Modified "tubeless" percutaneous nephrolithotomy using a tail-stent

"Tubeless" percutaneous renal surgery has previously been described at our institution. Avoiding external nephrostomy tube drainage significantly decreases the pain and morbidity of percutaneous renal surgery. However, internal drainage with a double-J ureteral stent still results in bothersome bladder symptoms, especially in younger male patients. In addition, removal of the stent requires uncomfortable office cystoscopy. We report a technical enhancement of our "tubeless" technique that uses a novel tail-stent for internal drainage.

A tubeless approach to any renal surgery should only be attempted in select uncomplicated cases. The exclusion criteria should include operative times longer than 2 hours, three or more percutaneous accesses, significant perforations or disruptions of the collecting system, significant residual stone burden, and significant bleeding. In these instances, and when second-look nephroscopy is desired, traditional external nephrostomy tube drainage should be used. In our select cases, in lieu of the standard double-J stent, we place a 7F/3F tail-stent with the string attached exiting the urethral meatus. Care is taken in correct placement to avoid having the tail of the stent exiting the meatus.

In our initial 4 patients, tail-stents were successfully placed. The pain scores were low and stent symptoms appeared minimal. All stents were easily removed without the use of cystoscopy. Fluoroscopic visualization of the 3F tail is poor, and positioning of the tail can be difficult. Nevertheless, this modification appears feasible and safe with excellent patient satisfaction.