Nephrostomy tube after percutaneous nephrolithotomy: Large-bore or pigtailcatheter?

Background and Purpose: A nephrostomy tube is an integral part of any percu taneous renal surgery. Commonly, a nephrostomy tube that is 2F to 3F smalle r than the percutaneous tract is used after percutaneous nephrolithotomy (P CNL), In our experience, quite a few patients have pain at the nephrostomy tube site, and many patients complain of a prolonged urinary leak after tub e removal when a large nephrostomy tube is used. This prospective study was planned to document whether these symptoms could be attributed to the size of the nephrostomy tube and whether a small pigtail catheter could reduce these problems without increasing complications. Patients and Methods: Forty well-matched patients in whom a one-stage PCNL was done for calculus disease were studied prospectively, Alternate patient s had a 28F nephrostomy tube or a 9F pigtail catheter placed at the end of the procedure. Patients were observed for the duration of hematuria, number of analgesic injections needed, and the duration of urinary leak after tub e removal. Results: The groups were comparable in the amount and duration of hematuria after PCNL, There was a statistically significant difference in the analge sic need and the duration of urinary leak after tube removal, both of which were less in patients having a pigtail catheter. Conclusions: A pigtail catheter nephrostomy tube after PCNL reduces the hos pital stay by reducing the duration of the urinary leak, The postoperative course is smooth, as patient has less pain and needs less analgesic support , There is no statistically significant increase in the postoperative bleed ing secondary to use of a pigtail catheter, Second-look nephroscopy was eas y in the one patient with a pigtail nephrostomy catheter who needed the pro cedure.