Urolithiasis ranks second among urological diseases, after inflammatory processes, and first among surgical interventions in urological hospitals. The problem of this disease treatment is a long-term rehabilitation and disablement, which entails a significant increase in costs and requires changes in the tactics of treatment of patients. Since its introduction until today, percutaneous nephrolithotomy (PCNL) is the standard treatment for nephrolithiasis with a stone size of more than 1.5–2.0 cm. In its standard version, PCNL ends with the placement of nephrostomy catheter through the formed parenchymal channel, but there are techniques of the surgery completion either without nephrostomy catheter with a JJ stent – tubeless PCNL, or without nephrostomy and JJ stent at all – totally tubeless PCNL. However, nowadays, the use of tubeless and totally tubeless techniques is one of the most controversial topics in percutaneous nephrolithotomy in terms of safety and efficacy in their application. Aim. To analyze the results and safety of percutaneous nephrolithotomy by means of tubeless and totally tubeless techniques based on scientific evidence. Analysis of the scientific literature shows that tubeless and totally tubeless PCNL techniques are a safe method of percutaneous surgery and their application reduces pain and analgesic requirements in the postoperative period, shortens the length of postoperative hospital stay, and enhances recovery after surgery in patients, therefore resulting in cost-saving treatment. Conclusions. Tubeless and totally tubeless PCNLs are recommended for widespread use in urological practice, but it is worth to mention that these techniques should be performed in selected patients and by an operating surgeon with significant experience in percutaneous surgery.

Abstract. The present study aimed to assess the effectiveness and safety of mini-percutaneous nephrolithotomy (mPNL) in comparison with standard percutaneous nephrolithotomy (sPNL) for the treatment of complex nephrolithiasis. Methods. During the period from 2012 to 2020, 1021 patients with solitary (10.0-30.0 mm), staghorn and multiple renal calculi were retrospectively divided into two groups: sPNL (500 patients) and mPNL (521 patients). The groups were compared by the stone-free rate (%, SFR), the duration of the surgery, complications and hospital stay. Results. SPNL and mPNL were highly effective procedures for the treatment of nephrolithiasis. The mPNL group had longer operative times (81.0±15.5 vs 69.1±13.9 min, p<0.001) and higher frequency tubeless/totally tubeless procedures (41.1 vs 6.8%, p<0.001). mPNL showed a higher SFR (96.4 vs 91.8%, р=0.002 in patients with complete staghorn (90.1 vs 77.3%, p<0.05) and multiple kidney stones (89.5 vs 70.8%, p=0.03). Postoperative decrease in hemoglobin was lower in mPNL group 1.1±0.34 vs 2.1±0.26 g/dl (p<0.001). The incidence rate of urinary tract infections and postoperative hospital stay was lower in the mPNL group: 7.3 vs 13.2%, p=0.03 and 1.9±0.6 vs 4.3±2.4 days, р<0.001. Conclusions. MPNL is a safe and effective treatment for patients with complex renal stones with an improved stone-free rate and lower complication rate and shorter hospital stay. Smaller diameter tract in mPNL procedures was associated with a longer duration of surgery.

Mini percutaneous nephrolithotomy (mPNL) is a standard treatment for kidney stones larger than 1.5 cm, with the placement of a nephrostomy drainage at the end of it, which is considered the standard procedure, but tubeless/ totally tubeless mPNL techniques reduce postoperative discomfort in patients and shorten hospital stays. The aim of article was to compare the efficacy and safety of our proposed modified method of totally tubeless mPNL with control of the parenchymal canal, with existing methods of tubeless/totally tubeless mPNL. Novelty of the study presented by modified method of totally tubeless mPNL. During the period from 2018 to 2020 we performed 486 mPNL were performed in our clinic in total, among which 63 (12.9%) patients underwent tubeless PNL. Patients whose surgeries ended with using tubeless techniques were divided into three groups: Group I – 22 patients who had tubeless mPNL (with ureteral stent), Group II (20 patients) – totally tubeless mPNL with a safety thread (the proposed procedure), Group III (21 patients) – totally tubeless mPNL. In all three groups, the access point was most often made through the lower group of renal calyces: Group I – 12 (54.5%), Group II – 14 (70.0%), Group III – 13 (61.9%); then through the middle calyx: Group I – 8 (36.4%), Group II – 6 (30.0%), Group III – 7 (33.3%); and the upper calyx: Group І – 2 (9.1%), Group ІІ – 0%, Group ІІІ – 1 (4.8%), no differences in the distribution of access points between groups were found (p=0.67). There were no differences in the distribution of tract sizes between the groups (p=0.95) with tract dilatation to 16.5/17.5 Fr was performed most often: Group I – 12 (54.5%), in Group II – 11 (55.0%) and Group III – 11 (52.4%). The mean duration of surgery in Group I was 83.0±22.9 min, in Group II – 74.9±13.6 min, in Group III – 72.6±12.0 min (p=0.47). This study confirms the high effectiveness of totally tubeless mPNL. The proposed modification to perform totally tubeless mPNL allows you to have permanent postoperative control over the parenchymal channel and in case of postoperative bleeding it enables you to immediately insert nephrostomy drainage through the safety thread. Study contributes to practical methods as an intermediate step for surgeons who are considering transition to a totally tubeless PCNL technique.

Urolithiasis is one of the most common urological conditions (30–45 %), peaking in the 4th–6th decades of life. About 50 % of patients have one recurrent episode of nephrolithiasis during their lifetime, and among the operated patients, more than 10–15 % of individuals report recurrences with the need for repeated surgical treatment. Increasing the incidence of nephrolithiasis in the world requires the development of new and improvement of existing methods of surgical treatment, which would be characterized by a high level of efficiency and low invasiveness with minimal complications and postoperative rehabilitation. The use of a combination of percutaneous nephrolithotripsy and flexible ureteronephrolithotripsy, especially in complex cases of urolithiasis, can increase the safety and improve the treatment of nephrolithiasis by combining the positive qualities of both methods. Aim. To summarize the data of the world scientific literature on the treatment of nephrolithiasis by studying a combination of percutaneous nephrolithotripsy and retrograde or antegrade flexible intrarenal surgery based on the evaluation of their effectiveness and safety. Materials and methods. The literature review was conducted using the databases PubMed, Google Scholar, Web of Science and Scopus for the period 2015–2022. The following keywords were used for the search: surgical treatment of nephrolithiasis, endoscopic combined intrarenal surgery (ECIRS), percutaneous nephrolithotomy, retrograde intrarenal surgery, simultaneous use of flexible ureterorenoscopy and percutaneous nephrolithotomy, simultaneous use of flexible ureterorenoscopy and percutaneous nephrolithotripsy. Conclusions. The use of ECIRS increases the effectiveness of one-stage treatment of nephrolithiasis with minimal complications and reduces the number of re-operations required. Treatment of complex forms of nephrolithiasis may be a priority for ECIRS. The main disadvantages of ECIRS are the need for simultaneous operation of two operating surgeons and the availability of two sets of endoscopic equipment, which make this procedure expensive.

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