Purpose: we challenge the requirement for routine placement of a nephrostomy tube following percutaneous renal surgery.Objectives: To assess the outcome, safety and efficacy of patients undergoing tubeless renal surgery.Methods: A total of 146 patients underwent percutaneous renal surgery from May 2001 to May 2003. The tubeless procedure was done in 128 patients; consisted of nephrolithotomy and antegrade endopyelotomy. An externalized ureteral catheter or an antegrade DJ was fixed. Nephrostomy tubes were not used in 128 patients. The incidence of complications, postoperative extravasation, intrarenal blood clots, perirenal collection, length of hospitalization, analgesia requirements, outcome, transfusion rate, and stone burden, stone-free rates were obtained. The relation between dilatation techniques, parenchymal thickness, stone site, number and size with the tubeless technique was also accessed.Results: Of the 146 cases, 128 patients underwent the tubeless technique; 120 patients underwent percutaneous stone extraction and 8 patients underwent percutaneous antegrade endopyelotomy. External ureteral catheter was used in 116 patients and an antegrade DJ was used in 12 patients. The stone sizes ranged from 2-7 cm with a mean of 4.1 cm. Stone free rate was 90.5%. The mean length of hospitalization was 1.7 days. Incidence of postoperative transfusion was 2.4%. The correlation between parenchymal thickness, stone size, stone number, and technique of dilatation were not statistically significant. Conclusion: Tubeless percutaneous renal surgery is a safe procedure and offers numerous advantages over routine placement of a nephrostomy tube. It can be performed in patients with any degree of parenchymal thickness, and with large stone burden. The hospitalization, analgesia requirements, return to normal activities are significantly less with this technique.