Presented by: Hayden Hill MD
Washington University School of Medicine in St. Louis

Introduction

The necessity of nephrostomy tube after percutaneous nephrolithotomy (PCNL) has been called into question in modern series. We sought to examine differences in post operative complications and outcomes of tubeless PCNL versus standard PCNL at our institution.

Materials

A retrospective review of our institutional stone database was conducted from January 2016 to December 2021 for patients who had undergone either tubeless PCNL, defined by placement of only an internal ureteral stent, or standard PCNL, which involved placement of an externalized nephrostomy tube. Patients were excluded if they underwent totally tubeless PCNL. 

Results

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A total of 438 patients were included for analysis: 329 patients underwent tubeless PCNL and 109 patients underwent standard PCNL. Between tubeless and standard groups there was no difference in readmission rates 6.1% vs 9.2% (p=0.268), clavien 2 or > complications 18.5% vs 19.3% (p=0.923), and clavien 3 or > complications 4.0% vs 7.3% (p=0.151). The tubeless group experienced shorter operative duration 121.5 vs 144.8 minutes (p=0.012), shorter length of stay 2.5 vs 3.8 days (p=0.002), higher stone free rates 72.3% vs 60.2% (p=0.014), but also increased blood transfusion rates 6.4% vs 0.9% (p=0.022). 

Conclusion

In comparing tubeless with standard PCNL there was no difference in readmission rates, or significant clavien complication rates. Patients undergoing tubeless PCNL experienced higher stone free rates, but more required post operative blood transfusion. The decision to leave a nephrostomy tube after PCNL appears unlikely to impact overall complication rates and can be left to surgeon experience and case-based discretion. 

Funding

None

Co-Authors

Rebekah Keller, MD
Washington University School of Medicine in St. Louis

Susan Talamini, MD
Washington University School of Medicine in St. Louis

Joel Vetter,
Washington University School of Medicine in St. Louis

Charles Nottingham, MD
Washington University School of Medicine in St. Louis