Efficacy of Tubeless versus Standard Percutaneous Nephrolithotomy (PCNL) – A Randomized Controlled Trial

Author(s): Dr. S M Yunus Ali, Dr. Kamrun Nahar, Dr. Muhammad Serajul Islam, Dr. Md Immam Hossain, Prof. Dr. Md. Saiful Islam, Dr. Md. Rasel Ahmad.

Background: Percutaneous Nephrolithotomy (PCNL) is commonly used to remove large renal stones but often requires nephrostomy tubes, which can increase postoperative pain and hospital stay. Tubeless PCNL, which omits the tube, may reduce discomfort and speed recovery, though its clinical advantages over standard PCNL remain uncertain. Methods: A randomized controlled trial was conducted at Bangladesh Medical University, enrolling 100 adult patients with renal stones greater than 2 cm. Patients were randomly assigned to either the Tubeless PCNL or Standard PCNL group. Primary outcomes included postoperative pain (measured by the Visual Analog Scale), hospital stay duration, complication rates, and stone-free status (assessed by imaging at 3 months). Statistical analyses included descriptive statistics, independent t-tests, and chi-square tests. Result: The Tubeless PCNL group had significantly lower postoperative pain (p < 0.001), shorter hospital stay (1.6 vs. 3.2 days, p < 0.001), and fewer complications, including urinary leakage (p = 0.03) and overall complication rate (14% vs. 44%, p = 0.002). Stone-free rates at 3 months (88% vs. 84%, p = 0.57) and 12-month recurrence rates (6% vs. 10%, p = 0.44) were comparable between groups. Conclusion: Tubeless PCNL appears to be a safe and effective alternative to Standard PCNL, offering less pain, shorter hospitalization, and fewer complications while maintaining comparable stone-free and recurrence outcomes, though larger and longer studies are still needed to validate these findings.