Nephrostomy tube-free percutaneous nephrolithotomy for patients with large stones and staghorn stones

Objectives. To perform a retrospective study to assess the outcome and safety of 64 nephrostomy tube-free percutaneous nephrolithotomies (PCNLs) in 62 patients with calculi 3 cm or greater. Methods. Between March 2001 and June 2004, 365 consecutive patients underwent 389 PCNLs at our hospital. Electrocauterization of the access tract was performed at the end of the operation in every patient. No nephrostomy tube was inserted in the patient if a bloodless tract had been obtained. Of the 389 PCNLs, 154 were performed in patients with a stone size of 3 cm or greater. Of these 154 PCNLs, 64 were performed with the nephrostomy tube-free modification (group 1) and 90 were performed with insertion of the nephrostomy tube after the operation (group 2). The hospital course and complications were evaluated in both groups. Results. No statistically significant differences in age, stone size, urinary tract infection rate, or blood transfusion rate were found between those with and without insertion of the nephrostomy tube. Fourteen patients in group 1 had complete staghorn stones. A shorter operative time, lower analgesic requirement, and shorter postoperative hospital stay were noted in the group with the nephrostomy tube-free modification (group 1). Conclusions. With adequate homeostasis, nephrostomy tube-free PCNL can be performed in patients with complicated urolithiasis without any increase in morbidity. UROLOGY 67: 30-34, 2006. (c) 2006 Elsevier Inc.