To explore the case selection and intraoperative decisions in tubeless percutaneous nephrolithotomy(PCNL).

From January 2017 to March 2018, the data of 364 consecutive cases were analyzed before PCNL. According to the comprehensive preoperative evaluation, some patients were selected for tubeless PCNL. The selected patients were divided into two groups according to whether the nephrostomy tube was placed in the final. The postoperative hospitalization days, stone clearance rate, intraoperative blood loss, visual pain score and perioperative complications were evaluated.

42 cases were selected for tubeless PCNL before operation, and 37 cases were done in the final. Stone clearance rate was 100% in both groups. No differences in grade Ⅰ complications (P=0.424). The mean operative time (P=0.207) and intraoperative blood loss (P=0.450) between the two groups were not different significantly. The visual pain score in the tubeless PCNL was lower than that in tube group, no matter on the day of surgery (P=0.029), on the first day after surgery (P<0.001) or on the day of discharge (P=0.025). The postoperative hospitalization days in the tubeless PCNL were shorter than that in tube group (P<0.001).

The tubeless PCNL is safe as long as we select the patients according to 4 criteria before operation, and should pay attention to 4 key procedures and make 5 times of confirmation during operation. The postoperative pain is significantly relieved and the postoperative hospitalization days were significantly shortened in the tubeless percutaneous nephrolithotomy.