Effectiveness and Safety of Tubeless Minimally Invasive Percutaneous Nephrolithotomy in Management of Lower Pole Renal Stones

Abstract
Background: Placement of a percutaneuos nephrostomy tube for drainage has been an integral part of the standard Percutaneous Nephrolithotomy (PNL) procedure. However, in recent years, the procedure has been modified to what has been called tubeless PNL, in which the nephrostomy tube is replaced with internal drainage by ureteral catheter or double-J stent.
Aim of Study: This study aims to assess the safety, efficacy and complications of tubeless minimally invasive percutaneous nephrolithotomy (mini PNL) in lower calyceal stones.
Patients and Methods: Patients with lower calyceal stones £2cm were enrolled and underwent tubeless mini PNL between February 2014 and January 2016 using a semi rigid uretero-scope through a 16 Fr sheath and holmium laser lithotripsy. Patients were considered stone free when no stones or residuals <3mm were found on plain X-ray UT or non contrast CT.
Result: Twenty four patients with mean age of 39.8±7.1 years underwent mini PNL for lower calyceal stones ranging in size from 10-20mm (15.47±3.04). A single tract was used (16Fr). All patients had a tubeless procedure. Mean hospital stay was 1.5±0.1 days. Twenty patients (83.4%) had no or mild post-operative pain that required no analgesia. Minor complications occurred in two patients (8.3%) in the form of post-operative fever that was treated conservatively.
Conclusion: Tubeless PNL can be safe and effective procedure in selected patients (stone burden <2cm, single tract access, no significant residual stones, no significant perforation, minimal bleeding, and no requirement for a secondary procedure), with the potential advantages of de-creased post-operative pain, analgesia requirement, and hospital stay. Stone Free Rate (SFR) is comparable to PNL and is significantly better than SWL and RIRS.