Abstract: Aims & objectives:
To assess the benefits of Tubeless PCNL [T PCNL] with regard to cost, tolerability over conventional PCNL [C PCNL].
Materials and Methods: This prospective study included patients undergoing Percutaneus nephrolithotomy during a period between 2007 to 2017. The selection criteria for placing the patient in tubeless arm were - Maximum stone burden of 3 cm; Single access tract; Minimal or negligible hemorrhage during the procedure; Operative time of less than two hours; lack of collecting system perforations; clinically insignificant residual fragments. In those who met the criteria antegrade stenting was done without a nephrostomy. In those patients, who did not full fill the inclusion criteria, a 24 F Nephrostomy tube was placed at the end of procedure.
Results: The study cohort included 373 patients consisting of 211 males and 162 females in 3rd to 5th decades of their lives. Those under T PCNL and C PCNL arms were 301 and 72 respectively. The stone size varied from 17-27 mm with a mean of 22 mm. The procedure time varied between 35 to 97 minutes with a mean of 66 minutes. The T PCNL arm was analyzed with regard to Analgesic requirement; Duration of hospital stay and the total cost of the treatment and compared with those under C PCNL.
Patients under had their catheter removed on 2nd postoperative day and discharged on the same day afternoon if the operative site did not develop any leak. For those under C PCNL, Nephrostomy was clamped at 48hrs if the drainage was clear and X KUB did not show any significant residual fragments. Re look procedure was planned if there bigger residual fragments. The pain was assessed using visual analogue scale (VAS) at 6, 12 & 24 hrs. Post procedure and analgesia was administered as per requirement. Majority of patients (90.7%), under T PCNL rated their pain perception highest (4-6) at 6 hrs., which came down to 2-4 at 12 hrs. They did not need any analgesia at 24 hrs., rating their pain at 1-2. mean of 3.9. The same under C PCNL was higher at 8-9 on VAS at 6 hrs, 6-8 at 12 hrs and 4-6 at 24 hrs. Parenteral Diclofenac the drug of choice for pain relief and the mean analgesic requirement was 75 mg of Diclofenac. The Analgesic requirement was higher under C PCNL arm. None required blood transfusion as the fall in hematocrit was negligible under T PCNL. The mean hospital stay in those who underwent T PCNL was 3 days as compared to 5 days under C PCNL.
Conclusion: Tubeless PCNL offers a significant benefit in terms of lesser analgesic requirement, shorter hospital stay but necessitates an additional procedure with cost in stent removal. By using stents with setons might obviate stent removal and hence the cost.