Safety and Feasibility of Tubeless Percutaneous Nephrolithotomy with Expanded Indication
Wichien Sirithanaphol MD*, Siroj Jitpraphai MD*, Tawatchai Taweemonkongsap MD*, Chaiyong Nualyong MD*, Ekkarin Chotikawanich MD*
Affiliation : * Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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.
Keywords : Percutaneous nephrolithotomy, Tubeless, Expanded indication, Safety, Efficacy
