TUBELESS PERCUTANEOUS NEPHROLITHOTOMY;

ANALGESIA REQUIREMENT IN CONVENTIONAL AND TUBELESS PERCUTANEOUS NEPHROLITHOTOMY: A COMPARISON

Abstract

Revolutionary advances in the minimally invasive and non invasive management of stone disease over the past two
decades have greatly facilitated the removal of stones. Renal stone management moved from open surgery to minimally invasive
procedures with the aim of achieving maximum stone clearance with the least morbidity and mortality. Percutaneous nephrolithotomy
(PCNL) remains the most efficient procedure in all patient groups. Tubeless PCNL is increasing in popularity and the technique of
percutaneous nephrolithotomy is in constant evolution. Nephrostomy tube has been implicated in causing postoperative discomfort or
pain and morbidity. Nephrostomy-free or tubeless PCNL reduces postoperative pain and analgesia related to the drainage tube. Objective:
To compare mean analgesia requirement with tubeless PCNL and standard PCNL in renal stone patients Study design: Randomized
controlled trial conducted at Shaikh Zayed Hospital Lahore from July 2010 to January 2011. Methods: 100 patients were divided into two
groups randomly by using random number tables i.e. 50 patients in group A and 50 patients in group B. Group A patients were operated by
standard PCNL method i.e. with Placement of nephrostomy tube and ureteric catheter and group B were operated by tubeless PCNL i.e.
without nephrostomy tube but with ureteric catheter. The data was collected on attached predesigned computer based proforma. Results:
The analgesic dose requirement in Group A was 116.50± 26.55mg and analgesic dose requirement in Group B was 73.00±30.24mg of
pethidine. So, analgesia requirement in both groups showed a significant difference (p<0.05). Conclusions: Tubeless PCNL can be used
with a favorable outcome in renal stone patients, with the potential advantage of decreased analgesia requirement.