A comparison of tubeless versus

totally tubeless PCNL

Mumtaz Ahmad, Maryam Jahangir,
Muhammad Ali Shahiman
Department of Urology & Renal
Transplantation, Benazir Bhutto Hospital,
Rawalpindi Medical University, Rawalpindi
 Abstract
Aims & objectives
• The aim of this study is to compare the safety
of tubeless versus totally tubeless PCNL in
terms of important postoperative clinical
parameters.
 Materials & methods
• A total of 80 patients who were candidates for PCNL
with no comorbid were randomized into two groups.
• 40 patients underwent tubeless PCNL in whom a 4.8fr
DJ stent was placed at the end of the procedure .
• 40 patients underwent totally tubeless in whom a 5fr
open ended ureteric catheter was placed and kept for
24 hours.
• Postoperative fever, flank pain, hematuria, urinary
leakage and any infection requiring additional
antibiotic coverage were recorded on a well-structured
proforma for each patient.
 Results
• From January 2017 to October 2017 80
patients who underwent PCNL were divided
into two groups tubeless PCNL (n=40) and
totally tubeless PCNL (n=40).
• Mean age, mean BMI and mean stone size
was comparable among two groups .
• The mean operative time was 42.3 minutes in
tubeless group versus 32.3 minutes in totally
tubeless group.
 Results
• Postoperative hematoma/urinoma was not
observed in any group.
• Regarding the postoperative pain , mean
visual analogue score was 3 In the tubeless
versus mean 1.8 in the totally tubeless group.
• Postoperative fever was observed in 20% of
patients with DJ-Stent versus 12.5% with
totally tubeless PCNL
 Results
• Mild hematuria was observed in 7.5% of tubeless
group versus 2.5% of the totally tubeless group .
• Average rise in TLC was 4300/cmm in tubeless
versus 2700/cmm in the totally tubeless group.
• Infections required additional antibiotics was 7.5
versus 5 in the tubeless & totally tubeless group.
• Soakage was not found in any case of tubeless
group, however it was observed in 5% of patients
with totally tubeless PCNL
 Conclusion
• In our study totally tubeless PCNL when
compared to the Tubeless PCNL was associated
with less operative time, less postoperative pain,
fever, hematuria, infection.
• However, tubeless PCNL had a less postoperative
leakage and soakage of dressing probably due to
improvrd renal drainage.
• In our opinion totally tubeless PCNL is an
excellent and importantly a safe modification of
the conventional procedure and should be
employed in routine.