COMPARISON BETWEEN TUBELESS AND TUBE PERCUTANEOUS NEPHROLITHOTOMIES IN PEDIATRIC POPULATION: A RANDOMIZED CONTROLLED TRIAL

Authors

  • Sajjad Ali Khyber Teaching Hospital, Peshawar
  • Tariq Ahmad Khyber Teaching Hospital, Peshawar
  • Murad Ali Khyber Teaching Hospital, Peshawar
  • Mohammad Anees Iqbal Khyber Teaching Hospital, Peshawar
  • Abdul Jabbar Khyber Teaching Hospital, Peshawar
  • Aboozar Khan Khyber Teaching Hospital, Peshawar

DOI:

https://doi.org/10.37762/jgmds.13-1.797

Keywords:

Pediatric Nephrolithiasis, Percutaneous Nephrolithotomy, Tubeless Pcnl, Stone-Free Status, Blood Transfusion

Abstract

ABSTRACT

OBJECTIVES

This study aimed to compare the efficacy and safety of tubeless versus conventional tube PCNL in pediatric patients with renal calculi >10mm.

METHODOLOGY

A randomized controlled trial conducted at Khyber Teaching Hospital, Peshawar (October 2024-Sep 2025). Six hundred forty pediatric patients (6-18 years) with kidney stones >10mm were randomly allocated to Group A (Tubeless PCNL, n=320) and Group B (Tube PCNL, n=320). A single experienced urologist performs the procedures. Primary outcomes, including operative time, hospital stay, blood transfusion requirements, and stone-free status, were measured.

RESULTS
Groups had similar baseline characteristics (mean ages 11.2±3.1 vs 11.4±3.2 years). Tubeless PCNL showed significantly shorter operative time (45±10 vs 50±12 minutes, p<0.01), reduced hospital stay (2.0±0.8 vs 2.5±1.0 days, p<0.01), lower blood transfusion requirements (7.8% vs 14.1%, p=0.02), and higher stone-free rates (95.3% vs 90.6%, p=0.04).

CONCLUSION

Tubeless PCNL demonstrated statistically and clinically significant advantages, including shorter operative times, reduced hospital stays, fewer transfusions, and higher stone-free rates, supporting its adoption as the preferred approach for pediatric renal calculi management.

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Author Biographies

Sajjad Ali, Khyber Teaching Hospital, Peshawar

Postgraduate Resident,
Urology Department,
Khyber Teaching Hospital, Peshawar

Tariq Ahmad, Khyber Teaching Hospital, Peshawar

Associate Professor,
Urology Department,
Khyber Teaching Hospital, Peshawar

Murad Ali, Khyber Teaching Hospital, Peshawar

Postgraduate Resident, Urology Department, Khyber Teaching Hospital, Peshawar

Mohammad Anees Iqbal, Khyber Teaching Hospital, Peshawar

Postgraduate Resident, Urology Department, Khyber Teaching Hospital, Peshawar

Abdul Jabbar, Khyber Teaching Hospital, Peshawar

Postgraduate Resident, Urology Department, Khyber Teaching Hospital, Peshawar

Aboozar Khan, Khyber Teaching Hospital, Peshawar

Postgraduate Resident, Urology Department, Khyber Teaching Hospital, Peshawar

References

Tong CM, Ellison JS, Tasian GE. Pediatric stone disease: current trends and future directions. Urol Clin North Am. 2023;50(3):465–75. https://doi.org/10.1016/j.ucl.2023.04.009. PMID: 37385708 DOI: https://doi.org/10.1016/j.ucl.2023.04.009

Raghavan VR, Porter JJ, Monuteaux MC, Neuman MI, Nelson KA. Imaging trends and surgical outcomes for nephrolithiasis in the pediatric emergency department. Am J Emerg Med. 2025;78:112–8. https://doi.org/10.1016/j.ajem.2024.10.012. PMID: 40088706 DOI: https://doi.org/10.1016/j.ajem.2024.10.012

Zhang SY, Collingwood JD, Fujihashi A, He K, Oliver LA, Dangle P. Incidence of emergency department presentations of symptomatic stone disease in pediatric patients: a Southeastern study. Cureus. 2022;14(11):e30979. https://doi.org/10.7759/cureus.30979. PMID: 36465204 DOI: https://doi.org/10.7759/cureus.30979

Gabrigna Berto F, Wang P, McClure JA, Bjazevic J, Golomb D, Filler G, et al. A population-based retrospective cohort study of surgical trends and outcomes of pediatric urolithiasis in Ontario, Canada (2002–2019). J Pediatr Urol. 2023;19(6):758.e1–10. https://doi.org/10.1016/j.jpurol.2023.08.035. PMID: 37739819 DOI: https://doi.org/10.1016/j.jpurol.2023.08.035

