Double-J Stenting Compared with One Night Externalized Ureteral Catheter Placement in Tubeless Percutaneous Nephrolithotomy

Abstract

PURPOSE: We prospectively analyzed the outcome of tubeless percutaneous nephrolithotomies (PCNLs) using two different stenting techniques (i.e., externalized ureteral catheter compared with Double-J placement) without strict exclusion or inclusion criteria. PATIENTS AND METHODS: Forty-six patients who were undergoing tubeless PCNL were randomized to two groups: Group 1 (tubeless PCNL with externalized ureteral catheter) and group 2 (tubeless PCNL with Double-J placement). The only exclusion criterion was presence of significant residual stones. The two groups were comparable with regard to age, sex, stone laterality, stone burden, and number of previous open renal surgeries. Factors evaluated included operative time, stent-related symptoms, analgesic requirement, postoperative pain, postoperative morbidity, hospital stay, blood loss, and success rates. RESULTS: The mean operative times, mean number of accesses, percentage of supracostal accesses, mean visual analog scale scores, analgesic requirements, mean decreases in hemoglobin level, blood transfusion rates, success rates, and mean hospital stays were not statistically significant in both groups. The only statistically significant difference between groups was the postoperative stent-related symptoms. In group 2, 52.1% experienced some sort of stent-related symptoms. In most of the patients, these symptoms were not severe; however, in two of them (16.6 %), oral medication therapy with anticholinergics was needed. None of the patients in group 1 had stent-related symptoms and needed medication (P < 0.01). CONCLUSIONS: Tubeless PCNL with externalized ureteral catheter is as feasible as Double-J stenting. Moreover, stent-related discomforts because of the presence of a Double-J stent and the need for postoperative cystoscopy to remove the Double-J stent can be avoided with an externalized ureteral catheter.