Totally tubeless percutaneous nephrolithotomy

To establish if totally tubeless percutaneous nephrolithotomy (PCNL) is a safe management technique. PCNL is a well-established option for upper tract stones. The procedure traditionally concludes with the placement of a nephrostomy drainage tube but in those patients in whom there has been minimal blood loss and complete stone clearance, it may not be necessary to place a nephrostomy.

Totally tubeless PCNL was performed in uncomplicated cases, when there was no significant bleeding or residual stone load, an intact pelvicaliceal system, and no evidence of a residual ureteral stone.

100 procedures were analyzed during a 10-year period from 1996 to 2006. The mean stone size was 15.9 mm (range 7-40 mm). Mean residual stone load was 1.74 mm (range 1-10 mm). Access was considered difficult in 2%. Transfusion rate was 1% with a mean fall in hemoglobin of 1.4 g/dL ([-0.4] - [+5.6] g/dL), and a mean rise in creatinine level of 0.3 micromol/L ([-43] - [+52] micromol/L). The minor sepsis rate was 5%, and the major sepsis rate was 1%. The readmission rate was 1%. The mean length of stay was 2.9 days (range 1-10 d). Secondary treatment was required in 5%, and stone clearance rate at 3 months was 90%.

This study demonstrates that PCNL without nephrostomy or stent is a safe and well-tolerated procedure in selected patients. It is the authors' belief that totally tubeless PCNL may be considered an accepted standard of care for selected patients, and it is possible to reserve placement of a nephrostomy tube or internal ureteral stent for specific indications.