Advances in Tubeless Percutaneous Nephrolithotomy and Patient Selection: An Update

Abstract

Percutaneous nephrolithotomy (PCNL) is the gold standard for the treatment of large renal calculi. Recently, modifications to the standard PCNL with nephrostomy tube placement have evolved, most notably the introduction of tubeless PCNL. Tubeless PCNL appears to decrease postoperative discomfort and shorten hospital stays, without increasing complication rates in the appropriately selected patient population. Urologists have attempted to expand the role of tubeless PCNL in more complex clinical scenarios, including pediatric and geriatric patients, and in stones complicated by multiple access tracts, renal anomalies or previous renal surgery. In an attempt to further improve outcomes following tubeless PCNL, adjunct interventions such as the use of hemostatic agents along the percutaneous access tract and local tract anesthetic have also been evaluated. We report the most recent published data over the past year, reviewing the employment and efficacy of tubeless PCNL, and discuss the selection of appropriate patients for this modified procedure.

Tubeless percutaneous nephrolithotomy (pcnl) in renal allografts: a case report and mini-review

“…2,9 PCNL has significant advantages in renal calculi extraction such as: need for minimal intra-operative bleeding, high stone-free rate, and renal access by one or maximum two attempts in tubeless approaches. 9,23,24 In our case, the patient had a large stone in the renal pelvis. We performed tubeless PCNL for him [ and removed the stone completely.…”

Outpatient bilateral supracostal tubeless percutaneous nephrolithotomy for staghorn calculi

“…1 The original procedure, introduced in 1976, was developed using nephrostomy tubes to secure the tract and to impede postoperative hemorrhage. 2 However, the high rates of morbidity in the form of postoperative discomfort, and the prolonged duration of hospitalization with this method have inspired the development of numerous variations to the procedure.…”

“…3 Numerous studies have supported the use of the tubeless method as a viable alternative to standard PCNL. 1,[4][5][6][7] The advantages of tubeless PCNL over the standard procedure include reduced postoperative analgesic requirements, as well as reduced duration of hospitalization without an increase the rate of complications. Surgical advancements have enabled the use of tubeless PCNL in complex cases, including pediatric, geriatric and bilateral simultaneous renal calculi.…”

“…1 Since its emergence in 1976, 2 numerous modifications have been made to the procedure. The traditional method, which continues to be widely used, involves placing an indwelling nephrostomy tube.…”

“…Multiple studies to date have demonstrated that this is a safe and effective method of stone burden clearance in select patients. 1,[3][4][5][6][7] Recently, tubeless PCNL, on an outpatient basis, has been reported. 8,9 This case report is the first to describe a case of outpatient bilateral tubeless PCNL in a patient with bilateral large staghorn calculi.…”