Comparison of external drainage ureteral tube versus double-J catheter placement on subjective comfort and adverse events after percutaneous nephrolithotomy.

BACKGROUND

The procedure of percutaneous nephrolithotomy (PCNL) is widely recognized as the primary approach for the removal of large renal stones, yet the optimal postoperative drainage strategy in tubeless procedures remains debated. This study compares external ureteral catheter (EUC) and double-J stent (DJS) regarding patient comfort and complications.

METHOD: This retrospective analysis included patients undergoing tubeless PCNL from July 2021 to June 2025, divided into DJS and EUC groups based on drainage method. Pain in the postoperative period was measured using the visual analogue scale (VAS) at both 24 and 48 hours. Stent-related symptoms (SRS) were assessed two weeks, and a voiding cystourethrogram was conducted prior to catheter removal for the evaluation of vesicoureteral reflux (VUR) grade. Analgesic requirements, hospital stays, and complications (fever, urinary extravasation, perirenal hematoma) were recorded.

RESULTS

The study encompassed 262 patients, of whom 135 were allocated to the DJS cohort and 127 to the EUC cohort. The frequency of SRS was markedly greater in the DJS group than the EUC group (60.74% vs. 19.69%, P<0.001). Furthermore, the DJS group had a markedly greater percentage of patients with high-grade VUR (42.22% vs. 24.41%, P=0.002). There were no notable differences found between the groups regarding postoperative VAS scores, analgesic requirements, hospital stays, or the incidence of fever, urinary extravasation, or perirenal hematoma (all P>0.05). Multivariate analysis confirmed EUC as a protective factor against SRS (OR=0.200, P<0.001).

CONCLUSION

EUC drainage following tubeless PCNL significantly reduces SRS and severe VUR compared to DJS, while maintaining comparable safety.