Are Multiple Nephrostomy Tubes Necessary After Multitract Percutaneous Nephrolithotomy? A Randomized Comparison of Single Versus Multiple Nephrostomy Tubes

Abstract

Purpose:

Placement of multiple nephrostomy tubes is the standard practice after completion of multitract percutaneous nephrolithotomy (PCNL) for complex/staghorn calculi. We conducted a study to see whether use of a single nephrostomy tube in comparison with multiple tubes reduces postoperative discomfort without compromising safety of the procedure.

Patients and Methods:

One hundred and ninety-two patients with complex/staghorn renal calculi who were treated with PCNL requiring multiple tracts were included in the study. The inclusion criteria included normal renal function, complete clearance of calculi, and no significant intraoperative complication. Patients were randomized into two groups on operation table at completion of procedure—group A, single nephrostomy tube placement after multitract PCNL; group B, one nephrostomy tube for each tract.

Results:

Postoperative analgesia requirement in group A was significantly less than that in group B (111.9 ± 27.4 mg meperidine in group A; 165.8 ± 34.4 mg in group B) (p < 0.001). The difference in average blood loss for two groups was not statistically significant (drop in hemoglobin: group A, 0.48 gm%; group B, 0.51 gm%) (p = 0.55). Three patients in group A and four in group B required blood transfusion (p = 0.65). The average hospital stay in group A (42.4 ± 8.6 hours) was significantly shorter than that in group B (68.1 ± 6 hours) (p < 0.001). No long-term squealae were noticed in the median follow-up of 18 months in any patient.

Conclusion:

The present study demonstrates that use of a single nephrostomy tube in multitract PCNL is safe and as effective as the conventional practice of placing multiple tubes. In addition, a single tube minimizes postoperative morbidity related to the drainage tubes.