Comparison of Standard and Tubeless Percutaneous Nephrolithotomy for Renal calculi - A Prospective randomized control trial

Percutaneous Nephrolithotmy (PCNL) is the standard method for removal of large stones. Since its first description in 1976 by Fernström and Johansson, [1] considerable changes have occurred in the techniques and technology of PCNL. PCNL was associated with morbidities such as bleeding, pyrexia, incomplete stone removal, pleural injury, and adjacent organ injury. [2] After completion of stone removal, traditionally, a nephrostomy tube is placed. This helped in tamponade of bleeding, drainage of urine, tract recovery, and a guide for second look nephroscopy if needed. [3,4] Studies showed that smaller nephrostomy tubes were as effective as larger ones.[5-7]

Refinements in the technique, optics of the instruments, and better lithotripsy technologies have led to a reduction in these morbidities. The presence and removal of nephrostomy is associated with morbidities such as infection, pain, urine leak, bleeding, and prolonged hospitalization. [8]Bellman et al. in 1997 first described “tubeless†PCNL which involved placement of a ureteric stent without nephrostomy.[9] However, the presence of double‑J stent in tubeless PCNL is often associated with stent related problems such as frequency, urgency, nocturia, pain, and hematuria.[10]. In this study we will be evaluating the perioperative outcomes of tubless PCNL and compare it with standard PCNL. The purpose of this study is to determine whether tubeless PCNL are safe and less morbid management techniques for renal stones compared to the standard PCNL with nephrostomy tube.

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