Prospective randomized study of various techniques of percutaneous nephrolithotomy

Objectives. To compare the modifications of the technique of percutaneous n ephrolithotomy (PCN), including "mini-PCN" and tubeless PCN, to establish w hich technique is associated with the least morbidity and complications, Methods. We performed a prospective randomized trial to assess the efficacy and morbidity of each method of percutaneous renal access. Standard PCN in volved tract dilation to 30F for passage of a 34F working sheath, and our " mini-PCN" involved tract dilation to 22F for passage of a 26F sheath. Tubel ess PCN involved the use of a double-J stent for internal drainage without the use of a nephrostomy tube for external drainage at termination of the p rocedure. Thirty patients (10 patients in each group) were enrolled, and 27 patients completed the study. All three groups were compared with regard t o postoperative pain using a validated pain questionnaire comprised of a vi sual analogue scale and a verbal rating scale. The operative time, estimate d blood loss, stone burden, procedure success rate, stone-free rate, length of hospitalization, total procedural cost, and complications were also com pared for each technique. Results. The tubeless PCN population required less morphine use, had a decr eased length of hospitalization, and had a smaller total procedural cost co mpared with the other two groups. One complication was noted in both the st andard and mini-PCN groups, consisting of renal bleeding requiring a 2 and 3-U blood transfusion in the standard and mini-PCN groups, respectively. Conclusions. The tubeless technique is associated with the least amount of morbidity and the greatest cost efficiency compared with the other techniqu es. No overall advantage was found for the mini-PCN versus the standard tec hnique, but the mini-PCN is at a slight disadvantage because of poorer visu alization and optics and difficulty with use of the nephroscopic graspers. UROLOGY 58: 345-350, 2001. (C) 2001, Elsevier Science Inc.