Percutaneous nephrolithotomy; randomized comparison of large bore, small bore and tubeless

We compared postoperative outcome of conventional large bore percutaneous nephrolithotomy [PCNL] with small bore and tubeless percutaneous ephrolithotomy [PCNL]. prospective randomized trial. August 2008-2009 Setting: Shaikh Zayed Hospital Lahore. The study included 90 patients randomized in three groups. Group. 1 included 30 patients who underwent conventional PCNL with large bore 16 fr nephrostomy tube, Group2 included 30 patients, PCNL with small bore 10 fr nephrostomy tube, and Group3 included 30 patients who had tubeless PCNL. Comparison was made in the terms of analgesia requirement, fever, duration of urinary leak and hospital stay. In Group 1 analgesia requirement ranged from 40-70mg mean 50mg, in Group II, it was 30-60mg with mean 47.3mg while in Group III, The requirement of analgesia was 10-50mg with mean 21.1mg, p<0.005. Hospital stay was between 4 to 7days, mean 5.7days in group I while in group II, stay was between 3 to 5 days, mean 4.3days and in group III, it was between 1 to 4 days, mean 3.17days, p<0.005. Twelve patients had fever in group I, In group II, eleven patients while in group III, five patients developed fever, p<0.005. Leakage of urine from site of wound in group I was observed between 0 to 5 days while in group II leakage was between 0 to 4 days, and the leakage period reduced in group III from 0 to 2 days p<0.005. Tubeless PCNL is associated with the least postoperative pain, urinary leakage, fever and hospital stay, it's a good option after an uncomplicated percutaneous renal procedure