The purpose of this study was to perform a randomized controlled trial to evaluate the role, safety, and effectiveness of totally tubeless PCNL and whether this procedure is less morbid in terms of
analgesia requirement, related complications and
convalescence. A total of 131 patients, with impacted ureteropelvic junction stone or single renal pelvic stone larger than 20 mm, were prospectively randomized (using random numbers table) into two groups, and underwent conventional (63 patients) or totally tubeless (68 patients) PCNL. Preoperative data included urinalysis, urine culture, complete blood count, biochemistry study, renal ultrasonography, intravenous urography and
Tc 99m DTPA clearance for determination of selective glomerular filtration rate. Intraoperative findings,
operative time, and outcome were also recorded. All patients were followed regularly at clinic every 3 months during year 1 and every 6 months, thereafter, and
Tc 99m DTPA clearance for the determination of selective glomerular filtration rate, renal ultrasonography and intravenous urography was performed to assess the kidney function 6 months later. There was no difference between the groups with regard to serum
creatinine change,
hemoglobin decrease, morphology improvement, resumption of normal activity and complication grading. The
length of stay,
pain visual analog scale and
analgesic requirements favored the tubeless group with statistical significance. There was significant statistical difference in relative perfusion rate between preoperative and postoperative in both groups. This trial demonstrates that totally tubeless PCNL is safe and well tolerated in selected patients and associated with decreases in
length of stay,
postoperative pain and
analgesia requirement. Most importantly, patients undergoing uncomplicated PCNL are not mandated to have a
nephrostomy or ureteral
stent placed for specific indications.