Tubeless percutaneous renal surgery: review of first 112 patients

Objectives. To assess the outcome and safety of the first 112 patients undergoing tubeless percutaneous renal surgery. Methods. A total of 116 renal units in 112 patients underwent tubeless percutaneous renal surgery from December 1995 to November 2000 performed by a single urologist. The “tubeless” procedures consisted of nephrolithotripsy or endopyelotomy. An antegrade internal ureteral stent was placed during surgery, as was a Foley catheter for bladder drainage, in all patients. Nephrostomy tubes were not used in any patient. The incidence of complications, length of hospitalization, outcomes, transfusion requirements, stone burden, and stone-free rates were obtained by chart review. Results. Of the 112 patients, 86 patients underwent percutaneous stone extraction and 26 patients underwent percutaneous antegrade endopyelotomy. In the group of patients undergoing percutaneous stone extraction, the mean stone burden was 3.30 cm 2. Patients stayed in the hospital an average of 1.25 days. A total of 5 patients required postoperative transfusions. One patient was found on readmission to have a pseudoaneurysm. A 93.0% stone-free rate was achieved. The correlations between transfusion rates, days of hospitalization, and outcome with stone burden were not statistically significant ( P = 0.56, 0.78, and 0.18, respectively). For the endopyelotomy group, the mean length of hospitalization was 1.56 days. Only 1 patient required a transfusion, and 3 patients had postoperative complications. Of the 26 patients, 88.5% had a successful outcome from their endopyelotomy. Conclusions. Tubeless percutaneous renal surgery is a safe and effective procedure and can be performed in patients even with a moderate stone burden.