The efficacy of conventional PCNL and two modifications to standard procedure.

To compare the efficacy of conventional Percutaneous Nephrolithotomy (PCNL) with two of its modified procedures.A randomized controlled trial, was performed on 60 patients undergoing PCNL. Cases of renal stone regardless of stone size and configuration, having pre-operative negative urine culture, no coagulopathy, and no visible residual stone in intra-operative fluoroscopy, were included. They were randomly divided into 3 groups of 20 cases each with nephrostomy tube (NT) and temporary ureteral catheter (TU) in group A, only TU in group B and only indwelling ureteral catheter (IU) in group C. Mean age of cases were 43.2 (25-70), 40.1 (25-73), and 44 (25-70) years in groups A , B and C, respectively (P = 0.6). Procedures were performed under general anaesthesia, using standard techniques for access and lithotomy. Forty-eight hours, 2 weeks and 3 months after PCNL, plain X-ray abdomen, ultrasonography and IVP were performed for each case.Only one case in group A had urinary leakage after removal of nephrostomy tube. No cases in the other two groups encountered this problem. There was no haemorrhagic episode. Ultrasonic evaluation showed mild residue in 3, 1 and 1 cases of groups A, B and C, respectively (P = 0.2). No collective fluid was found in these groups. IVP showed dilatation without obstruction in 3 subjects of group A and none in group B or C (P = 0.03).Tubeless PCNL seems to be accompanied by better outcome. So, further evaluation on more patients seems necessary.