The efficacy of conventional PCNL and two modifications to standard procedure.

OBJECTIVE To compare the efficacy of conventional Percutaneous Nephrolithotomy (PCNL) with two of its modified procedures. METHODS A randomized controlled trial, was performed on 60 patients undergoing PCNL. Cases of renal stone regardless of stone size and configuration, having pre-operative negative urine culture, no coagulopathy, and no visible residual stone in intra-operative fluoroscopy, were included. They were randomly divided into 3 groups of 20 cases each with nephrostomy tube (NT) and temporary ureteral catheter (TU) in group A, only TU in group B and only indwelling ureteral catheter (IU) in group C. Mean age of cases were 43.2 (25-70), 40.1 (25-73), and 44 (25-70) years in groups A , B and C, respectively (P = 0.6). Procedures were performed under general anaesthesia, using standard techniques for access and lithotomy. Forty-eight hours, 2 weeks and 3 months after PCNL, plain X-ray abdomen, ultrasonography and IVP were performed for each case. RESULTS Only one case in group A had urinary leakage after removal of nephrostomy tube. No cases in the other two groups encountered this problem. There was no haemorrhagic episode. Ultrasonic evaluation showed mild residue in 3, 1 and 1 cases of groups A, B and C, respectively (P = 0.2). No collective fluid was found in these groups. IVP showed dilatation without obstruction in 3 subjects of group A and none in group B or C (P = 0.03). CONCLUSION Tubeless PCNL seems to be accompanied by better outcome. So, further evaluation on more patients seems necessary.