Kidney Drainage and Percutaneous Tract Closure

  • Cesare Marco ScoffoneEmail author
  • András Hoznek
  • Cecilia Maria Cracco


Exit strategy after PNL, irrespective to the patient’s position, is an area of continuous innovation to improve its outcomes and minimize its morbidity. Traditionally, a nephrostomy tube at the conclusion of a PNL was left for kidney drainage, hemostasis and tract healing, and allowance for postoperative renal access. During the years, various modifications have been made in the design and size of the nephrostomy tubes. Recently, the possibility of avoiding nephrostomy tube placement (tubeless but stented or totally tubeless PNL) has become real, according to definite inclusion criteria. The various techniques to establish hemostasis of a tubeless access tract are also reported, with particular reference to the use of hemostatic agents.


Fibrin Sealant Nephrostomy Tube Stone Burden Percutaneous Tract Calyceal Diverticulum 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Paul EM, Marcovich R, Lee BR, Smith AD (2003) Choosing the ideal nephrostomy tube. BJU Int 92:672–677PubMedCrossRefGoogle Scholar
  2. 2.
    Srinivasan AK, Herati A, Okeke Z, Smith AD (2009) Renal drainage after percutaneous nephrolithotomy. J Endourol 23:1743–1749PubMedCrossRefGoogle Scholar
  3. 3.
    Maheshwari PN, Andankar MG, Bansal M (2000) Nephrostomy tube after percutaneous nephrolithotomy: large-bore or pigtail catheter? J Endourol 14:735–737PubMedCrossRefGoogle Scholar
  4. 4.
    Liatsikos EN, Hom D, Dinlenc CZ et al (2002) Tail stent versus re-entry tube: a randomized comparison after percutaneous stone extraction. Urology 59:15–19PubMedCrossRefGoogle Scholar
  5. 5.
    Pietrow PK, Auge BK, Lallas CD et al (2003) Pain after percutaneous nephrolithotomy: impact of nephrostomy tube size. J Endourol 17:411–414PubMedCrossRefGoogle Scholar
  6. 6.
    Desai MR, Kukreja RA, Desai MM et al (2004) A prospective randomized comparison of type of nephrostomy drainage following percutaneous nephrostolithotomy: large bore versus small bore versus tubeless. J Urol 172:565–567PubMedCrossRefGoogle Scholar
  7. 7.
    Kukreja R, Desai M, Patel S, Bapat S (2004) Factors affecting blood loss during percutaneous nephrolithotomy: prospective study. J Endourol 18:715–722PubMedGoogle Scholar
  8. 8.
    Choi M, Brusky J, Weaver J et al (2006) Randomized trial comparing modified tubeless percutaneous nephrolithotomy with tailed stent with percutaneous nephrostomy with small-bore tube. J Endourol 20:766–770PubMedCrossRefGoogle Scholar
  9. 9.
    De Sio M, Autorino R, Quattrone C et al (2011) Choosing the nephrostomy size after percutaneous nephrolithotomy. World J Urol 29:707–711PubMedCrossRefGoogle Scholar
  10. 10.
    Dirim A, Turunc T, Kuzgunbay B et al (2011) Which factors may affect urinary leakage following percutaneous nephrolithotomy? World J Urol 29:761–766PubMedCrossRefGoogle Scholar
  11. 11.
    Shen P, Liu Y, Wang J (2012) Nephrostomy tube-free versus nephrostomy tube for renal drainage after percutaneous nephrolithotomy: a systematic review and meta-analysis. Urol Int 88:298–306PubMedCrossRefGoogle Scholar
  12. 12.
    Armitage JN, Irving SO, Burgess NA (2012) Percutaneous nephrolithotomy in the United Kingdom: results of a prospective data registry. Eur Urol 61:1188–1193PubMedCrossRefGoogle Scholar
  13. 13.
    Borges CF, Fregonesi A, Silva DC, Sasse AD (2010) Systematic review and meta-analysis of nephrostomy placement versus tubeless percutaneous nephrolithotomy. J Endourol 24:1739–1746CrossRefGoogle Scholar
  14. 14.
    Giusti G, Piccinelli A, Taverna G et al (2007) Miniperc? No, thank you! Eur Urol 51:810–815PubMedCrossRefGoogle Scholar
  15. 15.
