A Cross-Sectional Study Comparing Tubed PCNL And Tubeless PCNL: An Experience at the Institute of Kidney Diseases (IKD), Peshawar
Article Sidebar
Main Article Content
Abstract
Background: Percutaneous Nephrolithotomy (PCNL) has revolutionized the treatment of large renal and proximal ureteric stones, offering a minimally invasive alternative to open surgery. The introduction of tubeless PCNL, which omits the placement of a nephrostomy drainage tube, has generated discussion regarding its efficacy and safety compared to the traditional tubed PCNL.
Objective: This study aims to compare the outcomes of tubed versus tubeless PCNL in terms of post-operative complications, recovery time, and efficacy in stone removal.
Methods: A retrospective cross-sectional analysis was conducted on 110 patients who underwent PCNL at the Institute of Kidney Disease, Peshawar, from January 2017 to December 2020. Patients were allocated into two groups, tubed PCNL (n=50) and tubeless PCNL (n=50), based on 1:1 sequential randomization. The inclusion criteria were ASA I and ASA II classification, age between 5 to 70 years, and single tract procedure with complete clearance without the need for a second look nephrostomy. Exclusion criteria included patients with a solitary kidney, active urinary tract infections, and congenital malformations. Data on age, gender, co-morbidities, history of ESWL, stone size, location, quantity, and post-operative outcomes were collected and analyzed using SPSS version 25.
Results: No significant differences were found in patient demographics or stone characteristics between the two groups. The tubeless PCNL group demonstrated a significantly lower rate of post-operative ESWL sessions (4% vs. 22%, p=0.02) and a trend towards shorter hospital stays, although not statistically significant. The drop in hemoglobin levels post-operation was less in the tubeless group (0.84 ± 1.87 mg/dl) compared to the tubed group (1.56 ± 0.91 mg/dl), but this was not statistically significant (p=0.17).
Conclusion: Tubeless PCNL offers a viable alternative to traditional tubed PCNL, particularly for patients with smaller renal stones. It is associated with a lower need for post-operative ESWL sessions and potentially shorter hospital stays, suggesting an advantage in terms of recovery and post-operative comfort. Further prospective studies are warranted to confirm these findings and explore the long-term outcomes of the tubeless technique.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Istanbulluoglu, M. O., Cicek, T., Ozturk, B., Gonen, M., & Ozkardes, H. (2010). Percutaneous nephrolithotomy: nephrostomy or tubeless or totally tubeless? Urology, 75(5), 1043-1046.
Agrawal, M. S., Agrawal, M., Gupta, A., Bansal, S., Yadav, A., & Goyal, J. (2008). A randomized comparison of tubeless and standard percutaneous nephrolithotomy. Journal of Endourology, 22(3), 439-442.
Surag, K. R., Singh, A., Sharma, P., Pai, V., Choudhary, A., Patil, S., ... & Singh, A. (2023). Comparing tubeless and tubed approaches in percutaneous nephrolithotomy for moderate renal calculi: Outcomes on safety, efficacy, pain management, recovery time, and cost-effectiveness. Cureus, 15(5).
Collins, T. C., Daley, J., Henderson, W. H., & Khuri, S. F. (1999). Risk factors for prolonged length of stay after major elective surgery. Annals of Surgery, 230(2), 251.
Penman, I. D., Ralston, S. H., Strachan, M. W., & Hobson, R. (Eds.). (2022). Davidson's Principles and Practice of Medicine E-Book. Elsevier Health Sciences.
Bellman, G. C., Davidoff, R., Candela, J., Gerspach, J., Kurtz, S., & Stout, L. (1997). Tubeless percutaneous renal surgery. The Journal of Urology, 157(5), 1578-1582.
Zilberman, D. E., Lipkin, M. E., De la Rosette, J. J., Ferrandino, M. N., Mamoulakis, C., Laguna, M. P., & Preminger, G. M. (2010). Tubeless percutaneous nephrolithotomy—the new standard of care? The Journal of Urology, 184(4), 1261-1266.
Pietrow, P. K., Auge, B. K., Lallas, C. D., Santa-Cruz, R. W., Newman, G. E., Albala, D. M., & Preminger, G. M. (2003). Pain after percutaneous nephrolithotomy: impact of nephrostomy tube size. Journal of Endourology, 17(6), 411-414.
Bilen, C. Y., Gunay, M., Ozden, E., Inci, K., Sarikaya, S., & Tekgul, S. (2010). Tubeless mini percutaneous nephrolithotomy in infants and preschool children: A preliminary report. The Journal of Urology, 184(6), 2498-2503.
Sebaey, A., Khalil, M. M., Soliman, T., Mohey, A., Elshaer, W., Kandil, W., & Omar, R. (2016). Standard versus tubeless mini-percutaneous nephrolithotomy: A randomised controlled trial. Arab Journal of Urology, 14(1), 18-23.
Ichaoui, H., Samet, A., Hadjalouane, H. B., Hermi, A., Hedhli, H., Bakir, M. A., ... & Alouane, H. B. H. (2019). Percutaneous nephrolithotomy (PCNL): standard technique versus tubeless-125 procedures. Cureus, 11(3).
Giusti, G., Piccinelli, A., Maugeri, O., Benetti, A., Taverna, G., & Graziotti, P. (2009). Percutaneous nephrolithotomy: tubeless or not tubeless? Urological Research, 37, 153-158.
Rana, A. M., & Mithani, S. (2007). Tubeless percutaneous nephrolithotomy: call of the day. Journal of Endourology, 21(2), 169-172.
Gupta, V., Sadasukhi, T. C., Sharma, K. K., Yadav, R. G., & Mathur, R. (2005). Tubeless and stentless percutaneous nephrolithotomy. BJU International, 95(6), 905-906.
Garofalo, M., Pultrone, C. V., Schiavina, R., Brunocilla, E., Sanguedolce, F., Borghesi, M., ... & Martorana, G. (2013). Tubeless procedure reduces hospitalization and pain after percutaneous nephrolithotomy: results of a multivariable analysis. Urolithiasis, 41, 347-353.
Akman, T., Binbay, M., Yuruk, E., Sari, E., Seyrek, M., Kaba, M., ... & Muslumanoglu, A. Y. (2011). Tubeless procedure is most important factor in reducing length of hospitalization after percutaneous nephrolithotomy: results of univariable and multivariable models. Urology, 77(2), 299-304.
Nouralizadeh, A., Simforoosh, N., Shemshaki, H., Soltani, M. H., Sotoudeh, M., Ramezani, M. H., ... & Ansari, A. (2018). Tubeless versus standard percutaneous nephrolithotomy in pediatric patients: A systematic review and meta-analysis. Urologia Journal, 85(1), 3-9.
Amer, T., Ahmed, K., Bultitude, M., Khan, S., Kumar, P., De Rosa, A., ... & Hegarty, N. (2012). Standard versus tubeless percutaneous nephrolithotomy: a systematic review. Urologia Internationalis, 88(4), 373-382.
Hill H, Talamini S, Vetter J, Nottingham C. Complications of tubeless versus standard percutaneous nephrolithotomy. International Urology and Nephrology. 2024 Jan;56(1):63-7.
Kumar N, Somani B. Supine tubeless upper pole PCNL under spinal anaesthesia: Safety, feasibility and outcomes from a tertiary endourology centre. Arab Journal of Urology. 2024 Jan 28:1-7.