www.ijcmr.com International Journal of Contemporary Medical Research Volume 3 | Issue 9 | September 2016 | ICV: 50.43 | ISSN (Online): 2393-915X; (Print): 2454-7379 2608 A Prospective Study on Outcomes of Tubeless Percutaneous Nephrolithotomy – Our Experience in SVIMS A Tyagi 1 , B Ramana 2 , D Ramesh 2 , J Jayaraju 3 , P Prasad 2 , S Suresh Goud 2 ORIGINAL RESEARCH ABSTRACT Introduction: The standard PCNL includes insertion of a nephrostomy tube and a Double J stent after the procedure. In recent days practice started towards Tubeless PCNL i.e no neprostomy tube or Double J stent following a PCNL in view of reduced morbidity and hospital stay. This leads to our study on tubeless PCNL with the objectives of evaluation of outcomes and complications with the same and systematically analyse to evaluate the eficacy and safety of tubeless percutaneous nephrolithotomy (PCNL). Material and Methods: This study conducted in department of urology SVIMS, Tirupati, where 54 patients underwent tubeless PCNL. In the group of tubeless PCNL, no nephrostomy tube or DJ Stent was inserted after removal of the stone fragments. We compared the results of tubeless PCNL with those of traditional procedure. The operative time, blood loss, perioperative complications, postoperative analgesic requirements and duration of hospitalization in the two groups were analyzed. Results: In our series, mean duration of surgery for Tubeless PCNL group is 56.4±6.52 minutes where as for traditional group it was 81.8±8.21 minutes, the average length of hospitalization was 2.5±0.93 days for tubeless PCNL group, and 4.8±1.2 days for traditional PCNL group (P<0.020). Besides, postoperative total analgesic requirements are signiicantly decreased in tubeless PCNL patients (P<0.0001). However, there were no statistical difference in patient’s age and gender, and blood loss for both the groups. There were no major complications or mortality in these two groups. Conclusions: Tubeless PCNL is a safe, economic and effective procedure compared with traditional PCNL, and it can markedly reduce the postoperative analgesic requirements and shorten the hospital stay and costs. Keywords: nephrostomy tube, DJ Stent, duration of surgery, analgesic usage, complications INTRODUCTION Percutaneous nephrolithotomy (PCNL) is the current treatment of choice for large renal stones. Traditionally, following PCNL a nephrostomy tube and DJ Stent were placed; however, it often resulted in postoperative discomfort and other complications. Several authors recently did not insert nephrostomy tube and DJ Stent after PCNL to reduce postoperative morbidity. A “Tubeless” percutaneous procedure—one that omits the postoperative nephrostomy tube-was initially proposed by Wickham and colleagues. 1 The concept was revived by Bellman and colleagues 2 , with the addition of an internal ureteral stent left in place for a week or two. Tubeless PCNL is mainly two types - Tubeless with ureteral stent, where after completion of procedure only double J stent passed, no nephrostomy tube inserted. - Totally tubeless PCNL i.e.no nephrostomy tube or DJ stent placed after the procedure. Karami et al 3 reported their 5-year experience in 201 patients undergoing tubeless PCNL with only an externalized ureteral catheter, and concluded that it was a safe, effective, and economical option. Similar results were reported by Ashraf Abou-Elela et al in 128 patients and Gupta et al in a study of 69 patients. 4 In light of the indings of studies comparing internal stents with nephrostomy tubes, it is not surprising that the three randomized controlled trials of “totally tubeless” percutaneous renal surgery (Aghamir et al, 2008; Crook et al, 2008a; Istanbulluoglu et al, 2009) also found reduced duration and intensity of convalescence in the groups without nephrostomy tube and DJ stent. 5 Purpose was to study outcomes and complications of tubeless PCNL and to systematically analyse the safety and eficacy of the tubeless PCNL. MATERIAL AND METHODS This was a prospective comparative study, conducted in the Department of Urology, SVIMS (Sri Venkateshwara Institute of Medical Sciences), Tirupati, for a period of 12 months from March 2015 to February 2016. A total number of 54 cases of tubeless PCNL was studied data collected and results analysed. Sample size estimated based on prevalence of the operable renal calculi (using formula S =4pq/l 2 ) Results of study group were compared with other group of traditional PCNL with 58 patients. Inclusion criteria: Patients with renal and/or upper uretric calculi of greater than 1.5cm, negative urine culture and no coagulopathy. Exclusion criteria: Those patients with solitary kidney, more than 2 percutaneous accesses, signiicant perforation of the collecting system and signiicant intraoperative bleeding and patients with raised creatinine, patients with ectopic, malrotated and fused kidneys. Pre-operative assessment done with indication for surgery and patient's complete history and physical examination. Important laboratory parameters such as urine analysis and culture / sensitivity, haemoglobin, electrolytes and serum urea/creatinine, coagulation proile were checked before the surgery. Hb%, 1 Professor and HOD Urology, 2 Senior Resident, 3 Asst Professor, Sri Venkateswara Institute of Medical Sciences, Tirupati, AP, India Corresponding author: Dr Ramana Bdumuru, Senior Resident, Department of Urology, SVIMS, Tirupati, PIN:517507, AP, India. How to cite this article: A Tyagi, B Ramana, D Ramesh, J Jayaraju, P Prasad, S Suresh Goud. A prospective study on outcomes of tubeless percutaneous nephrolithotomy – our experience in SVIMS. International Journal of Contemporary Medical Research 2016;3(9):2608-2611.