Tubeless procedure reduces hospitalization and pain after percutaneous nephrolithotomy: results of a multivariable analysis.

The objective of the study was to assess the efficacy and safety of tubeless percutaneous nephrolithot- omy (t-PCNL) in comparison with standard PCNL (s-PCNL). We retrospectively evaluated 317 consecutive PCNL and compared perioperative results, time of hospi- talization and analgesic requirement of t-PCNL (114; 36.0 %) to s-PCNL (203; 64.0 %). The decision to perform a tubeless PCNL was made at the end of the procedures depending on the surgeon’s preference and according to the following inclusion criteria: (a) no serious bleeding or perforation in the collecting system during the procedure; (b) patients with no more than one access; and (c) residual stone burden needing a second-stage nephroscopy. Stag- horn stones and anatomic anomalies were not considered as exclusion criteria for t-PCNL. Univariate analyses were conducted with one-way ANOVA, Fisher’s exact test, Pearson’s Chi-square and linear-by-linear association test as appropriate. Stepwise multivariable regression analyses were used to assess the independent correlation between demographics and clinical variables and the clinical out- comes. There were no significant differences between the two groups in terms of stone-free rate, hemoglobin decrease, blood transfusion and complication rate. Mean hospital stay was significantly shorter in the t-PCNL group (3.3 vs. 4.6 days; P \ 0.001). Tubeless PCNL was asso- ciated with less analgesia requirement (68.4 vs. 86.7 %; P \ 0.001) and with lower analgesic dose requirement (1.6 vs. 2.1 mean doses; P = 0.010). Multivariable analyses showed that t-PCNL ( P \ 0.001), postoperative fever ( P \ 0.001), transfusions ( P \ 0.001), operative time ( P = 0.002), postoperative hydronephrosis ( P = 0.005) and residual fragment dimension ( P = 0.024) were inde- pendently correlated with duration of hospitalization, while analgesic dose requirement was independently influenced by hemoglobin decrease ( P \ 0.001), t-PCNL ( P = 0.005) and stone number ( P = 0.044). Our study confirmed that t-PCNL has similar outcomes to s-PCNL in terms of stone- free rate without increasing complications in selected cases. t-PCNL is a factor independently associated with shorter hospitalization and lower analgesic requirement.