Original Article: Clinical Investigation Tubeless simultaneous bilateral percutaneous nephrolithotomy: Safety, feasibility and efficacy in an Indian setting Sunil Pillai, Dilip Mishra, Pritam Sharma, Giridhar Venkatesh, Arun Chawla, Padmaraj Hegde and Joseph Thomas Department of Urology, Kasturba Medical College and Hospital, Manipal University, Manipal, Karnataka, India Abbreviations & Acronyms AKI = acute kidney injury CSRF = clinically significant residual fragments HD = hemodialysis ICD = intercostal drainage ICS = intercostal space INR = Indian rupees PCNL = percutaneous nephrolithotomy SBPCNL = simultaneous bilateral percutaneous nephrolithotomy SWL = shock wave lithotripsy Correspondence: Dilip Mishra M.S., M.R.C.S., M.Ch., Department of Urology, Kasturba Medical College, Manipal University, Manipal, Karnataka 576104, India. Email: docdilipmishra@yahoo.co.in Received 28 June 2013; accepted 23 October 2013. Online publication 28 November 2013 Objectives: To study the safety, feasibility and efficacy of tubeless simultaneous bilateral percutaneous nephrolithotomy. Methods: We retrospectively studied 85 patients who underwent tubeless simultaneous bilateral percutaneous nephrolithotomy in the Department of Urology, Kasturba Medical College, Manipal, Karnataka, India, from July 2006 to June 2013. The demographic profile and outcomes were compared with the other existing series reported in the literature. Results: A total of 65 male and 20 female patients with a mean age of 45.7 ± 11.6 years underwent tubeless simultaneous bilateral percutaneous nephrolithotomy. The mean stone burden was 299 mm 2 , with 12 staghorn calculi. Mean operative time was 87.6 ± 35.5 min. A total of 95% of stones were cleared with single access tracts. The success rate of tubeless simultaneous bilateral percutaneous nephrolithotomy (stone clearance) was 95.2%. Mean hemoglobin drop was 1.1 ± 0.9 gm% per patient, with 10.5% of patients requiring blood transfusion. Mean hospital stay was 69.6 ± 28.4 h. Complications included urosepsis (Clavien grade 4), acute kidney injury requiring hemodialysis (grade 3), pneumonia (grade = 2) and hydrothorax requiring intercostal drainage tube insertion (grade 3). On follow up, 4.7% of the renal units required ancillary procedures. Conclusions: Our findings confirm that tubeless simultaneous bilateral percutaneous nephrolithotomy is a safe and effective modality of treatment. It allows obviating a second anesthetic exposure, thus reducing analgesic requirement, hospitalization time and costs. This translates into a significant socioeconomic impact on the outlook of Indian patients presenting with bilateral renal stone disease. Key words: bilateral, cost-effective, percutaneous nephrolithotomy, simultaneous, tubeless. Introduction Much has changed since the first PCNL was carried out by Fernstrom and Johannson in 1976, almost four decades ago, when it was carried out as a staged procedure. 1 It was 8 years later that Wickham described his series of single stage PCNL in 1984, with a mandatory nephrostomy tube drain post operatively. 2 The nephrostomy tube was believed to tamponade bleeding, help in drainage of the pelvi-calyceal system, minimize urinary extravasation and provide access for “second look” procedures if required. Bellman first described the technique of tubeless PCNL in 1997. 3 Since then, the practice of routine tubeless PCNL has been increasingly accepted for large, uncomplicated renal calculi. 4,5 In the past decade, it has been extended to tubeless SBPCNL – when it was first carried out by Weld and Wake in 2000. 6 Tubeless SBPCNL allows faster convalescence with less postoperative pain, offering equal efficacy to stone clearance, in addition to obviating a second anesthetic exposure. 6–10 Currently, totally tubeless PCNL is also carried out, but in more selected cases. 11–14 Only a limited number of studies are available on tubeless SBPCNL. 6–10 In the Department of Urology, Kasturba Medical College, Manipal, Karnataka, India, we treat a large volume of patients with renal stones. A large number of these comprise of patients having bilateral renal calculi. The present study was initiated to evaluate the safety, feasibility and cost-effectiveness of tubeless SBPCNL in treatment of bilateral renal stone disease. To our knowledge, this represents the largest series of such cases published in the literature. Methods This was a retrospective descriptive study of patients undergoing tubeless SBPCNL from July 2006 to June 2013 in our institution. During the study period, a total of 4267 PCNL were carried International Journal of Urology (2014) 21, 497–502 doi: 10.1111/iju.12352 © 2013 The Japanese Urological Association 497