Arch Esp Urol. 2025 Dec;78(10):1353-1361. doi: 10.56434/j.arch.esp.urol.20257810.177.
ABSTRACT
BACKGROUND: Percutaneous nephrolithotomy (PCNL) is the preferred technique for kidney stones larger than 20 mm in maximum diameter. The objective of this study is to evaluate the effect of the nephrostomy tube technique vs. that of the tubeless technique in patients undergoing supine PCNL, focusing on postoperative complications and hospital stay duration.
METHODS: This retrospective observational study was conducted from January 2018 to June 2024. A total of 243 patients underwent supine PCNL. Clinical, surgical and postoperative variables were compared between patients with and without nephrostomy tubes. Complications were classified into clinically relevant categories: Infectious (fever ≥38 °C), haemorrhagic (postoperative haemoglobin drop >1 g/dL within 48 h or the requirement for blood transfusion) and severe (including nephrectomy and mortality). A binary logistic regression model was used to identify independent predictors of complications. Stone-free status was assessed by noncontrast computed tomography (CT) at six weeks. All analyses were performed with IBM SPSS Statistics 26.0.
RESULTS: In 50% of patients, a nephrostomy tube was placed at the end of the procedure. The overall complication rate was 14.4% and was significantly higher in patients with nephrostomy tubes (22.9% vs. 6.7%; p < 0.001) than in those without. Hospital stay was longer in patients with nephrostomy tubes (median 3 days (interquartile range (IQR) 2-4) vs. 1 day (IQR 1-2); p < 0.001) than in those without. Stone-free rate was comparable between groups (80.9% vs. 77.8%; p = 0.529). In multivariate analysis, nephrostomy remained independently associated with complications (odds ratio 4.15; 95% confidence interval 1.72-10.02; p = 0.001).
CONCLUSIONS: In this retrospective series, tubeless PCNL was associated with significantly reduced overall complication rates, mainly as a result of a low number of bleeding events, and short hospital stay without compromising stone-free rates. These findings support the safety of a tubeless approach in appropriately selected patients.
PMID:41492665 | DOI:10.56434/j.arch.esp.urol.20257810.177
