Tubeless simultaneous bilateral percutaneous nephrolithotomy: Safety, feasibility and efficacy in an Indian setting

Objectives: To study the safety, feasibility and efficacy of tubeless simultaneous bilateral percutaneous nephrolithotomy. Methods: We retrospectively studied 85 patients who underwent tubeless simultaneous bilateral percutaneous nephrolithotomy in the Department of Urology, Kasturba Medical College, Manipal, Karnataka, India, from July 2006 to June 2013. The demographic profile and outcomes were compared with the other existing series reported in the literature. Results: A total of 65 male and 20 female patients with a mean age of 45.7±11.6 years underwent tubeless simultaneous bilateral percutaneous nephrolithotomy. The mean stone burden was 299mm², with 12 staghorn calculi. Mean operative time was 87.6±35.5min. A total of 95% of stones were cleared with single access tracts. The success rate of tubeless simultaneous bilateral percutaneous nephrolithotomy (stone clearance) was 95.2%. Mean hemoglobin drop was 1.1±0.9gm% per patient, with 10.5% of patients requiring blood transfusion. Mean hospital stay was 69.6±28.4h. Complications included urosepsis (Clavien grade 4), acute kidney injury requiring hemodialysis (grade 3), pneumonia (grade=2) and hydrothorax requiring intercostal drainage tube insertion (grade 3). On follow up, 4.7% of the renal units required ancillary procedures. Conclusions: Our findings confirm that tubeless simultaneous bilateral percutaneous nephrolithotomy is a safe and effective modality of treatment. It allows obviating a second anesthetic exposure, thus reducing analgesic requirement, hospitalization time and costs. This translates into a significant socioeconomic impact on the outlook of Indian patients presenting with bilateral renal stone disease.