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<p>Percutaneous nephrolithotomy (PCNL) is the standard surgical treatment for large or complex kidney stones. This randomized controlled trial evaluated the safety and efficacy of tubeless intercostal PCNL compared with the standard technique, focusing on short-term perioperative outcomes.In this single-center, single-blind, parallel-group randomized controlled trial conducted at Shahid Beheshti Hospital, Hamadan, Iran, from 2017 to 2018, 70 patients with kidney stones requiring intercostal PCNL were randomized 1:1 to tubeless intercostal PCNL (<i>n</i> = 35) or standard intercostal PCNL with nephrostomy tube placement (<i>n</i> = 35). Primary outcomes were surgical duration, length of hospital stay, and postoperative opioid use. Secondary outcomes included antipyretic use, blood transfusion rates, and complications graded by the modified Clavien-Dindo system.The mean age was 46.17 ± 2.23 years in the intervention group and 49.66 ± 1.99 years in the control group (<i>P</i> = 0.249). Each group comprised 25 males and 10 females (<i>P</i> = 1.00). The intervention group had a shorter mean surgical duration (52.85 ± 8.12 vs. 56.71 ± 9.34&#xa0;min, <i>P</i> = 0.112), shorter hospitalization (2.20 ± 0.76 vs. 2.74 ± 0.89 days, <i>P</i> = 0.067), lower opioid use (4.64 ± 2.15 vs. 4.88 ± 2.32&#xa0;mg, <i>P</i> = 0.678; 40% vs. 60% required opioids, <i>P</i> = 0.098), and lower antipyretic use (20% vs. 31.4%, <i>P</i> = 0.267). Blood transfusion rates were identical (5.7% vs. 5.7%, <i>P</i> = 1.00). Complication rates were comparable (28.58% vs. 31.43%, <i>P</i> = 0.795), with no significant differences in fever, bleeding, hematoma, hydrothorax, or pleural injury.&#xa0;Tubeless intercostal PCNL offers comparable safety and efficacy to the standard technique, with potential benefits in reduced surgical time, hospital stay, and analgesia requirements. These findings support tubeless PCNL as a viable alternative for select patients, particularly those with uncomplicated stone burdens, contributing to the growing evidence for less invasive approaches.</p>

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Comparison of tubeless intercostal percutaneous nephrolithotomy with the standard technique: A randomized controlled clinical trial

  • 期刊论文

  • 发表日期：

    2026年1月30日

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  • Mehdi Shah Mirzaei,
  • Shahriar Amirhassani,
  • Arian Karimi Rouzbahani,
  • Golnaz Mahmoudvand,
  • Maede Mohseni,
  • Seyed Habibollah Mousavi-Bahar

摘要

Percutaneous nephrolithotomy (PCNL) is the standard surgical treatment for large or complex kidney stones. This randomized controlled trial evaluated the safety and efficacy of tubeless intercostal PCNL compared with the standard technique, focusing on short-term perioperative outcomes.In this single-center, single-blind, parallel-group randomized controlled trial conducted at Shahid Beheshti Hospital, Hamadan, Iran, from 2017 to 2018, 70 patients with kidney stones requiring intercostal PCNL were randomized 1:1 to tubeless intercostal PCNL (n = 35) or standard intercostal PCNL with nephrostomy tube placement (n = 35). Primary outcomes were surgical duration, length of hospital stay, and postoperative opioid use. Secondary outcomes included antipyretic use, blood transfusion rates, and complications graded by the modified Clavien-Dindo system.The mean age was 46.17 ± 2.23 years in the intervention group and 49.66 ± 1.99 years in the control group (P = 0.249). Each group comprised 25 males and 10 females (P = 1.00). The intervention group had a shorter mean surgical duration (52.85 ± 8.12 vs. 56.71 ± 9.34 min, P = 0.112), shorter hospitalization (2.20 ± 0.76 vs. 2.74 ± 0.89 days, P = 0.067), lower opioid use (4.64 ± 2.15 vs. 4.88 ± 2.32 mg, P = 0.678; 40% vs. 60% required opioids, P = 0.098), and lower antipyretic use (20% vs. 31.4%, P = 0.267). Blood transfusion rates were identical (5.7% vs. 5.7%, P = 1.00). Complication rates were comparable (28.58% vs. 31.43%, P = 0.795), with no significant differences in fever, bleeding, hematoma, hydrothorax, or pleural injury. Tubeless intercostal PCNL offers comparable safety and efficacy to the standard technique, with potential benefits in reduced surgical time, hospital stay, and analgesia requirements. These findings support tubeless PCNL as a viable alternative for select patients, particularly those with uncomplicated stone burdens, contributing to the growing evidence for less invasive approaches.