A modern view on tubeless percutaneous nephrolithotomy

Abstract

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.

Keywords

• nephrolithiasis
• percutaneous ultrasonic lithotripsy
• nephrostomy
• tubeless percutaneous nephrolithotomy