["Tubeless" percutaneous nephrolithotomy: a series of 37 cases].

Objective: To assess the value and feasibility of "tubeless" percutaneous nephrolithotomy (without postoperative nephrostomy tube).

Material And Method: Prospective study of 37 consecutive patients operated by "tubeless" percutaneous nephrolithotomy (PCNL) between 1998 and 2007 for renal stones. Inclusion criteria for this technique were: a single puncture tract, a procedure lasting less than 2 hours, <3 stones with a diameter <25 mm, complete extraction of all stones and no significant bleeding in the renal cavities at the end of the operation. A 7 Fr ureteric stent was inserted at the beginning of the operation in 33 patients and a double J stent was already present in the last four patients. All these stents were not remowed at the end of the procedure and the nephrostomy tract was electrocoagulated by a blunt electrocautery loop mounted on a 26 F resectoscope. No nephrostomy tube was left in place and no haemostatic product was used. Complications, length of hospital stay, operating time, blood loss, transfusions and intensity of pain were recorded.

Result: The mean stone diameter was 172 mm. The mean percutaneous operating time was 72 min. The mean length of hospital stay was 1.9 days (range: 1 to 7 days). The success rate was 95% and the complication rate was 13.5%. Complications were: two cases of pyelonephritis, one case of prolonged haematuria, one case of renal colic and one case of urinary extravasation. The mean decrease in haemoglobin was 0.95 g/dl (range: 0 to 2 g/dl). The mean intensity of pain evaluated by visual analogue scale (VAS) was 1.9. No blood transfusion was required. The ureteric stent was removed on postoperative D1 in 91% of patients with a stent.

Conclusion: "Tubeless" percutaneous nephrolithotomy is an effective and reproducible procedure with low morbidity that provides satisfactory results in selected cases.