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The management of the access tract after percutaneous nephrolithotomy

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Abstract

Purpose

To describe the evolution of the current technique in percutaneous nephrolithotomy (PCNL) with a special focus on access tract closure techniques.

Methods

A systematic review of outcomes and complications of tubeless PCNL was conducted using the MEDLINE and Pubmed databases between 1976 and 2014.

Results

During the past decade, PCNL underwent fundamental modifications due to miniaturization of the instruments and advancements in technique. The routine use of the nephrostomy tube after PCNL has been subsequently questioned. Currently, the nephrostomy tube is increasingly omitted, and the access tract is usually sealed by haemostatic agents. An additionally ureteric stent is commonly inserted at the end of the procedure. However, the application of haemostatic sealants increases the immediate costs significantly. Still there are inconsistent data because of small study populations, lack of randomization, retrospective character and further more heterogeneous surgical techniques.

Conclusion

The current body of literature does not provide high-level evidence for the preferred treatment of the access tract in PCNL. However, most authors agree that a tract sealing can be omitted without increasing the risk of complication in uncomplicated procedures.

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Abbreviations

DTPA:

Tc 99m technetium diethylenetriaminepentacetic acid

NSD:

No significant difference

PCNL:

Percutaneous nephrolithotomy

POD:

Postoperative day

SWL:

Shock wave therapy

URS:

Ureterorenoscopy

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Conflict of interest

None of the authors has any conflicting interest concerning the contents of this text.

Author information

Authors and Affiliations

  1. Department of Urology and Paediatric Urology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany

    Tanja Hüsch, Michael Reiter, René Mager, Eva Steiner, Axel Haferkamp & David Schilling

  2. Department of Urology and Urologic Oncology, University Hospital Hannover, Hannover, Germany

    Thomas R. W. Herrmann

Authors
  1. Tanja Hüsch
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  2. Michael Reiter
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  3. René Mager
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  4. Eva Steiner
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  5. Thomas R. W. Herrmann
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  6. Axel Haferkamp
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  7. David Schilling
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Corresponding author

Correspondence to David Schilling.

Additional information

Thomas R. W. Herrmann and David Schilling: for the Training and Research in Urologic Surgery and Technology (T.R.U.S.T.) Group.

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Hüsch, T., Reiter, M., Mager, R. et al. The management of the access tract after percutaneous nephrolithotomy. World J Urol 33, 1921–1928 (2015). https://doi.org/10.1007/s00345-015-1558-8

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  • DOI: https://doi.org/10.1007/s00345-015-1558-8

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