Ciongradi CI, Filip F, Sârbu I, Iliescu Halițchi CO, Munteanu V, Candussi IL. The impact of water and other fluids on pediatric nephrolithiasis. Nutrients. 2022;14(19):4161. https://doi.org/10.3390/nu14194161. PMID: 36235817 DOI: https://doi.org/10.3390/nu14194161

Rendina D, De Filippo G, Iannuzzo G, Abate V, Strazzullo P, Falchetti A. Idiopathic osteoporosis and nephrolithiasis: two sides of the same coin? Int J Mol Sci. 2020;21(21):8183. https://doi.org/10.3390/ijms21218183. PMID: 33142950 DOI: https://doi.org/10.3390/ijms21218183

Huynh LM, Dianatnejad S, Tofani S, Carrillo Ceja R, Liang K, Tapiero S, et al. Metabolic diagnoses of recurrent stone formers: temporal, geographic and gender differences. Scand J Urol. 2020;54(6):456–61. https://doi.org/10.1080/21681805.2020.1840430. PMID: 33215605 DOI: https://doi.org/10.1080/21681805.2020.1840430

Alexander RT. Kidney stones, hypercalciuria, and recent insights into proximal tubule calcium reabsorption. Curr Opin Nephrol Hypertens. 2023;32(4):359–65. https://doi.org/10.1097/MNH.0000000000000892. PMID: 37049363 DOI: https://doi.org/10.1097/MNH.0000000000000892

Alexander RT, Fuster DG, Dimke H. Mechanisms underlying calcium nephrolithiasis. Annu Rev Physiol. 2022;84:559–83. https://doi.org/10.1146/annurev-physiol-052521-121822. PMID: 35893552 DOI: https://doi.org/10.1146/annurev-physiol-052521-121822

Rodriguez Cuellar CI, Wang PZT, Freundlich M, Filler G. Educational review: role of the pediatric nephrologists in the work-up and management of kidney stones. Pediatr Nephrol. 2020;35(3):383–97. https://doi.org/10.1007/s00467-018-4179-9. PMID: 30514670 DOI: https://doi.org/10.1007/s00467-018-4179-9

Downie ML, Alexander RT. Molecular mechanisms altering tubular calcium reabsorption. Pediatr Nephrol. 2022;37(8):1743–50. https://doi.org/10.1007/s00467-021-05049-0. PMID: 35024598 DOI: https://doi.org/10.1007/s00467-021-05049-0

Lotan P, Hendel H, Babaoff R, Tor R, Ben-Meir D, Morag R, et al. Pediatric age-related distribution of calcium oxalate monohydrate and calcium oxalate dihydrate in urinary tract stones: metabolic, gender, and ethnic correlates. J Endourol. 2023;37(9):1020–7. https://doi.org/10.1089/end.2022.0526. PMID: 37234934 DOI: https://doi.org/10.1089/end.2022.0526

Grivas N, Thomas K, Drake T, Donaldson J, Neisius A, Petřík A, et al. Imaging modalities and treatment of paediatric upper tract urolithiasis: a systematic review and update on behalf of the EAU urolithiasis guidelines panel. J Pediatr Urol. 2020;16(5):612–24. https://doi.org/10.1016/j.jpurol.2020.07.003. PMID: 32870847 DOI: https://doi.org/10.1016/j.jpurol.2020.07.003

Hughes T, Ho HC, Pietropaolo A, Somani BK. Guideline of guidelines for kidney and bladder stones. Turk J Urol. 2020;46(Suppl 1):S104–12. https://doi.org/10.5152/tud.2020.20315. PMID: 34192888 DOI: https://doi.org/10.5152/tud.2020.20315

Blasl-Kling F, Dold SK, Klein JT, Wakileh GA, Humke U, Ebert AK. Guideline-adherence in the treatment of symptomatic urolithiasis in children and adolescents in southwestern Germany. BMC Urol. 2020;20(1):73. https://doi.org/10.1186/s12894-020-00643-0. PMID: 32606568 DOI: https://doi.org/10.1186/s12894-020-00643-0

Akram M, Jahrreiss V, Skolarikos A, Geraghty R, Tzelves L, Emilliani E, et al. Urological guidelines for kidney stones: overview and comprehensive update. J Clin Med. 2024;13(4):1114. https://doi.org/10.3390/jcm13041114. PMID: 36960516 DOI: https://doi.org/10.3390/jcm13041114

Tsai SH, Chung HJ, Tseng PT, Wu YC, Tu YK, Hsu CW, et al. Comparison of the efficacy and safety of shockwave lithotripsy, retrograde intrarenal surgery, percutaneous nephrolithotomy, and minimally invasive percutaneous nephrolithotomy for lower-pole renal stones: a systematic review and network meta-analysis. Medicine (Baltimore). 2020;99(11):e19403. https://doi.org/10.1097/MD.0000000000019403. PMID: 32124615 DOI: https://doi.org/10.1097/MD.0000000000019403

