Outcomes of complete supine percutaneous nephrolithotomy (csPCNL): Tubeless versus totally tubeless: a randomized clinical trial

Purpose: Percutaneous nephrolithotomy is an effective treatment for large and complicated renal stones, performed in different techniques including placement of an external nephrostomy tube, placement of an internal ureteral stent, and no external or internal tube. We aimed to compare the safety and feasibility of totally tubeless (without ureteral stenting or nephrostomy) with tubeless (with ureteral stenting), in complete supine percutaneous nephrolithotomy (csPCNL). Materials and methods: This randomized clinical trial was performed on 83 patients who underwent csPCNL by a single urologist between September 2022 and June 2023. Patients were divided into 2 groups: group A, tubeless csPCNL (n = 40), and group B, totally tubeless csPCNL (n = 43). Demographical data and intraoperative and postoperative parameters were recorded for all patients and compared between groups. Results: No significant differences were observed among the groups in preoperative and perioperative variables ( P > 0.05). Thirty-six (90.0%) patients in group A and 40 (93.0%) in group B were stone-free, which was not statistically significant ( P = 0.706). The mean operative time between groups A and B (43.50 ± 24.21 and 43.56 ± 23.64, respectively) was not considered significant ( P = 0.991). There was also no significant difference between groups with regard to serum creatinine change, hemoglobin drop, analgesic requirement, hospital stay, and time of return to normal life ( P > 0.05). The postoperative complication rate was higher in group A than in the other group with no statistically significant difference ( P > 0.05). Conclusion: Both tubeless and totally tubeless csPCNL are technically feasible with comparable outcomes. Concerning the high stone-free and low complications rate associated with the totally tubeless approach, it can be considered as a safe and cost-effective alternative to tubeless csPCNL in selected patients.