Skip to main content

Advertisement

SpringerLink
Log in

Advances in Tubeless Percutaneous Nephrolithotomy and Patient Selection: An Update

  • Minimally Invasive Surgery (V Bird, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Percutaneous nephrolithotomy (PCNL) is the gold standard for the treatment of large renal calculi. Recently, modifications to the standard PCNL with nephrostomy tube placement have evolved, most notably the introduction of tubeless PCNL. Tubeless PCNL appears to decrease postoperative discomfort and shorten hospital stays, without increasing complication rates in the appropriately selected patient population. Urologists have attempted to expand the role of tubeless PCNL in more complex clinical scenarios, including pediatric and geriatric patients, and in stones complicated by multiple access tracts, renal anomalies or previous renal surgery. In an attempt to further improve outcomes following tubeless PCNL, adjunct interventions such as the use of hemostatic agents along the percutaneous access tract and local tract anesthetic have also been evaluated. We report the most recent published data over the past year, reviewing the employment and efficacy of tubeless PCNL, and discuss the selection of appropriate patients for this modified procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as:• Of importance•• Of major importance

  1. Fernström I, Johansson B. Percutaneous pyelolithotomy: a new extraction technique. Scand J Urol Nephrol. 1976;10:257–9.

    PubMed  Google Scholar 

  2. Bellman GC, Davidoff R, Candela J, et al. Tubeless percutaneous renal surgery. J Urol. 1997;157:1578–82.

    Article  PubMed  CAS  Google Scholar 

  3. • Crook TJ, Lockyer CR, Keoghane SR, et al. A randomized controlled trial of nephrostomy placement versus tubeless percutaneous nephrolithotomy. J Urol. 2008;180:612–4. This study represents one of the earliest randomized trials comparing standard PCNL to the tubeless approach.

    Article  PubMed  CAS  Google Scholar 

  4. Maheshwari PN, Andankar MG, Bansal M. Nephrostomy tube after percutaneous nephrolithotomy: large-bore or pigtail catheter? J Endourol. 2000;14:735–7.

    Article  PubMed  CAS  Google Scholar 

  5. Liatsikos EN, Hom D, Dinlenc CZ, et al. Tail stent versus re-entry tube: a randomized comparison after percutaneous stone extraction. Urology. 2002;59:15–9.

    Article  PubMed  Google Scholar 

  6. Pietrow PK, Auge BK, Lallas CD, et al. Pain after percutaneous nephrolithotomy: impact of nephrostomy tube size. J Endourol. 2003;17:411–4.

    Article  PubMed  Google Scholar 

  7. Kim SC, Tinmouth WW, Kuo RL, et al. Using and choosing a nephrostomy tube after percutaneous nephrolithotomy for large or complex stone disease: a treatment strategy. J Endourol. 2005;19:348–52.

    Article  PubMed  Google Scholar 

  8. • Chang CH, Wang CJ, Huang SW. Totally tubeless percutaneous nephrolithotomy: a prospective randomized controlled study. Urol Res. 2011;39:459–65. This article is a randomized controlled trial evaluating conventional PCNL and tubeless PCNL.

    Article  PubMed  CAS  Google Scholar 

  9. Mandhani A, Goyal R, Vijjan V, et al. Tubeless percutaneous nephrolithotomy-should a stent be an integral part? J Urol. 2007;178:921–4.

    Article  PubMed  Google Scholar 

  10. Wickham JE, Miller RA, Kellett MJ, et al. Percutaneous nephrolithotomy: one stage or two? Br J Urol. 1984;56:582–5.

    Article  PubMed  CAS  Google Scholar 

  11. Lojanapiwat B, Soonthornphan S, Wudhikarn S. Tubeless percutaneous nephrolithotomy in selected patients. J Endourol. 2001;15:711–3.

    Article  PubMed  CAS  Google Scholar 

  12. Limb J, Bellman GC. Tubeless percutaneous renal surgery: review of first 112 patients. Urology. 2002;59:527–31.

    Article  PubMed  Google Scholar 

  13. Abou-Elela A, Emran A, Mohsen MA, et al. Safety and efficacy of tubeless percutaneous renal surgery. J Endourol. 2007;21:977–84.

    Article  PubMed  Google Scholar 

  14. Shoma AM, Elshal AM. Nephrostomy tube placement after percutaneous nephrolithotomy: critical evaluation through a prospective randomized study. Urology. 2012. doi:10.1007/s00345-012-0921-2

  15. Lu Y, Ping JG, Zhao XJ, et al. Randomized prospective trial of tubeless versus conventional minimally invasive percutaneous nephrolithotomy. World J Urol. 2012, In press.

  16. Resorlu B, Kara C, Sahin E, et al. Comparison of nephrostomy drainage types following percutaneous nephrolithotomy requiring multiple tracts: single tube versus multiple tubes versus tubeless. Urol Int. 2011;87:23–7.

    Article  PubMed  Google Scholar 

  17. Shah HN, Shah RH, Sodha HS, et al. A randomized control trial evaluating efficacy of nephrostomy tract infiltration with bupivacaine after tubeless percutaneous nephrolithotomy. J Endourol. 2012;26:478–83.

    Article  PubMed  Google Scholar 

  18. Jou YC, Shen CH, Lin CT, et al. Safety and efficacy of tubeless percutaneous nephrolithotomy in patients on anti-platelet therapy and cirrhotic patients. Urol Res. 2011;39:393–6.

    Article  PubMed  CAS  Google Scholar 

  19. Aghamir SM, Modaresi SS, Aloosh M, et al. Totally tubeless percutaneous nephrolithotomy for upper pole renal stone using subcostal access. J Endourol. 2011;25:583–6.

