Introduction:
Percutaneous nephrolithotomy (PCNL) is the standard treatment for moderate-to-large renal calculi. Conventionally, a
nephrostomy tube is placed after the procedure to ensure drainage and haemostasis. Tubeless PCNL, using only a double-J (DJ) ureteric stent, has emerged as a less invasive alternative that may reduce postoperative morbidity.Methods: This prospective comparative observational study included ۷۲ adults (۱۸–۷۰ years) with a single unilateral renal or proximal ureteric stone (۱–۳ cm) treated between June ۲۰۲۴ and May ۲۰۲۵. Patients with complete stone clearance, minimal bleeding, single-tract access, and no collecting-system perforation underwent tubeless PCNL (n=۳۶); the remainder received standard tubed PCNL (n=۳۶). Primary outcomes included operative time, postoperative pain (Visual Analogue Scale), analgesic requirement, and hospital stay. Secondary outcomes were stone clearance and complications.Results: Stone location differed significantly between groups (P-value=۰.۰۰۸۸), with more calyceal stones in the tubed group and more pelvic/proximal ureteric stones in the tubeless group. The tubeless group had significantly shorter operative time (۵۷.۴±۷.۵ vs. ۶۶.۶±۸.۷ min; P-value=۰.۰۰۰۱), lower pain scores (۲.۳۵±۰.۵۰ vs. ۳.۹۵±۰.۸۰; P-value=۰.۰۰۰۱), fewer analgesic days (۲.۵۸±۰.۵۰ vs. ۴.۲۵±۰.۷۵; P-value=۰.۰۰۰۱), lower rescue tramadol requirement (۴۵.۰±۵.۰ vs. ۱۰۷.۵±۱۶.۳ mg; P-value<۰.۰۰۰۱), and shorter hospital stay (۳.۳۸±۰.۳۵ vs. ۴.۵۸±۰.۵۲ days; P-value=۰.۰۰۰۱). Stone clearance was comparable (۹۴.۴% vs. ۸۸.۹%; P-value=۰.۶۴۰۴), with similar haemoglobin decline and no major complications.Conclusion: Selective tubeless PCNL was associated with reduced postoperative pain, analgesic use, and hospital stay without compromising stone clearance or safety. However, non-random intraoperative allocation and differences in stone location limit causal inference. Randomised studies are needed to confirm the independent benefit of nephrostomy omission.