A retrospective study: Is nephrostomy tube necessary after uncomplicated PCNL

Abstract

Introduction: PCNL is widely used to treat upper urinary tract calculi. An indwellinglarge bore nephrostomy tube is left at the conclusion of the procedure to tamponadethe bleeding site made during the access tract. In recent times, the introduction
of tubeless PCNL has led to a decrease in post-operative pain, urinary leakage, andhospital stay duration.
Objective: The aim of this study is to find the difference between standard PCNLand tubeless PCNL with regard to postoperative pain, duration of hospital stay andanalgesic requirement.
Methodology: 233 patients who had undergone PCNL were divided into two groups.Group A - 125 patients with nephrostomy tube placement postoperatively along with Double-J stent and Group B - 108 patients with antegrade placement of a DJ stentwithout nephrostomy. The two groups were compared for age and sex, postoperative pain (VAH score), analgesia requirement, blood loss, postoperative morbidity (urinary leakage, pyrexia), and length of hospitalization.
Results: All patients had an uneventful postoperative recovery. The mean age and preoperative hemoglobin values were not significantly different between the two groups. Postoperatively, postoperative pain (p< 0.01), analgesia requirement (p< 0.01),
and length of hospitalization (p< 0.01) were significantly lower in the tubeless PCNL group. At the same time, the incidence of urine leakage, pyrexia and blood transfusion were not statistically not significant with p value of 0.387, 0.38 and 0.102 respectively..
Conclusion: In cases of PCNL without complication, the practice of keeping the nephrostomy tube is not required. Need of further prospective study with proper randomization will further validate this result.