title: Tubeless percutaneous nephrolithotomy with antegrade stent tether: clinical experience.
abstract: OBJECTIVE
  A limitation of tubeless percutaneous nephrolithotomy (PCNL) is the need for post-operative office cystoscopy to remove the ureteral stent. We developed a novel technique of intraoperative stent placement that allows removal via the flank. Herein, we report on our initial clinical experience.
  
  
  METHODS
  Thirty consecutive patients (36 renal moieties) undergoing tubeless PCNL had ureteral stents placed at the end of the procedure with a stent tether exiting the flank incision. Patients were discharged home with the tether protected by a clear occlusive bandage. The stents were removed in the office between 3 and 12 days postoperatively by gently pulling on the tether. Patients were assessed for difficulty in removing the stent, leakage of urine from the flank, and any other postoperative complications.
  
  
  RESULTS
  All stents could be removed from the flank using the tether. No urine leakage was noted in any patient, nor did any patient develop any complication related to stent placement or removal. Stents from several manufacturers were employed, with no difference noted. Patients reported no additional discomfort from the presence of the flank tether, and no significant pain was noted during stent removal.
  
  
  CONCLUSIONS
  Utilization of the tether to remove the ureteral stent via the flank after tubeless PCNL is a feasible, safe, and cost-effective improvement on the standard tubeless PCNL technique. This modification obviates postoperative office cystoscopy, allowing easy removal of a stent.
authors.affiliation: Department of Urology, Kaiser Foundation Hospital, Los Angeles, California.
authors.forename: Andrew I
authors.initials: AI
authors.lastname: Shpall
authors.forename: Ashish R
authors.initials: AR
authors.lastname: Parekh
authors.forename: Gary C
authors.initials: GC
authors.lastname: Bellman
mesh_terms: D003362:Cost-Benefit Analysis; D003558:Cystoscopy / Q000379:methods*; D020878:Device Removal; D004867:Equipment Design; D006801:Humans; D007668:Kidney / Q000473:pathology*; D007669:Kidney Calculi / Q000628:therapy*; D008953:Models, Anatomic; D009398:Nephrology / Q000379:methods*; D009403:Nephrostomy, Percutaneous / Q000295:instrumentation* / Q000379:methods*; D011183:Postoperative Complications; D015607:Stents; D014513:Ureter / Q000473:pathology*