• SHAKIR S. BALANDI Assistant Professor, Department of Surgery, College of Medicine, University of Duhok, Kurdistan Region, Iraq
  • ISAM H. IBRAHEM Physycian, Department of Urology, Azadi Teaching Hospital, Duhok, Kurdistan Region, Iraq
Keywords: calculi, standard, tubeless PCNL


Background: Urolithiasis is one of the common diseases of human being. The introduction of endoscopic and minimally invasive procedures [extra corporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), and Ureteroscopy] has revolutionized the treatment of stone disease. Percutaneous nephrolithotomy is the gold standard for the treatment of renal calculi. Recently, modifications to the standard PCNL regarding tube placement have evolved. This study aimed to evaluate the safety, benefits and feasibility of tubeless PCNL in comparison to the standard PCNL.

 Subject and Methods: Fifty patients were prospectively randomized equally into two groups, group 1 (tubeless PCNL) and group 2 (standard PCNL). All patients underwent PCNL for the treatment of upper urinary tract stones. The operations were done under general anesthesia with antimicrobial cover; of them 29 were males and 21 were females. In group 1, 25 patients had no nephrostomy tube placed while in group 2, 25(50%) patients had nephrostomy tube. We evaluated and compared between both groups in operative time, length of hospitalization, analgesic requirements; stone free rate and post-operative complications (infection or blood transfusion).

Results: Thirty-one patients (62%) in both groups had a single stone, while 19 patients (38%) had multiple stones. PCNL alone was successful in completely clearing all the stone(s) in (88%) of patients, while 5 patients (10%) were treated by ESWL and one patient required another session of PCNL. The mean operative time for group 1 was 56.72 minutes vs. 77.0 minutes for group 2. The mean hospital stay was 1.2 days and 2.32 days in group 1 and group 2 respectively. Only 12% of group1 needed more than 2 analgesia (injectable), while 52% of group2 needs more than 2 analgesia (injectable). Blood transfusion was required in one patient (4%) of each group.

Conclusions: Tubeless PCNL is a safe and effective procedure with advantage of short hospital stay and lesser analgesic requirement without increasing complications.


