The aim of this study is to compare the safety of tubeless versus totally tubeless PCNL in terms of important postoperative clinical parameters.
A total of 80 patients who were candidates for PCNL with no co-morbid were randomized into two groups, 40 patients underwent tubeless PCNL in whom a 4.8Fr DJ stent was placed at the end of the procedure and 40 patients underwent totally tubeless in whom a 5Fr open ended ureteric catheter was placed and kept for 24 hours. Postoperative fever, flank pain, hematuria, urinary leakage and any infection requiring additional antibiotic coverage were recorded on a well-structured proforma for each patient.
From January 2017 to October 2017 eighty patients who underwent PCNL were divided into two groups tubeless PCNL (n=40) and totally tubeless PCNL (n=40). Mean age, mean BMI and mean stone size was comparable among two groups. The mean operative time was 42.3 minutes in tubeless group versus 32.3 minutes in totally tubeless group. Postoperative hematoma/urinoma was not observed in any group. Regarding the postoperative pain, mean visual analogue score was 3 in the tubeless versus 1.8 in the totally tubeless group. Postoperative fever was observed in 20% of patients with DJ stent versus 12.5% with totally tubeless PCNL. Mild hematuria was observed in 7.5% of tubeless group versus 2.5% of the totally tubeless group. Average rise in TLC was 4300/cmm in tubeless versus 2700/cmm in the totally tubeless group. Infections requiring additional antibiotics were 7.5 versus 5 in the tubeless & totally tubeless groups respectively. Soakage of dressing was not found in any case of tubeless group, however it was observed in 5% of patients with totally tubeless PCNL.
In our study totally tubeless PCNL when compared to the tubeless PCNL was associated with less operative time, less postoperative pain, fever, hematuria, infection. However, tubeless PCNL had a less postoperative leakage and soakage of dressing probably due to improved renal drainage. In our opinion totally tubeless PCNL is an excellent and importantly a safe modification of the conventional procedure and should be employed in routine.