Totally tubeless percutaneous nephrolithotomy in renal anomalies.

OBJECTIVES To assess the outcome and safety of the totally tubeless percutaneous nephrolithotomy in renal anomalies. PATIENTS AND METHODS During a prospective clinical trial from December 2002 to November 2006, 60 patients with renal anomalies and nephrolithiasis were included in our study. The anomalies consisted of the horseshoe kidney, rotational anomalies of pyelocalyceal system, and ectopic kidney. The patients were randomly divided in two groups: the "totally tubeless" procedures performed in 30 patients (the nephrostomy tube and internal stent were not used in any patient), and 30 patients underwent standard percutaneous nephrolithotomy (PCNL; using both nephrostomy tube and ureteral stent). The incidence of complications, hospital stay, transfusion requirements, and stone-free rates were compared in the two groups. RESULTS In the group of patients that underwent totally tubeless PCNL for the stone extraction, the mean stone burden was 2.54 cm(2) (standard deviation [SD] = 0.96). Patients' stay in the hospital averaged 1.3 (SD = 0.43) days. The average analgesics requirement was 4.5 (SD = 1.6) mg of morphine. The patients returned to normal activity in 10 (SD = 3.2) days. The postoperative complications were blood transfusion in one patient (3.3%) and fever in one patient (3.3%). An 83.3% stone-free rate was achieved. For the standard PCNL group, the mean stone size was 2.83 (SD = 0.76) cm(2), and the mean length of hospitalization was 2.6 (SD = 0.65) days. The average analgesics requirement was 10.4 (SD = 3.2) mg of morphine, and the time to return normal activity was 15.5 (SD = 3.2) days. Only 2 (6.7%) patients required a transfusion, and 1 (3.3%) patient had postoperative complications (penumothorax). Of the 30 patients, 86.7% became stone free. The differences between operation time, transfusion rates, complications, retreatment, and overall stone-free rate were not statistically significant in the two groups but days of hospitalization (P < 0.001), analgesics requirement (P < 0.001), and time of return tonormal activity (P < 0.001) were statistically significant. CONCLUSIONS Totally tubeless percutaneous renal surgery is a safe and effective procedure in renal anomalies and can be performed in patients even with a moderate to large stone burden.