Words of wisdom. Re: A randomized comparison of totally tubeless and standard percutaneous nephrolithotomy in elderly patients. Kara C, Resorlu B, Bayindir M, Unsal A.

摘要

Expert's summary: The authors have performed a study with strong methodology regarding a topic on which there is much controversy: totally tubeless percutaneous nephrolithotomy (PCNL) in the elderly. Over a 2.5-yr period, 410 PCNLs were performed by a single surgeon. Only after the stone removal portion of each case were the patients assessed for inclusion in the study. Only 60 highly selected cases (15%) were identified and randomized to receive either no tube (ie, no nephrostomy tube or internal stent) or an 18-Fr nephrostomy tube. A decision was made a priori that no patient would be considered for second-look nephroscopy. Preoperatively, the groups were similar. Postoperatively, a large proportion of patients in each group were stone free (86% on kidney-ureter-bladder [KUB] radiography and 83% on ultrasound). Totally tubeless patients had significantly lower analgesic requirements and hospital stays. Interestingly, the totally tubeless group did not have a higher complication rate or require higher rates of secondary shock wave lithotripsy or ureteroscopy procedures.