Tubeless percutaneous nephrolithotomy without losing the possibility of second-look nephroscopy: The perfect combination

Modified tubeless minimally invasive percutaneous nephrolithotomy for management of renal stones in children: A single-centre experience

“…Our modified supine mini-PCNL technique shortened the patients' postoperative hospital stay and lowered both the pain score and analgesic requirement, as our mean (SD; range) hospital stay was 1.42 (0.53; 1-3) days. This agrees with the Domenech et al [7] study that reported a median (range) hospital stay of 3 (2-4) days and Chung et al [6] who found that the modified tubeless group had a mean (SD) of 5.9 (2.7) days, which was shorter than the standard PCNL at 6.8 (2.9) days. On the other hand, our present mean hospital stay was shorter than other studies reporting on conventional mini-PCNL such as Wah et al [18], who reported a mean (range) hospital stay of 4.78 (2-11) days, D'Souza et al [19] reported a mean hospital stay of 3 days, and Desoky et al [20] reported a mean (SD; range) hospital stay of 4.4 (0.9; 3.2-5.9) days.…”

“…The primary SFR was 80% that increased to 100% after successfully treating the residual stones via second-look mini-PCNL after recovering the trackback though the externalised ureteric catheter. This agrees with Zeng et al [14] who found that the SFR after a single session of mini-PCNL (initial SFR) was 80.4% that increased to 94.7% after an auxiliary procedure; and the Domenech et al [7] study of a modified tubeless technique in which they used polypropylene suture externalised at the flank through the track and attached to an internalised ureteric catheter and reported that two patients (15%) required a second-look mini-PCNL after which the SFR increased from 77% to 92%. On the other hand, Wah et al [18] reported a primary SFR of 83.6%, probably higher than our present study due to the use of a paediatric nephroscope and laser lithotripsy for stone disintegration, which increased to 91.3% after treating the residual fragments; whilst in 8.7% there was a failure to establish a satisfactory PCNL tract.…”

“…In recent years, there has been an increase in the number of percutaneous surgeries that, once the procedure has been completed, dispense with the use of nephrostomy, leaving internal drainage through a JJ or ureteric catheter. This modality, known as 'tubeless', has been shown to cause less postoperative pain, reduce analgesia requirements, and shorten hospital stays [7]. The major disadvantage of tubeless PCNL is losing the option to perform an early second-look nephroscopy in cases of residual stones, considering that up to 16% of tubeless PCNL require some type of auxiliary procedure to render the patient stone-free [8].…”