Safety of tubeless or totally tubeless drainage and nephrostomy tube as a drainage following percutaneous nephrolithotomy: A comprehensive review

Abstract

Percutaneous nephrolithotomy (PCNL) using a nephrostomy tube as a drainage has been considered the standard procedure. However, recently many literatures have reported the use of tubeless and totally tubeless drainage following PCNL with excellent results. A literature search was conducted using MEDLINE databases to review each drainage technique following PCNL (tubeless, totally tubeless, or nephrostomy tube) and also to assess the most recent evidence that compare the safety of these drainage procedures with a clear-cut clinical parameter imposed. Tubeless or totally tubeless PCNL is significantly superior to standard PCNL in terms of length of hospital stay, postoperative pain (visual analog scale) score, demands or dosage of analgesics required, as well as faster return to activity for the patients. However, despite the many advantages of tubeless or totally tubeless PCNL over standard PCNL, there are a number of situations requiring the consideration of nephrostomy tube placement. Nonetheless, decision to use or not to use nephrostomy tube after PCNL depends on the surgeon's experience and clinical judgment.

Tubeless PCNL – Contemporary Analysis of Indications, Safety and Efficacy

“…We performed tubeless PCNL safely in patients with anomalous kidneys, staghorn or complex renal calculi, multiple tracts and supra costal approach. We found that tubeless PCNL is safe in patients with no evidence of perforation of renal pelvis, minimal intraoperative bleeding and in patients in whom there was no need of a relook PCNL as also reported by Tirtayasa (9). We observed that multiple tract PCNL was not a contraindication for tubeless PCNL in our experience.…”

“…Cost of performing tubeless PCNL was reported to be significantly lesser than standard PCNL in a study done by Choi et al (9,15).Bleeding has always been a pointer against tubeless PCNL. In a large report of 1000 tubeless PCNL with 17% patients having staghorncalculi, custom-made electrode probe was used to cauterize bleeding points.…”

“…Placement of a nephrostomy tube or ureteral catheter may increase the risk of postoperative pain and morbidity (9)(10)(11)(12). When the nephrostomy was avoided, it was observed that complications were comparable to standard PCNL and that tubeless PCNL was safe and costeffective (13).…”

“…The main problem is hemorrhage that can happen during any stage of the procedure. Placing a nephrostomy may help avoid this complication and provides the opportunity for second look PCNL or percutaneous chemolitholysis (9,15). Despite continual technical refinements, hemorrhage is still a problem as reported in a meta-analysis and placement of a nephrostomy has been found to reduce it (15).…”

Updates in endourological management of urolithiasis

“…95 Tubeless PCNL, with or without ureteric stent, has significantly reduced postoperative pain and hospital stay when compared with standard PCNL with nephrostomy tubes. [96][97][98][99] However, it is important that the inclusion criteria are strict in most of these studies; therefore, the recommendation for tubeless PCNL is for selected patients.…”