reducing post-operative pain and early recovery.