Comparison of Complications and Surgical Outcomes of Percutaneous Nephrolithotomy with and Without Nephrostomy: A Double-Blind Randomized Controlled Trial

Background: Percutaneous nephrolithotomy (PCNL) has been established as a minimally invasive treatment option for removal of kidney stones. The aim of this research was to compare complications and surgical outcomes of standard PCNL with tubeless PCNL. Methods: In this double-blind randomized controlled trial, 50 consecutive patients with kidney stone were randomly assigned to intervention and control groups. In the control group, a nephrostomy was placed at the end of PCNL and in the intervention group, nephrostomy was omitted. Incidence of fever, hospital stay, analgesic requirement, blood transfusion, urinary leakage, and patient’s satisfaction were compared between the 2 groups. Results: Pain score was significantly lower in the tubeless group in comparison with the control group (P 0.001). Analgesic use among patients of the tubeless PCNL group was significantly lower than the control group (P value 0.02). Eight percent of the control group and 20% of the intervention group had a transient fever (P value 0.05). Hemoglobin levels did not show any significant difference between the 2 groups (P value 0.78). The number of patients with “low urine leakage” was significantly higher in the tubeless group than in the control group (P 0.002). Hospital stay was significantly lower while patient satisfaction was significantly higher in patients, who underwent tubeless PCNL in comparison with the control group (P 0.02). Conclusions: The evidence from this study provides some support for application of tubeless percutaneous nephrolithotomy for patients with renal stone, regardless of the stone size and type.