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INTRODUCTION[|]The primary treatment of primary spontaneous pneumothorax (PSP) is still controversial. The large-bore thoracic catheter has traditionally been used, but there is now a global trend toward the increased use of the small-bore thoracic catheters (SBTC). The present study aims to compare the use of SBTC and chest tube (CT) in first-line treatment of PSP.[¤]METHODS[|]This prospective randomized study included 90 patients diagnosed with PSP. The patients were randomly distributed into two groups. In the first group, catheter thoracostomy was applied with an 8 French thorax catheter and in the other group, a tube thoracostomy with a 28 French chest tube. The parameters used for comparison in this study were defined as pneumothorax side, pneumothorax size, pain, need of additional analgesia, malpositioning drain, duration of air leakage, duration of hospitalization, complications and recurrence.[¤]RESULTS[|]In the evaluation of pain using the Numerical Rating Scale (NRS) at 1, 4, 12 and 24 hours after the application, the mean NRS values of the SBTC patients were seen to be lower than those of the CT patients but at 1, 12 and 24 hours, the difference was not statistically significant. At the 4th hour, the difference was determined to be statistically significant (p=0.022). The duration of air leakage was 1.7+-1.4 days for the SBTC group and 2.2+-1.9 days for the CT group. The period of termination of the drain was 3.3+-1.2 days for the SBTC group and 4.0+-1.7 days for the CT group. The duration of hospitalization was 3.5+-1.3 days for the SBTC group and 4.5+-1.9 days for the CT group.[¤]DISCUSSION AND CONCLUSION[|]No significant difference was determined in respect of air leakage, hospital stay, failure rates or complications between the two procedures. When compared concerning postoperative pain, ease of application, patient comfort and incision scar, SBTC can be considered to be subjectively superior to CT, and can be used safely in the treatment of PSP.[¤]