Timing of nephrostomy tube removal and its association with stone-related morbidity following endoscopic management of obstructive urolithiasis: a retrospective cohort study.

This study aimed to evaluate the impact of nephrostomy tube removal timing on postoperative outcomes in patients undergoing definitive stone surgery after percutaneous nephrostomy (PCN) placement for obstructive urolithiasis. We retrospectively analyzed 159 patients who underwent PCN followed by endoscopic stone surgery between January 2021 and June 2025. Patients were categorized into two groups based on nephrostomy tube removal timing: intraoperative removal (Group 1) and postoperative day 1 removal (Group 2). Demographic data, perioperative outcomes, Clavien-Dindo grade ≥ 3 complications, postoperative fever, and length of hospital stay were compared. Univariable logistic regression analysis was performed to identify predictors of major complications and fever; however, a multivariable analysis to control for potential confounders was precluded by the low event rate. Group 1 (n = 95) and Group 2 (n = 64) were similar in baseline characteristics. Postoperative fever (1.1% vs. 7.8%, p = 0.028) and Clavien-Dindo grade ≥ 3 complications (1.1% vs. 15.6%, p < 0.001) were significantly lower in Group 1. Median hospital stay was also shorter (12 [9-15] vs. 15 [11-19] days, p = 0.008). Intraoperative tube removal was associated with significantly lower odds of major complications (OR: 17.41, 95% CI: 2.17-139.71, p = 0.007) and fever (OR: 7.97, 95% CI: 0.91-69.88, p = 0.061). In patients undergoing definitive stone surgery after PCN placement, intraoperative nephrostomy tube removal is associated with lower complication and fever rates and a shorter hospital stay. This approach may be a safe and preferable option in selected patients.