The Safety and Efficacy of Tubeless Percutaneous Nephrolithotomy: A Local Study
Abstract
Background: Percutaneous nephrolithotomy (PCNL) has become the standard treatment for stones of the kidney or upper ureter, but whether nephrostomy tube placement is necessary after PCNL is still inconclusive. To evaluate the effectiveness and safety of tubeless PCNL, we undertook a review of English language publications involving studies on PCNL and performed a meta-analysis of operation duration, analgesic requirement, hospital stay and postoperative haematocrit change
Aim of the study:The objective of this study was to conduct a systematic review and meta-analysis to evaluate the efficacy and safety of tubeless versus standard percutaneous nephrolithotomy (PCNL) for renal calculi.
Patients And Methods: Between September 2021 and October 2022, PNL was performed in 150 patients in this prospective and retrospective study. Patients with no serious bleeding or perforation in the collecting system during the operation, stone-free status, or clinically insignificant residual fragments (<4 mm) at the end of the procedure and patients with no more than one access were enrolled in the study. Patients were categorized into 2groups. In group 1 (n =50), no nephrostomy catheter was placed but antegrade J-stent was used (tubeless group), and in group 2 (n =100), standard nephrostomy catheters were placed (standard group). Two groups were compared with respect to age, stone volume, postoperative hemoglobin change, transfusion rate, operation time, analgesic requirement, hospitalization time, and complication rates.Results: No significant differences were found in mean stone volume, operation time, transfusion rates, and hemoglobin level change between the groups. However, hospitalization time and the amount of narcotic analgesic required were significantly higher in group 2 compared with the other groups (P <.05). Complications were observed in 3 (7.3%), and 7 (7.6%) patients in groups 1, and 2, respectively (P = 0.738).
Conclusions: In patients with no major intraoperative bleeding and calyceal perforation, tubeless PCNL technology is associated with shorter hospitalization time, lower incidence of postoperative pain and less analgesia requirement after nephrolithotomy. Tube-less PCNL can be used as a substitute for traditional standard PCNL of the first-line treatment. Nevertheless, further research in this field is urgently needed to confirm it.