Fang H, Wang Z, Wei K, Liu X, Wu S, Hua Y, et al. Safety and efficacy of standard vs tubeless percutaneous nephrolithotomy in pediatric populations: an updated systematic review and meta-analysis. BMC Urol. 2025;25(1):110. https://doi.org/10.1186/s12894-025-01798-4 DOI: https://doi.org/10.1186/s12894-025-01798-4

Surag KR, Shah A, Vishwanath Gali K, Krishnakanth AVB, Chawla A, Hegde P, et al. Severe bleeding in patients following "tubeless" percutaneous nephrolithotomy: predictors of angioembolization. Urologia. 2025;92(1):89–95. https://doi.org/10.1177/03915603241282409 DOI: https://doi.org/10.1177/03915603241282409

Fernandez N, Ellison JS, Wang Z, Huang J, Chu DI, Sturm R, et al. Surgeon and institution characteristics associated with surgical preferences in the Pediatric KIDney Stone Care Improvement Network. Urology. 2024;188:20–7. https://doi.org/10.1016/j.urology.2024.02.040 DOI: https://doi.org/10.1016/j.urology.2024.02.040

DiBianco JM, Ghani KR. Precision stone surgery: current status of miniaturized percutaneous nephrolithotomy. Curr Urol Rep. 2021;22(4):24. https://doi.org/10.1007/s11934-021-01042-0. PMID: 33858699 DOI: https://doi.org/10.1007/s11934-021-01042-0

Gadzhiev N, Malkhasyan V, Akopyan G, Petrov S, Jefferson F, Okhunov Z. Percutaneous nephrolithotomy for staghorn calculi: troubleshooting and managing complications. Asian J Urol. 2020;7(2):139–48. https://doi.org/10.1016/j.ajur.2019.10.004. PMID: 33344434 DOI: https://doi.org/10.1016/j.ajur.2019.10.004

Siddique FH, Rahman MM, Hossain ME, Rahman MA, Hossain MA, Kabir MA, et al. Comparing totally tubeless and tubeless percutaneous nephrolithotomy with standard techniques. Mymensingh Med J. 2024;33(4):1140–5

Akdoğan N, Değer M, Yılmaz İÖ, Kolkıran SS, Yücel SP, Yurtseven Ş, et al. Effect of prilocaine infiltration into the nephrostomy tract after percutaneous nephrolithotomy on postoperative pain. J Urol Surg. 2024;11(3):159–63. https://doi.org/10.4274/jus.galenos.2024.2024-1-6 DOI: https://doi.org/10.4274/jus.galenos.2024.2024-1-6

Sharifi K, Kalhor F. Enhancing pediatric satisfaction in healthcare services: an integrative review. SAGE Open Pediatr. 2025;12:30502225251310503. https://doi.org/10.1177/30502225251310503 DOI: https://doi.org/10.1177/30502225251310503

Nawaz A, Sohail M, Shah S, Khan MI, Ullah A. A cross-sectional study comparing tubed PCNL and tubeless PCNL: an experience at the Institute of Kidney Diseases (IKD), Peshawar. JHRR. 2024;4(1):933–7. Available from: https://jhrlmc.com/index.php/home/article/view/495 DOI: https://doi.org/10.61919/jhrr.v4i1.495

Qamar SF, Ghani AA, Ullah W, Rashid Z, Malik R, Muhammad R, et al. Effectiveness of percutaneous cystolithotripsy in pediatric age group. Avicenna J Health Sci. 2025;2(2):57–62. Available from: https://avicennajhs.com/index.php/ajhs/article/view/67

Öncel HF, Salar R, Bahçeci T. Extracorporeal shock wave lithotripsy for urinary tract stones in pediatric patients: our 11 years of experience. J Surg Med. 2022;6(9):798–802. Available from: https://jsurgmed.com/article/view/7431 DOI: https://doi.org/10.28982/josam.7431

Hirani R, Podder D, Stala O, Mohebpour R, Tiwari RK, Etienne M. Strategies to reduce hospital length of stay: evidence and challenges. Medicina (Kaunas). 2025;61(5):922. https://doi.org/10.3390/medicina61050922 DOI: https://doi.org/10.3390/medicina61050922

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Published

2026-01-01

How to Cite

Sajjad Ali, Tariq Ahmad, Murad Ali, Mohammad Anees Iqbal, Abdul Jabbar, & Aboozar Khan. (2026). COMPARISON BETWEEN TUBELESS AND TUBE PERCUTANEOUS NEPHROLITHOTOMIES IN PEDIATRIC POPULATION: A RANDOMIZED CONTROLLED TRIAL. Journal of Gandhara Medical and Dental Science, 13(1), 12–17. https://doi.org/10.37762/jgmds.13-1.797