TUBELESS PERCUTANEOUS RENAL SURGERY

Purpose: We challenge the requirement for routine placement of a nephr ostomy tube following percutaneous renal surgery. Materials and Method s: A total of 50 patients underwent tubeless percutaneous renal proced ures consisting of nephrolithotripsy, endopyelotomy, and stone extract ion plus endopyelotomy performed during the same setting. In the initi al 30 patients a Double-J stent and a Councill nephrostomy tube were placed at the end of the procedure. The Councill catheter was removed 2 to 3 hours postoperatively. The subsequent 20 patients received only a Double-J stent with no Councill catheter. This study group was comp ared to a control group of 50 age, sex and procedure matched patients who had previously undergone standard percutaneous renal procedures wi th routine placement of postoperative nephrostomy tubes. The incidence of complications, analgesia requirements, length of hospitalization, interval to return to normal activities and cost of treatment were com pared between the 2 groups. Results: All 50 tubeless percutaneous proc edures were performed successfully without significant complications. In the initial 15 patients postoperative renal ultrasound demonstrated no urinoma. Hospitalization was 0.6 days for the study group and 4.6 days for the controls (p = 0.0001). Average parenteral or intramuscula r analgesia requirements were 11.58 and 36.06 mg. morphine sulfate, re spectively (p = 0.0001), with patients requiring oral analgesia for 5. 9 and 11.7 days, respectively (p = 0.0001). Patients in the study grou p returned to normal activities within 17.85 days versus 26.6 days for the controls (p = 0.0004). The costs of the procedures were $1,638 an d $3,750 (129% greater), respectively, for a cost saving of $2,112 per case. Conclusions: Tubeless percutaneous renal surgery is a safe proc edure and offers numerous advantages over routine placement of a nephr ostomy tube. The hospitalization, analgesia requirements, return to no rmal activities as well as cost are significantly less with this new t echnique.