    Etemadian M, Soleimani MJ, Haghighi R et al (2011) Does bleeding during percutaneous nephrolithotomy necessitate keeping the nephrostomy tube? A randomized controlled clinical trial. Urol J 8:21–26PubMedGoogle Scholar
  16. 16.
    Crook TJ, Lockyer CR, Keoghane SR et al (2008) Totally tubeless percutaneous nephrolithotomy: our experience. J Endourol 22:25–28CrossRefGoogle Scholar
  17. 17.
    Shoma AM, Elshal AM (2012) Nephrostomy tube placement after percutaneous nephrolithotomy: critical evaluation through a prospective randomized study. Urology 79:771–776PubMedCrossRefGoogle Scholar
  18. 18.
    Cormio L, Preminger G, Saussine C et al (2012) Nephrostomy in percutaneous nephrolithotomy (PCNL): does nephrostomy tube size matter? Results from the Global PCNL Study from the Clinical Research Office of Endourology Society. World J Urol PMID 23073656 (in press)Google Scholar
  19. 19.
    Agrawal MS, Agrawal M (2010) Tubeless percutaneous nephrolithotomy. Indian J Urol 26:16–24PubMedCrossRefGoogle Scholar
  20. 20.
    Lahme S, Zimmermanns V, Hochmuth A, Liske P (2008) Stones of the upper urinary tract. Update on minimal-invasive endourological treatment. Arch Ital Urol Androl 80:13–17PubMedGoogle Scholar
  21. 21.
    Knoll T, Wezel F, Michel MS et al (2010) Do patients benefit from miniaturized tubeless percutaneous nephrolithotomy? A comparative prospective study. J Endourol 24:1075–1079PubMedCrossRefGoogle Scholar
  22. 22.
    Kruck S, Anastasiadis AG, Herrmann TR et al (2012) Minimally invasive percutaneous nephrolithotomy: an alternative to retrograde intrarenal surgery and shockwave lithotripsy. World J Urol 30:639–646Google Scholar
  23. 23.
    Karami H, Gholamrezaie HR (2004) Totally tubeless percutaneous nephrolithotomy in selected patients. J Endourol 18:475–476PubMedCrossRefGoogle Scholar
  24. 24.
    Aghamir SM, Hosseini SR, Gooran S (2004) Totally tubeless percutaneous nephrolithotomy. J Endourol 18:647–648PubMedCrossRefGoogle Scholar
  25. 25.
    Istanbulluoglu MO, Ozturk B, Gonen M et al (2009) Effectiveness of totally tubeless percutaneous nephrolithotomy in selected patients. A prospective randomized study. Int Urol Nephrol 41:541–545PubMedCrossRefGoogle Scholar
  26. 26.
    Marchant F, Recabal P, Fernandez MI et al (2011) Postoperative morbidity of tubeless versus conventional percutaneous nephrolithotomy: a prospective comparative study. Urol Res 39:477–481PubMedCrossRefGoogle Scholar
  27. 27.
    Falahatkar S, Khosropanah I, Roshani A et al (2008) Tubeless percutaneous nephrolithotomy for staghorn stones. J Endourol 22:1447–1451PubMedCrossRefGoogle Scholar
  28. 28.
    Rana AM, Bhojwani JP, Junejo NN, Das Bhagia S (2008) Tubeless PCNL with patient in supine position: procedure for all seasons? With comprehensive technique. Urology 71:581–585PubMedCrossRefGoogle Scholar
  29. 29.
    Shah HN, Kausik VB, Hedge SS et al (2005) Safety and efficacy of bilateral simultaneous tubeless percutaneous nephrolithotomy. Urology 66:500–504PubMedCrossRefGoogle Scholar
  30. 30.
    Shah H, Khandkar A, Sodha H et al (2009) Tubeless percutaneous nephrolithotomy: 3 years of experience with 454 patients. BJU Int 104:840–846PubMedCrossRefGoogle Scholar
  31. 31.
    Kara C, Resorlu B, Bayndir M, Unsai A (2010) A randomized comparison of totally tubeless and standard percutaneous nephrolithotomy in elderly patients. Urology 76:289–294PubMedCrossRefGoogle Scholar
  32. 32.
    Zilberman DE, Lipkin ME, de la Rosette JJ et al (2010) Tubeless percutaneous nephrolithotomy – the new standard of care? J Urol 184:1261–1266PubMedCrossRefGoogle Scholar
  33. 33.
    Aghamir SM, Hamidi M, Aloosh M et al (2011) Efficacy and morbidity following PCNL in patients with renal anomalies: the outcome from a randomized study comparing different imaging modalities for assessment. Minerva Urol Nefrol 63:207–212Google Scholar
  34. 34.
