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Totally tubeless percutaneous nephrolithotomy.

Tim J Crook¹, C R Lockyer, Stephen R Keoghane

¹The Solent Department of Urology, St Mary's Hospital, Portsmouth, United Kingdom. timj@crook69.wanadoo.co.uk

Journal of Endourology

|December 22, 2007

Summary

Totally tubeless percutaneous nephrolithotomy (PCNL) is a safe and effective treatment for select patients with upper tract stones. This approach avoids nephrostomy tubes and stents, simplifying recovery and potentially reducing complications associated with these devices.

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Area of Science:

Urology
Minimally Invasive Surgery

Background:

Percutaneous nephrolithotomy (PCNL) is a standard treatment for upper tract stones.
Traditionally, PCNL involves placing a nephrostomy tube for drainage.

Purpose of the Study:

To evaluate the safety and efficacy of totally tubeless percutaneous nephrolithotomy (PCNL).
To determine if omitting nephrostomy tubes and ureteral stents is feasible in select PCNL cases.

Main Methods:

Retrospective analysis of 100 totally tubeless PCNL procedures performed between 1996 and 2006.
Inclusion criteria: uncomplicated cases with minimal bleeding, complete stone clearance, intact pelvicaliceal system, and no residual ureteral stones.

Main Results:

Mean stone size was 15.9 mm; mean residual stone burden was 1.74 mm.
Low complication rates: 1% transfusion, 1% major sepsis, 1% readmission.
High stone clearance rate of 90% at 3 months, with a mean hospital stay of 2.9 days.

Conclusions:

Totally tubeless PCNL is a safe and well-tolerated procedure in carefully selected patients.
Omitting nephrostomy tubes and stents can be considered a standard of care for these patients.
Nephrostomy tubes or stents should be reserved for specific indications requiring them.