Safety and efficacy of tubeless percutaneous renal surgery.
OBJECTIVE
We challenge the requirement for routine placement of a nephrostomy tube after percutaneous renal surgery, assessing the outcome, safety, and efficacy of tubeless procedures.


METHODS
A total of 128 patients underwent tubeless percutaneous renal surgery from May 2001 to May 2004: stone extraction in 120 patients and endopyelotomy +/- stone extraction in 8. The stone sizes ranged from 2 to 7 cm with a mean of 4.1 cm. An external ureteral catheter was used in 120 patients and was removed after 24 hours if a retrograde study revealed no extravasation. An antegrade Double-J stent was used in 8 patients and removed 4 to 6 weeks postoperatively. Among the 128 patients treated by the tubeless technique, we met situations that mandated insertion of a nephrostomy tube in 18.


RESULTS
The stone free-rate was 90.4%. The mean hospital stay was 1.7 days. The incidence of significant intraoperative bleeding was 1.5% and that of significant postoperative hematuria was 4.6%. Postoperative sonography revealed a small perirenal collection (<50 mL) in 10 patients (7.8%) and significant perirenal collections (100-250 mL) in 3 (2.3%). The postoperative retrograde study revealed minor extravasation in 14 patients (12%) and significant extravasation in 3 (2.3%)


CONCLUSIONS
Tubeless percutaneous renal surgery with an externalized ureteral catheter is a safe procedure that is suitable for any patient who can be rendered stone free with a single procedure regardless of the initial stone burden.
Abou-Elela
Ashraf
A
Department of Urology, Cairo University, Cairo, Egypt. ashrafboelela@yahoo.co.uk
Emran
Ashraf
A
Mohsen
Mostafa Abdel
MA
Reyad
Ihab
I
Bedair
Ahmed S
AS
Kader
Mongy Abdel
MA
D000293:Adolescent; D000328:Adult; D002648:Child; D020878:Device Removal; D004867:Equipment Design; D005260:Female; D006417:Hematuria / Q000175:diagnosis; D006470:Hemorrhage; D006801:Humans; D007431:Intraoperative Complications; D007669:Kidney Calculi / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000379:methods*; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation* / Q000379:methods*; D012449:Safety; D015607:Stents; D016896:Treatment Outcome