Totally tubeless percutaneous nephrolithotomy.

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.