Totally tubeless percutaneous nephrolithotomy for upper pole renal stone using subcostal access.

Purpose: To assess the outcome and safety of the totally tubeless percutaneous nephrolithotomy (PCNL) from subcostal access in patients with renal stone in the upper pole of the kidney.

Patients And Methods: Seventy patients with upper pole renal stones were enrolled in a randomized clinical trial from April 2003 to November 2008. The inclusion criteria were the existence of solely upper pole stones, stone size >1.5 cm, extracorporeal shockwave lithotripsy failure or stone in closed calix and diverticulum, and successful subcostal access for reaching the stone. The exclusion criteria were unsuccessful subcostal access, more than two percutaneous accesses, prominent collecting system perforation, intraoperative significant bleeding, ureteral obstruction, and renal anomaly. The totally tubeless procedure was performed on 35 patients (group A); another 35 patients (group B) underwent standard PCNL. The incidence of complications, hospital stay, transfusion rate, stone-free rate, and analgesics use as well as return to normal activity were compared during a 1-month study period.

Results: The mean stone burden was 2.81 (standard deviation [SD] = 0.59) in group A vs 2.87 (SD = 0.62) cm(2) in group B. Hospitalization averaged 1.49 (SD = 0.7) vs 2.89 (SD = 0.99) days (P < 0.001), and the average analgesics use was 8.2 (SD = 3.59) mg vs 14.3 (SD = 5.99) mg of morphine, respectively (P < 0.001). The patients returned to normal activity in 11 (SD = 4.2) days in group A vs 17.6 (SD = 4) days in group B (P < 0.001). Operative time, transfusion rate, complications, re-treatment, and the overall stone-free rate were not different significantly, and no major complication was seen in the study as well.

Conclusion: Totally tubeless PCNL for the upper pole renal stone from subcostal access is accompanied by decreased hospital stay and analgesics use and a rapid return to normal activity. It can be considered as an accepted and cost-beneficial procedure for upper pole renal stones.