Abstract: PD16-09
Sources of Funding: None

Introduction

Since introduction, tubeless PCNL has undergone various technical modifications to further improve the outcome. Several published literature report that use of an externalized ureteral catheter during tubeless PCNL can obviate the stent related discomfort and the need for a second procedure (i.e. cystoscopic removal of stent). We conducted a prospective, randomized study to compare the outcomes using 2 different techniques (externalized ureteric catheter and double J stent) of internal drainage following tubeless PCNL.

Methods

From June 2011 to March 2016, a total of 492 patients underwent tubeless PCNL at our institution. A double J stent was placed in all cases of bilateral simultaneous PCNL, residual stone fragments, PCNL in solitary kidney and in patients with renal failure, so were excluded from study (n=55). Rest 437 patients were randomized into 2 groups: Group A (Tubeless PCNL with externalized ureteral catheter n= 225) and Group B (Tubeless PCNL with double J stent n=212). Study parameters include baseline (age, sex, stone burden, stone location/laterality, anomalous kidneys, past history of stone surgery), intraoperative (operating time, number of punctures, supracostal access, blood loss) and postoperative (analgesia requirement, hospital stay, stent related symptoms, complications, cost of treatment) and appropriate statistical methods were used for analysis.

Results

Baseline characteristics were comparable in both the groups. No statistical significant difference was observed between the groups with regards to operating time, number of punctures, site of puncture (supracostal or infracostal) and blood loss. Analgesia requirement (P= 0.04), hospital stay (P= 0.02), stent related symptoms (P=0.001) and treatment cost (P=0. 005) were significantly less in group A.

Conclusions

Our study demonstrated that tubeless PCNL using a ureteric catheter is a safe, reliable and relatively cost effective technique. It can reduce the complications associated with double J stent without affecting the efficacy of the procedure. However, the surgeon must ensure complete stone clearance in order to avoid ureteric colic. Further prospective, randomized trials are required to substantiate our results.

Funding

None