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Complications of tubeless versus standard percutaneous nephrolithotomy

  • Urology - Original Paper
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Abstract

Purpose

The necessity of nephrostomy tube after percutaneous nephrolithotomy (PCNL) has been called into question in modern series. We sought to examine differences in postoperative complications and outcomes of tubeless PCNL versus standard PCNL at our institution.

Methods

A retrospective review of our institutional stone database was conducted from January 2016 to December 2021 for patients who had undergone either tubeless PCNL, defined by placement of only an internal ureteral stent, or standard PCNL, which involved placement of an externalized nephrostomy tube. Patients were excluded if they underwent totally tubeless PCNL.

Results

A total of 438 patients were included for analysis: 329 patients underwent tubeless PCNL and 109 patients underwent standard PCNL. Between tubeless and standard groups, there was no difference in readmission rates 6.1% vs. 9.2% (p = 0.268), Clavien 2 or > complications 18.5% vs. 19.3% (p = 0.923), and Clavien 3 or > complications 4.0% vs. 7.3% (p = 0.151). The tubeless group experienced shorter operative duration 121.5 vs. 144.8 min (p = 0.012), shorter length of stay 2.5 vs. 3.8 days (p = 0.002), and higher stone-free rates 72.3% vs. 60.2% (p = 0.014), but also increased blood transfusion rates 6.4% vs. 0.9% (p = 0.022).

Conclusion

In comparing tubeless with standard PCNL, there was no difference in readmission rates, or significant Clavien complication rates. Patients undergoing tubeless PCNL experienced higher stone-free rates, but more number of patients required postoperative blood transfusion. The decision to leave a nephrostomy tube after PCNL appears unlikely to impact overall complication rates and can be left to surgeon experience and case-based discretion.

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Data availability

The data that support the findings of this study are available from the corresponding author, [HH], upon reasonable request.

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Acknowledgements

The authors acknowledge the Washington University School of Medicine in St. Louis, Barnes-Jewish Hospital.

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Authors and Affiliations

  1. Department of Surgery, Division of Urology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA

    Hayden Hill, Susan Talamini, Joel Vetter & Charles Nottingham

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  1. Hayden Hill
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  2. Susan Talamini
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  3. Joel Vetter
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  4. Charles Nottingham
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Contributions

HH: conceptualization, methodology, investigation, writing—original draft and review/editing. ST: conceptualization, writing—review/editing. JV: statistics. CN: conceptualization, writing—review and editing.

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Correspondence to Hayden Hill.

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Hill, H., Talamini, S., Vetter, J. et al. Complications of tubeless versus standard percutaneous nephrolithotomy. Int Urol Nephrol 56, 63–67 (2024). https://doi.org/10.1007/s11255-023-03772-1

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