Modified "tubeless" percutaneous nephrolithotomy using a tail-stent

Area of Science:

• Urology
• Minimally Invasive Surgery

Background:

• Percutaneous renal surgery traditionally involves external nephrostomy tubes or double-J ureteral stents.
• External tubes increase pain and morbidity, while double-J stents cause bothersome bladder symptoms and require cystoscopic removal.

Purpose of the Study:

• To describe a technical enhancement to the "tubeless" percutaneous renal surgery technique.
• To introduce a novel tail-stent for internal drainage as an alternative to double-J stents.

Main Methods:

• A tubeless approach was used in select, uncomplicated percutaneous renal surgery cases.
• A 7F/3F tail-stent with a urethral meatus-exiting string was placed instead of a standard double-J stent.
• Exclusion criteria included prolonged operative times, multiple accesses, significant system disruption, residual stones, or bleeding.

Main Results:

• Tail-stents were successfully placed in 4 initial patients.
• Patients reported low pain scores and minimal stent-related symptoms.
• All tail-stents were removed easily without cystoscopy.

Conclusions:

• The novel tail-stent modification appears feasible and safe for internal drainage in tubeless percutaneous renal surgery.
• This technique offers excellent patient satisfaction by minimizing discomfort and simplifying stent removal.
• Challenges include poor fluoroscopic visualization and potential difficulty in precise tail-stent positioning.