Comparison of Mean Hospital Stay in Patients Undergoing Tubed Versus Tubeless Percutaneous Nephrolithotomy: A Randomized Controlled Trial
DOI:
https://doi.org/10.70749/ijbr.v3i7.1895Keywords:
Percutaneous Nephrolithotomy, Tubeless PCNL, Nephrostomy Tube, Hospital Stay, Randomized Controlled Trial.Abstract
Background: Percutaneous nephrolithotomy (PCNL) is the standard surgical intervention for managing large or complex renal calculi. Traditionally, the procedure concludes with the placement of a nephrostomy tube (tubed PCNL), intended to ensure drainage, hemostasis, and access for secondary procedures. However, growing interest in tubeless PCNL—where the nephrostomy tube is omitted—has prompted evaluation of its safety, efficacy, and impact on postoperative recovery, particularly hospital stay duration. Objective: To compare the mean hospital, stay in patients undergoing tubed versus tubeless percutaneous nephrolithotomy (PCNL) for renal calculi. Methods: This randomized controlled trial was conducted at Bolan Medical College and Hospital, Quetta, from January 2025 to May 2025. Sixty patients were randomized into two equal groups: one undergoing standard PCNL with nephrostomy tube placement and the other undergoing tubeless PCNL. Data on demographic, clinical, and perioperative characteristics were collected. The primary outcome was mean hospital stay. Results: The tubeless PCNL group demonstrated a significantly shorter hospital stay compared to the tubed group (mean ± SD: 3.1 ± 1.1 vs. 4.5 ± 2.1 days; p < 0.05). Conclusion: Tubeless PCNL offers a shorter hospital stay compared to traditional tubed PCNL without compromising patient safety.
Downloads
References
1. Agrawal, M. S., Agrawal, M., Gupta, A., Bansal, S., Yadav, A., & Goyal, J. (2008). A randomized comparison of tubeless and standard percutaneous Nephrolithotomy. Journal of Endourology, 22(3), 439-442.
https://doi.org/10.1089/end.2007.0118
2. Agrawal, M. S., Sharma, M., & Agarwal, K. (2014). Tubeless percutaneous Nephrolithotomy using Antegrade tether: A randomized study. Journal of Endourology, 28(6), 644-648.
https://doi.org/10.1089/end.2013.0693
3. Amir, Z. E., Shahiman, M. A., Qadeer, Z., Mughal, R. A., & Ali, A. (2021). Percutaneous Nephrolithotomy: A comparison of tubeless versus the standard technique. Journal of Rawalpindi Medical College, 25(1), 140-144.
https://doi.org/10.37939/jrmc.v25i1.1581
4. Bellman, G. C., Davidoff, R., Candela, J., Gerspach, J., Kurtz, S., & Stout, L. (1997). Tubeless percutaneous renal surgery. The Journal of Urology, 1578-1582.
https://doi.org/10.1097/00005392-199705000-00010
5. Chen, Z., Yan, Y., & Zhou, J. (2020). Comparison of tubeless percutaneous nephrolithotomy and standard percutaneous nephrolithotomy for kidney stones: A meta-analysis of randomized trials. Asian Journal of Surgery, 43(1), 60-68.
https://doi.org/10.1016/j.asjsur.2019.01.016
6. Ganpule, A. P., Vijayakumar, M., Malpani, A., & Desai, M. R. (2016). Percutaneous nephrolithotomy (PCNL) a critical review. International Journal of Surgery, 36, 660-664.
https://doi.org/10.1016/j.ijsu.2016.11.028
7. Geraghty, R. M., Jones, P., & Somani, B. K. (2017). Worldwide trends of urinary stone disease treatment over the last two decades: A systematic review. Journal of Endourology, 31(6), 547-556.
https://doi.org/10.1089/end.2016.0895
8. Gauhar, V., Traxer, O., García Rojo, E., Scarcella, S., Pavia, M. P., Chan, V. W., Pretore, E., Wroclawski, M. L., Corrales, M., Tiong, H. Y., Lim, E. J., Teoh, J. Y., Heng, C., De la Rosette, J., Somani, B. K., & Castellani, D. (2022). Complications and outcomes of tubeless versus nephrostomy tube in percutaneous nephrolithotomy: A systematic review and meta-analysis of randomized clinical trials. Urolithiasis, 50(5), 511-522.
https://doi.org/10.1007/s00240-022-01337-y
9. Iqbal, N., Assad, S., Hussain, I., Hassan, Y., Khan, H., Farooq, M. A., & Akhter, S. (2018). Comparison of outcomes of tubed versus tubeless percutaneous nephrolithotomy in children: A single center study. Türk Üroloji Dergisi/Turkish Journal of Urology, 44(1), 56-61.
https://doi.org/10.5152/tud.2018.19616
10. Istanbulluoglu, M. O., Cicek, T., Ozturk, B., Gonen, M., & Ozkardes, H. (2010). Percutaneous Nephrolithotomy: Nephrostomy or tubeless or totally tubeless? Urology, 75(5), 1043-1046.
https://doi.org/10.1016/j.urology.2009.06.104
11. Lu, Y., Ping, J., Zhao, X., Hu, L., & Pu, J. (2012). Randomized prospective trial of tubeless versus conventional minimally invasive percutaneous nephrolithotomy. World Journal of Urology, 31(5), 1303-1307.
https://doi.org/10.1007/s00345-012-0921-2
12. Ni, S., Qiyin, C., Tao, W., Liu, L., Jiang, H., Hu, H., Han, R., & Wang, C. (2011). Tubeless percutaneous Nephrolithotomy is associated with less pain and shorter hospitalization compared with standard or small bore drainage: A meta-analysis of randomized, controlled trials. Urology, 77(6), 1293-1298.
