Comparison of tubeless drainage and nephrostomy tube as a drainage method after percutaneous nephrolithotomy procedure: A prospective study

Abstract

Objective: The standard procedure of PCNL involves insertion of a nephrostomy tube for drainage. The nephrostomy tube also serves as a medium to tamponade bleeding, and in cases where any remnant calculus requires re-exploration, the nephrostomy tube has been proved to be beneficial in providing access. However, presence of a tube may hamper PCNL in cases of day surgery. Tubeless PCNL could be the ideal approach in selecting which patients might be suitable for same day discharge. The objective of this study is to re-explore each drainage technique following PCNL and to compare the safety of these drainage procedures with a clear-cut clinical parameter imposed.

Materials and Methods: Inclusion Criteria: people aged 18 years and above, patients of either gender, all cases of renal calculi who underwent percutaneous nephrolithotomy. Exclusion Criteria: patients who needed more than 2 percutaneous tracts, patients with a solitary kidney or with bilateral renal calculi or with staghorn calculi or patients who had a residual stone after the procedure, patients having congenital renal anomalies, for example horse shoe kidney, mal rotated kidney, duplex moiety, ectopic kidney, patients with pelvis injury and extravasation during surgery. Total sample size was calculated to be 140 (70 in each group). Post operatively, patients in the two groups will be assessed on the following parameters: postoperative pain, analgesic requirement, complications, duration of hospital stay, return to normal activity and mean Hb decrease.

Results: Tubeless PCNL was significantly associated with shorter operative time, shorter hospital stay, faster time to return to normal activity, lower postoperative pain score, lower postoperative analgesia requirements, and lower urine leakage. There were no significant differences in postoperative haemoglobin reduction, stone-free rate, postoperative fever rate, or rate of blood transfusion.

Conclusion: Conclusions made from the outcomes of this study were that in com- parison to standard PCNL, use of the tubeless PCNL conferred statistically significant advantages in terms of post-operative pain, morbidity, length of hospital stay and period of convalescence. As tubeless PCNL decreased length patient hospital stay and analgesic requirement this procedure is more efficacious for day care surgery.