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Tubeless percutaneous nephrolithotomy using antegrade tether: a randomized study.

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This study introduces a modified tubeless percutaneous nephrolithotomy (PCNL) using a tethered Double-J stent. This technique eliminates the need for postoperative cystoscopy for stent removal and facilitates "second-look" procedures for residual kidney stones.

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Area of Science:

  • Urology
  • Minimally Invasive Surgery

Background:

  • Tubeless percutaneous nephrolithotomy (PCNL) is established but has limitations.
  • Key challenges include postoperative cystoscopy for ureteral stent removal and the inability to perform a "second-look" procedure for residual fragments.

Purpose of the Study:

  • To present a modified tubeless PCNL technique.
  • The aim is to overcome the limitations of standard tubeless PCNL, specifically the need for cystoscopy and the lack of "second-look" capability.

Main Methods:

  • 166 patients undergoing PCNL were randomized into two groups (83 each).
  • Group A (control) received standard PCNL with a nephrostomy tube.
  • Group B (intervention) underwent modified tubeless PCNL with a tethered Double-J (DJ) stent exiting through the percutaneous tract.

Main Results:

  • Group B showed significantly lower postoperative analgesia requirements (81.3 mg tramadol vs 128 mg).
  • No urinary leakage occurred in Group B, unlike Group A (4 patients).
  • Group B patients had shorter hospital stays (21.6 hours vs 54 hours) and enabled "second-look" procedures via the tethered stent.

Conclusions:

  • Modified tubeless PCNL with a tethered DJ stent effectively addresses the drawbacks of standard tubeless PCNL.
  • This technique obviates the need for cystoscopy for stent removal.
  • It also provides access for repeat nephroscopic evaluation of the pelvicaliceal system.