Tubeless percutaneous nephrolithotomy: First 200 cases in Israel

Mario Sofer*, Ghalib Lidawi, Gal Keren-Paz, Ravit Yehiely, Avi Beri, Haim Matzkin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Tubeless percutaneous nephrolithotomy is defined as PCNL without postoperative nephrostomy tubes. It is reported to reduce postoperative pain, hospital stay and recovery time. To date the procedure has been reserved for selected patients. Objectives: To assess our initial experience in extending the implementation of tubeless PCNL without preoperative patient selection. Methods: All consecutive PCNLs performed during 2004-2008 were evaluated. Tubeless PCNL was performed when residual stones, bleeding and extravasation were excluded intraoperatively. Staghorn stones, stone burden, supracostal and multiple accesses, anatomic anomalies, solitary kidneys and operative time were not considered contraindications. We analyzed the clinical data and the choice of tubeless PCNL over time. Results: Of 281 PCNLs performed during the study period 200 (71%) were tubeless. The patients' average age was 53 years (range 28-82 years), the stone burden was 924 mm2 (400-3150 mm2), operative time was 99 minutes (45-210 min), complication rate was 14% and immediate stone-free rate 91%. There were 81 conversions to standard PCNL (29%) due to expected second-look (n=47, 58%), impression of bleeding (n=21, 26%), suspected hydrothorax (n=7, 9%) and extravasation (n=6, 7%). The transfusion rate was 1%. The median hospital stay was 1 day (1-15 days) and recovery time 7 days (5-20 days). The rate of implementing the tubeless procedure increased steadily along time from 46% to 83% ( P = 0.0001). Conclusions: Tubeless PCNL can be safely and effectively performed based on intraoperative decisions, without pre-operative contraindications. They are easily accommoda-ted by experienced endourologists and provide real advan-tages.

Original languageEnglish
Pages (from-to)164-166
Number of pages3
JournalIsrael Medical Association Journal
Volume12
Issue number3
StatePublished - Mar 2010

Keywords

  • Calculi
  • Kidney
  • Nephrostomy
  • Percutaneous nephrolithotomy
  • Stent

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