    Jou YC, Shen CH, Lin CT et al (2011) Safety and efficacy of tubeless percutaneous nephrolithotomy in patients on anti-platelet therapy and cirrhotic patients. Urol Res 39:393–396PubMedCrossRefGoogle Scholar
  35. 35.
    Resorlu B, Kara C, Sahin E, Unsal A (2011) Comparison of nephrostomy drainage types following percutaneous nephrolithotomy requiring multiple tracts: single tube versus multiple tubes versus tubeless. Urol Int 87:23–27PubMedCrossRefGoogle Scholar
  36. 36.
    Amer T, Ahmed K, Bultitude M et al (2012) Standard versus tubeless percutaneous nephrolithotomy: a systematic review. Urol Int 88:373–382PubMedCrossRefGoogle Scholar
  37. 37.
    Wang J, Zhao C, Zhang C et al (2011) Tubeless vs standard percutaneous nephrolithotomy: a meta-analysis. BJU Int 109:918–924PubMedCrossRefGoogle Scholar
  38. 38.
    Okeke Z, Andonian S, Srinivasan A et al (2009) Cryotherapy of the nephrostomy tract: a novel technique to decrease the risk of hemorrhage after tubeless percutaneous renal surgery. J Endourol 23:417–420PubMedCrossRefGoogle Scholar
  39. 39.
    Mishra S, Sabnis RB, Kurien A et al (2010) Questioning the wisdom of tubeless percutaneous nephrolithotomy (PCNL): a prospective randomized controlled study of early tube removal vs tubeless PCNL. BJU Int 106:1045–1049PubMedCrossRefGoogle Scholar
  40. 40.
    Li R, Louie MK, Lee HJ et al (2010) Prospective randomized trial of three different methods of nephrostomy tract closure after percutaneous nephrolithotripsy. BJU Int 107:1660–1665PubMedCrossRefGoogle Scholar
  41. 41.
    Jou YC, Cheng MC, Sheen JH et al (2004) Electrocauterization of bleeding points for percutaneous nephrolithotomy. Urology 64:443–447PubMedCrossRefGoogle Scholar
  42. 42.
    Aron M, Goel R, Kesarwani PK, Guota NP (2004) Hemostasis in tubeless PNL. Point of technique. Urol Int 73:244–247PubMedCrossRefGoogle Scholar
  43. 43.
    Choe CH, L’Esperance JO, Auge BK (2009) The use of adjunctive hemostatic agents for tubeless percutaneous nephrolithotomy. J Endourol 23:1733–1738PubMedCrossRefGoogle Scholar
  44. 44.
    Lipkin ME, Mancini JG, Simmons WN et al (2011) Pathologic evaluation of hemostatic agents in percutaneous nephrolithotomy tracts in a porcine model. J Endourol 25:1353–1357PubMedCrossRefGoogle Scholar
  45. 45.
    Aghamir SM, Khazaeli MH, Meisami A (2006) Use of Surgicel for sealing nephrostomy tract after totally tubeless percutaneous nephrolithotomy. J Endourol 20:293–295PubMedCrossRefGoogle Scholar
  46. 46.
    Lee DI, Uribe C, Eichel L et al (2004) Sealing percutaneous nephrolithotomy tracts with gelatin matrix hemostatic sealant: initial clinical use. J Urol 171:575–578PubMedCrossRefGoogle Scholar
  47. 47.
    Kaufmann OG, Sountoulides P, Kaplan A et al (2009) Skin treatment and tract closure for tubeless percutaneous nephrolithotomy: University of California, Irvine, Technique. J Endourol 23:1739–1741PubMedCrossRefGoogle Scholar
  48. 48.
    Eden CG, Sultana SR, Murray KH, Carruthers RK (1997) Extraperitoneal laparoscopic dismembered fibrin-glued pyeloplasty: medium-term results. BJU Int 80:382–389CrossRefGoogle Scholar
  49. 49.
    Kim IY, Eichel L, Edwards R et al (2007) Effects of commonly used hemostatic agents on the porcine collecting system. J Endourol 21:652–654PubMedCrossRefGoogle Scholar
  50. 50.
    Uribe CA, Eichel L, Khonsari S et al (2005) What happens to hemostatic agents in contact with urine? An in vitro study. J Endourol 19:312–317PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2014

Authors and Affiliations

  • Cesare Marco Scoffone
    • 1
    Email author
  • András Hoznek
    • 2
  • Cecilia Maria Cracco
    • 1
  1. 1.Department of UrologyCottolengo HospitalTorinoItaly
  2. 2.Department of UrologyCHU Henri MondorCréteil CedexFrance

Personalised recommendations