Total tubeless percutaneous nephrolithotomy without retrograde insertion of a ureteral catheter for the treatment of kidney stone patients without hydronephrosis: a randomized controlled trial

Objectives To evaluate the safety and efficacy of total tubeless percutaneous nephrolithotomy (PCNL) without retrograde insertion of a ureteral catheter for the treatment of kidney stone patients without hydronephrosis. Methods This prospective randomized controlled study at a tertiary care medical center was conducted from August 2019 to April 2023. Kidney stone patients diagnosed by computed tomography (CT) without significant hydronephrosis were randomly assigned to two groups: total tubeless PCNL without retrograde insertion of a ureteral catheter (group 1) and traditional PCNL (group 2). The primary endpoint was postoperative complications, while the secondary endpoints included the stone-free rate (SFR), operative time, length of postoperative hospital stay, and medical costs. Results A total of 99 patients were recruited, including 50 patients in group 1 and 49 patients in group 2. There were no significant differences in postoperative complications and SFR between the two groups (P > 0.05). However, relative to group 2, patients in group 1 had significantly shorter operative time (58.5 +/- 25.39 min vs. 82.98 +/- 26.02 min, P < 0.001) and length of postoperative hospital stay (1.98 +/- 1.72 days vs. 4.39 +/- 2.95 days, P < 0.001), as well as significantly lower medical costs (3190.30 +/- 590.58 dollars vs. 3552.78 +/- 967.79 dollars, P = 0.03). Conclusion Total tubeless PCNL without retrograde insertion of a ureteral catheter for the treatment of kidney stone patients without hydronephrosis is safe and effective for urologists with extensive experience in PCNL.