    Article  PubMed  Google Scholar 

  20. Yun SI, Lee YH, Kim JS, et al. Comparative study between standard and totally tubeless percutaneous nephrolithotomy. Korean J Urol. 2012;53:785–9.

    Article  PubMed  Google Scholar 

  21. •• Kara C, Resorlu B, Bayindir M, et al. A randomized comparison of totally tubeless and standard percutaneous nephrolithotomy in elderly patients. Urology. 2010;76:289–93. This study evaluates tubeless PCNL in the elderly,a potentially more vulnerable patient population.

    Article  PubMed  Google Scholar 

  22. Istanbulluoglu MO, Cicek T, Ozturk B, et al. Percutaneous nephrolithotomy: nephrostomy or tubeless or totally tubeless? Urology. 2010;75:1043–6.

    Article  PubMed  Google Scholar 

  23. Samad L, Aquil S, Zaidi Z. Paediatric percutaneous nephrolithotomy: setting new frontiers. BJU Int. 2006;97:359–63.

    Article  PubMed  Google Scholar 

  24. Gupta NP, Mishra S, Suryawanshi M, et al. Comparison of standard with tubeless percutaneous nephrolithotomy. J Endourol. 2008;22:1441–6.

    Article  PubMed  CAS  Google Scholar 

  25. Khairy Salem H, Morsi HA, Omran A, et al. Tubeless percutaneous nephrolithotomy in children. J Pediatr Urol. 2007;3:235–8.

    Article  PubMed  CAS  Google Scholar 

  26. •• Ozturk A, Guven S, Kilinc M, et al. Totally tubeless percutaneous nephrolithotomy: is it safe and effective in preschool children? J Endourol. 2010;24:1935–9. This article highlights the potential use of tubeless PCNL in very young children, a rarely evaluated patient population in PCNL series.

    Article  PubMed  Google Scholar 

  27. Samad L, Zaidi Z. Tubed vs tubeless PCNL in children. J Pak Med Assoc. 2012;62:892–6.

    PubMed  Google Scholar 

  28. Aghamir SM, Salavati A, Aloosh M, et al. Feasibility of totally tubeless percutaneous nephrolithotomy under the age of 14 years: a randomized clinical trial. J Endourol. 2012;26:621–4.

    Article  PubMed  Google Scholar 

  29. Desai M, Grover R, Manohar T, et al. Simultaneous bilateral percutaneous nephrolithotomy: a single-center experience. J Endourol. 2007;21:508–14.

    Article  PubMed  Google Scholar 

  30. Silverstein AD, Terranova SA, Auge BK, et al. Bilateral renal calculi: assessment of staged v synchronous percutaneous nephrolithotomy. J Endourol. 2004;18:145–51.

    Article  PubMed  Google Scholar 

  31. Holman E, Salah MA, Tóth C. Comparison of 150 simultaneous bilateral and 300 unilateral percutaneous nephrolithotomies. J Endourol. 2002;16:33–6.

    Article  PubMed  Google Scholar 

  32. Wang CJ, Chang CH, Huang SW. Simultaneous bilateral tubeless percutaneous nephrolithotomy of staghorn stones: a prospective randomized controlled study. Urol Res. 2011;39:289–94.

    Article  PubMed  Google Scholar 

  33. Yu A, Shahrour W, Andonian S. Simultaneous bilateral tubeless percutaneous nephrolithotomy: a report of 2 cases and review of the literature. Can Urol Assoc J. 2012;6:162–6.

    Google Scholar 

  34. • Lipkin ME, Mancini JG, Simmons WN, et al. Pathologic evaluation of hemostatic agents in percutaneous nephrolithotomy tracts in a porcine model. J Endourol. 2011;25:1353–7. A porcine study which compares of the use of Surgiflo and Evicel as hemostatic agents along the percutaneous tract to untreated access.

    Article  PubMed  Google Scholar 

  35. Gudeman SR, Stroup SP, Durbin JM, et al. Percutaneous stone surgery using a tubeless technique with fibrin sealant: report of our first 107 cases. BJU Int. 2012;110:E1048–52.

    Article  PubMed  Google Scholar 

  36. Cormio L, Perrone A, Di Fino G, et al. TachoSil(®) sealed tubeless percutaneous nephrolithotomy to reduce urine leakage and bleeding: outcome of a randomized controlled study. J Urol. 2012;188:145–50.

    Google Scholar 

  37. Li R, Louie MK, Lee HJ, et al. Prospective randomized trial of three different methods of nephrostomy tract closure after percutaneous nephrolithotripsy. BJU Int. 2011;107:1660–5.

    Article  PubMed  Google Scholar 

  38. Uribe CA, Eichel L, Khonsari S, et al. What happens to hemostatic agents in contact with urine? An in vitro study. J Endourol. 2005;19:312–7.

    Article  PubMed  Google Scholar 

  39. Duvdevani M, Razvi H, Sofer M, et al. Third prize: contemporary percutaneous nephrolithotripsy: 1585 procedures in 1338 consecutive patients. J Endourol. 2007;21:824–9.

    Article  PubMed  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Department of Urology, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, USA

    Mitra R. de Cógáin & Amy E. Krambeck

  2. Department of Urology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA

    Mitra R. de Cógáin & Amy E. Krambeck

Authors
  1. Mitra R. de Cógáin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amy E. Krambeck
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Amy E. Krambeck.

Rights and permissions

Reprints and permissions

About this article

Cite this article

de Cógáin, M.R., Krambeck, A.E. Advances in Tubeless Percutaneous Nephrolithotomy and Patient Selection: An Update. Curr Urol Rep 14, 130–137 (2013). https://doi.org/10.1007/s11934-013-0310-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-013-0310-4

Keywords

Search

Navigation