Tubeless percutaneous nephrolithotomy for complex renal stone disease: single center experience.

OBJECTIVE Tubeless percutaneous nephrolithotomy (PCNL) has become an option for treatment of renal stone disease, though no clearly defined algorithm exists for selection of patients suitable to tubeless PCNL. We investigated our experience with tubeless PCNL to evaluate its safety and efficacy for cases of complex renal calculi. PATIENTS AND METHODS Retrospective review of all tubeless PCNLs performed for complex renal calculus disease (bilateral stones, partial/complete staghorn, infundibular stenosis/calyceal diverticulum, pre-existing renal insufficiency) between January 2001 and January 2006. All patients had a ureteral stent placed in an antegrade fashion following stone treatment, and a foley catheter remained in place overnight. No patient received nephrostomy tube (NT). Imaging (CT or KUB) was obtained at the first outpatient follow-up visit. Patient demographics, incidence of complications, clinical outcomes and stone-free rates were noted and analyzed. "Stone free" was defined as negative imaging (CT or KUB). RESULTS Forty-two patients (47 renal units) were treated with tubeless PCNL for complex renal stone disease (5 bilateral, 25 total/partial staghorn, 12 renal insufficiency, and 10 infundibular stenosis or calyceal diverticulum). Mean age was 58.2+/-9.4 years. Mean length of hospital stay was 2.1 days. Mean preoperative and postoperative hematocrit were 40.5+/-4.5 and 37.2+/-5.8, respectively (p=0.001). Single-procedure stone free rate was 74.5%, and the two-procedure stone free rate was 91.5%. One patient (2.4%) required a blood transfusion and one patient (2.4%) developed urosepsis. CONCLUSIONS Tubeless PCNL is safe and effective and can be utilized in cases of complex renal stone disease.