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1. Wickham JEA. Treatment of urinary tract stones. BMJ 1993; 307: 1414-7.
2. Khan S, Toori LA, Anwer K. The efficacy of percutaneous nephrolithotomy in renal and upper ureteric calculi. Pakistan J Med Res 2005; 44: 89-91.
3. Marshall L. Stoller, MD. Urinary Stone Disease. In: Emil A. Jack W. Mc.Aninch editor. Smith General Urology. 17th edition. LANGE.2008:16:246-277.
4. John J. Pahira, MD. And Millie pevzner, MD. Nephrolithiasis. In: Philip M, Alan J, Bruce S. editors. Penn Clinical Manual of Urology. Vol 1. Saunders Elsevier,2007;8:235-257.
5. Lingeman JE, Matlaga BR, Evan AP. Surgical management of upper urinary tract calculi. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell – Walsh Urology. 9thed. Vol. 2. Philadelphia: Saunders Elsevier; 2007. P. 1431-5 07
6. Rudnick DM, Bennett PM, Dretler SP. Retrograde renoscopic Fragmentation of Moderate Size (1.5-3.0cm) renal cystine stone. J Endourol 1999;13:483-5.
7. Steven B. Steem and J. Stephen Jone. Renal Calculus Disease. In: Andrew C. Novich, J. Stephen, editors. Operative Urology at Cleveland clinic. 1st edition, Humana Press.2006;6:65-88.
8. Mark F, Kevin T. Stone Disease-Percutaneous nephrolithotomy. In: John RE, Stephen Mark, Noel AR, Kevin TU, Mark FE, Mark SU, editors. Urological Surgery. OXFORD University Press.2008;416-431.
9. Michel MS, Trojan L, Rassweiler JJ. Complications in Percutaneous Nephrolithotomy. Eur Urol 2007; 51: 899-906.
10. J.Stuart Wolf, Jr upper urinary trac., MD, FACS. Percutaneous Approaches to the Upper Urinary Tract Collecting System. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell – Walsh Urology. 10thed. Vol. 2. Philadelphia: Saunders Elsevier; 2012. P. 1023-1752.
11. Kessaris DN, Bellman GC, Pardalidis NP, Simth AG, Management of hemorrhage after percutaneous renal surgery. J Uro 1995;153: 1097-1100.
12. Martin X, Murat FJ, Fietosa LC et al. Severe bleeding after nephrolithotomy: result of hyperselective embolization. Eur Uro 2000;37:136—9.
13. LeRoy AJ, Williams HJ Jr, Bender CE, Segura JW, Patterson DE Benson RC. Colon perforation following percutaneous nephrostomy and renal calculus removal. J Radiology 1985; 155: 83-85.
14. Pardalidis N, Smith AD. Complications of Stone Treatment. In: Contraversis in Endourology, ed. Smit AD. Philadelphia, PA: WB Saundes, 1995; pp 179-85.
15. Carson CC, Nesbitt JA. Peritoneal extravasation during percutaneous lithotripsy. J Urology 1985; 134: 725.
16. Dimberg M, Norlen H, Hoglund N, Allgen LG. Absorption of irrigating fluid during percutaneous transrenal lithotripsy. Scand J Urol Nephrol 1993; 27: 463.
17. Hemendra N. Shah, Vikram B. Kausuk, Sunil S. Hagde, Jignesh N. Shah and Manish B. Bansal. Tubeless percutaneous nephrolithotomy: a prospective feasibility study and review of previous reports.BJU 2005; 879-883.
18. Shashikant Mishra, Ravindra B. Sabnis, Abraham Kurien, Arvind Ganpule, Veeramani Muthu and Mahesh Desai. Questioning the wisdom of tubeless percutaneous nephrolithotomy (PCNL): a prospective randomized controlled study of early tube removal vs tubeless. BJU; 2010:106, 1045–1049.
19. Bellman GC, Davidoff R, Candela J, Gerspach J, Kurtz S, Stout L. Tubeless percutaneous renal surgery. J Urol1997; 157: 1578–82.
20. Delnay KM, Wake RW. Safety and efficacy of tubeless percutaneous nephrolithotomy. World J Urol1998; 16: 375–7.-8.
21. Jou YC, Cheng MC, Sheen JH, Lin CT, Chen PC. Cauterization of access tract for nephrostomy tube-free percutaneous nephrolithotomy. J Endo Urol 2004; 18:547–9
22. . Aghamir SM, Hosseini SR, Gooran S. Totally tubeless percutaneous
nephrolithotomy. J Endourol2004; 18:647.
23. Kim SC, Kuo RL, Lingmen JE, Percutaneous nephrolithotomy: an up date. Current openion Urol. 2003;13:235-341.
24. . Hemendra Shah, Amit Khandkar, Hiren Sodha, Shabbir Kharodawala,
Sunil Hegde* and Manish Bansal. Tubeless percutaneous nephrolithotomy: 3 years of experience with 454 patients. BJU, 2009; 104: 840–846.
25. Percy Jal Chibber. Percutaneous nephrolithotomy for 1-2 cm lower-pole renal calculi. Indian J Urol. 2008 Oct-Dec; 24(4): 538.
26. Ziaee SAM, Abdolla N, Basiri A, Simforoosh N, Danish AK, Sharifi Aghdas F, Tabibi A. PCNL in the Management of Lower Pole Caliceal Calculi.Urology Journal. 2004;Vol. 1, No. 3, 174-176.
27. Karami H, Gholamrezaie HR. Totally tubeless percutaneous nephron-lithotomy in selected patients. J Endourol2004; 18:475–6
28. . Mahmoud M Shalaby, Medhat A Abdalla, Hassan A Aboul-Ella, Abdel Monem. A El-haggagy and Alaa A Abd-Elsayed .Single puncture percutaneous nephrolithomy for management of complex renal stones. BMC Research Notes 2009, 2:62
29. . Yang RM, Bellman GC. Tubeless percutaneous renal surgery in obese patients. Urology2004; 63: 1036–40.
30. . Aghamir SM, Modaresi SS, Aloosh M, Tajik A..Totally tubeless percutaneous nephrolithotomy for upper pole renal stone using subcostal access. J Endourol. 2011 Apr;25(4):583-6.
31. . Kara C, Resorlu B, Bayindir M, Unsal A.A randomized comparison of totally tubeless and standard percutaneous nephrolithotomy in elderly patients. 2010 Aug;76(2):289-93.
32. . Gonulalan U, Cicek T, Istanbulluoglu O, Kosan M, Ozturk B, Ozkardes H. Tubeless percutaneous nephrolithotomy is effective and safe in short- and long-term urinary drainage. Urolithiasis. 2013 Aug;41(4):341-6.
33. . Jiawu Wang, Chunlei Zhao , Chengyao Zhang , Xiaodong Fan, Yanjun Lin and Qing Jiang. Tubeless vs standard percutaneous nephrolithotomy: a meta-analysis. BJU. 2011; 109, 918–924.
34. Sang Cheol Lee, Chang Hee Kim, Kwang Taek Kim, Tae Beom Kim, Khae Hawn Kim, Han Jung, Sang Jin Yoon, and Jin Kyu Oh. Is Tubeless Percutaneous Nephrolithotomy a Feasible Technique for the Treatment of Staghorn Calculi? Korean J Urol. 2013 October; 54(10): 693–696.
35. Mustafa Kirac, Abdulkadir Tepeler, Omer Faruk Bozkurt, Fatih Elbir, Cem Ozluk, Abdullah Armagan, Ali Unsal, and Hasan Biri . The Efficacy of Bupivacaine Infiltration on the Nephrostomy Tract in Tubeless and Standard Percutaneous Nephrolithotomy: A Prospective, Randomized, Multicenter Study. UROLOGY 2013,82: 526-531.
36. . Salavati A,Aghamir SM, Aloosh M, Farahmand H, Meysamie A, Pourmand G. Feasibility of totally tubeless percutaneous nephron-lithotomy under the age of 14 years: a randomized clinical trial. J Endourol. 2012 Jun;26(6):621-4.
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