This prospective randomized controlled study will compare two techniques used after percutaneous nephrolithotomy, a procedure for removing kidney stones. Participants with renal stones measuring 2-3 cm will be randomly assigned to either tubeless percutaneous nephrolithotomy with nebulized Glubran 2 used to seal the access tract or conventional percutaneous nephrolithotomy with placement of a nephrostomy tube. The study will evaluate whether the Glubran 2-assisted tubeless technique is safe and effective and whether it can reduce postoperative pain, bleeding, hospital stay, urine leakage, and other complications while maintaining a satisfactory stone-free rate.
Inclusion Criteria:
Exclusion Criteria:
saad.ali@fmed.bu.edu.eg
Participants will undergo percutaneous nephrolithotomy followed by tubeless closure of the percutaneous access tract. After stone removal and confirmation of no significant collecting-system injury, 1 mL of Glubran 2 will be delivered into the tract using a special nebulizing applicator under endoscopic and fluoroscopic guidance. The tract will be temporarily occluded using the balloon of a 16 Fr Foley catheter. No nephrostomy tube will be placed. A 6 Fr double-J ureteral stent may be inserted when clinically indicated.
Participants will undergo conventional percutaneous nephrolithotomy. After stone removal, a 24 Fr Nelaton tube will be placed as a nephrostomy tube for postoperative drainage. The nephrostomy tube is planned to be removed after approximately 24 hours, according to the participant's clinical condition. A 6 Fr double-J ureteral stent may be inserted when clinically indicated.
Comparison of Tubeless Versus Standard Percutaneous Nephrolithotomy (PCNL) for Renal Stones
Tubeless vs Tube PCNL in Pediatric Nephrolithiasis: A Randomized Controlled Trial.
Standard Percutaneous Nephrolithotomy Percutaneous Nephrolithotomy (PNL) Versus Tubeless PNL Versus Tubeless Stentless PNL
Tubeless Percutaneous Nephrolithotomy Without Reverse Insertion of a Ureteral Catheter