https://doi.org/10.1016/j.urology.2010.10.023
13. Shah, H. N., Sodha, H. S., Khandkar, A. A., Kharodawala, S., Hegde, S. S., & Bansal, M. B. (2008). A randomized trial evaluating type of Nephrostomy drainage after percutaneous Nephrolithotomy: Small bore v tubeless. Journal of Endourology, 22(7), 1433-1440.
https://doi.org/10.1089/end.2007.0350
14. Turna, B., Nazli, O., Demiryoguran, S., Mammadov, R., & Cal, C. (2007). Percutaneous Nephrolithotomy: Variables that influence hemorrhage. Urology, 69(4), 603-607.
https://doi.org/10.1016/j.urology.2006.12.021
15. Wang, J., Zhao, C., Zhang, C., Fan, X., Lin, Y., & Jiang, Q. (2011). Tubeless vs standard percutaneous nephrolithotomy: A meta‐analysis. BJU International, 109(6), 918-924.
https://doi.org/10.1111/j.1464-410x.2011.10463.x
16. El-Nahas, A. R., Shokeir, A. A., El-Assmy, A. M., Mohsen, T., Shoma, A. M., Eraky, I., El-Kenawy, M. R., & El-Kappany, H. A. (2007). Post-percutaneous Nephrolithotomy extensive hemorrhage: A study of risk factors. Journal of Urology, 177(2), 576-579.
https://doi.org/10.1016/j.juro.2006.09.048
17. Hopper, K. D., Yakes, W. F., & Woods, T. O. (1997). Percutaneous nephrostomy tube complications. AJR, 168(6), 1515–1518.
https://doi.org/10.2214/ajr.168.6.9168717
18. Bansal, U., Sawant, A., Dhabalia, J. V., & Jagtap, J. (2012). Prospective randomized study comparing tubeless PCNL with standard PCNL. Urology Annals, 4(2), 132–136.
https://doi.org/10.4103/0974-7796.93847
19. Wong, C., Leveillee, R. J. (2005). Single lower-pole tract tubeless percutaneous nephrolithotomy: Outcomes. Journal of Endourology, 19(2), 147–151.
https://doi.org/10.1089/end.2005.19.147
20. Nagele, U., Schilling, D., Anastasiadis, A. G., & Stenzl, A. (2006). Tubeless PCNL with and without ureteral stent. Journal of Endourology, 20(10), 780–785.
https://doi.org/10.1089/end.2006.20.780
21. Aron, M., Goel, R., Gautam, G., Seth, A., & Gupta, N. P. (2005). PCNL for complete staghorn stones. Urologia Internationalis, 75(4), 327–332.
https://doi.org/10.1159/000087479
22. Falahatkar, S., Khosropanah, S., Mahdavi, M., & Kazemnezhad, E. (2008). Tubeless PCNL in children: Feasibility and outcomes. Journal of Endourology, 22(7), 1415–1419.
https://doi.org/10.1089/end.2008.0026
23. Kim, H. H., Park, T. C., & Park, Y. H. (2004). Comparison of nephrostomy tube, DJ stent, and tubeless PCNL. Korean Journal of Urology, 45(1), 72–76.
24. Lojanapiwat, B. (2006). Tubeless PCNL in large renal calculi. International Journal of Urology, 13(8), 870–874.
https://doi.org/10.1111/j.1442-2042.2006.01484.x
25. Mandal, S., Goel, A., Kathpalia, R., Sankhwar, S., Singh, V., & Sinha, R. J. (2012). Prospective randomized trial of tubeless PCNL. International Brazilian Journal of Urology, 38(1), 33–39.
https://doi.org/10.1590/S1677-55382012000100006
26. Shah, H. N., Kharodawala, S. J., Sodha, H. S., & Bansal, M. B. (2005). Tubeless PCNL: Prospective study in 200 patients. BJU International, 96(5), 879–883.
27. Memon, S., Shaikh, N. A., & Soomro, F. R. (2015). Tubeless PCNL for small stones: Experience from a tertiary hospital. Pakistan Journal of Medical Sciences, 31(2), 370–374.
https://doi.org/10.12669/pjms.312.6422
28. Miller, N. L., & Lingeman, J. E. (2007). Management of kidney stones. BMJ, 334(7591), 468–472.
https://doi.org/10.1136/bmj.39113.480185.80
29. Lingeman, J. E. (2002). Surgical management of urinary lithiasis. Campbell's urology, 3361-3451.
30. Kallidonis, P., Panagopoulos, V., Liatsikos, E. N. (2019). Complications of PCNL. World Journal of Urology, 37(6), 1059–1071.
https://doi.org/10.1007/s00345-018-2551-5
31. Sivalingam, S., & Monga, M. (2016). Surgical outcomes in percutaneous nephrolithotomy: Predictors and preventive strategies. Current Opinion in Urology, 26(2), 146–151.
https://doi.org/10.1097/MOU.0000000000000250
32. Kukreja, R., Desai, M., Patel, S., Bapat, S., & Desai, M. (2004). First prize: factors affecting blood loss during percutaneous nephrolithotomy: Prospective Study. Journal of endourology, 18(8), 715-722.
https://doi.org/10.1089/end.2004.18.715
33. Skolarikos, A., Papatsoris, A. G., Albanis, S., & Deliveliotis, C. (2007). Tubeless PCNL: Review of the literature. Urological Research, 35(5), 275–279.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Indus Journal of Bioscience Research
This work is licensed under a Creative Commons Attribution 4.0 International License.
