Totally tubeless, tubeless, and tubed percutaneous nephrolithotomy for treating kidney stones

Wilhelm, Konrad; Hein, Simon; Kunath, Frank; Schoenthaler, Martin; Schmidt, Stefanie

doi:10.1002/14651858.cd012607.pub2

Cited by 4 publications

(3 citation statements)

References 85 publications

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“…While some of these patients have their internalized tubes removed before discharge, they are not classified as totally tubeless if they are admitted for observation with some form of a drainage catheter. If a patient leaves the recovery room without any form internalized drainage (e.g., a foley catheter, ureteral stent with or without an antegrade or retrograde tether for removal, ureteral catheter, or nephrostomy tube), the procedure can then be truly considered to be totally tubeless nephrolithotomy (tt-PCNL) [ 5 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…The main concern for totally tubeless PCNL is lack of renal protection from obstruction post-operatively. Placing a stent or nephrostomy tube allows for drainage of urine, clots, and residual stone fragments, and a nephrostomy tube has the additional benefit of providing dilation tract hemostasis [ 4 , 5 ]. When performing a totally tubeless technique, the primary risk separating it from a stented PCNL is the risk of post-operative ureteral obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…When PCNL was first described in 1976, it was standard to leave a percutaneous nephrostomy tube (PCNT) post-operatively [ 4 ]. Leaving a nephrostomy tube was thought to ensure drainage of urine, clot, and residual stone fragments and provide hemostasis of the dilation tract [ 4 , 5 ]. However, leaving a nephrostomy tube was bothersome to the patient, and prolonged placement can lead to persistent urinary leakage from the flank.…”

Section: Introductionmentioning

confidence: 99%

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Is Totally Tubeless Percutaneous Nephrolithotomy a Safe and Efficacious Option for Complex Stone Disease?

Tomer,

Durbhakula,

Gupta

et al. 2024

JCM

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Background: Percutaneous nephrolithotomy is the gold standard treatment for large, complex intrarenal stones. Historically, this was performed using a nephrostomy tube (PCN) and/or internalized ureteral stent at the end of the procedure. However, totally tubeless nephrolithotomy (tt-PCNL) is a novel technique where no tubes (no stent nor nephrostomy tube) are left post-operatively. We review the literature on this subject regarding peri-operative outcomes, post-operative outcomes, and potential complications of the procedure, discuss our technique, and make recommendations on implementation for centers not currently utilizing the procedure. Materials and methods: We performed a comprehensive search of the literature on totally tubeless nephrolithotomy using MEDLINE database search. Our search included prior review articles, meta-analyses, systematic reviews, primary research articles, case reports, and case studies. Results: In comparison to prior approaches where a stent or nephrostomy tube is placed, tt-PCNL has a similar complication rate and better post-operative outcomes. Totally tubeless PCNL has similar operative times and similar changes in hemoglobin. However, it had shorter length of stays across all studies. The mean difference in length of stay in the studies reviewed was 1.96 days. Additionally, tt-PCNL had decreased post-operative analgesic requirements and pain scores. Conclusions: This review highlights totally tubeless percutaneous nephrolithotomy as a safe and feasible surgical technique with improved outcomes in properly selected patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%