title: Tubeless percutaneous nephrolithotomy without losing the possibility of second-look nephroscopy: The perfect combination.
abstract: OBJECTIVE
  To evaluate an alternative approach to tubeless surgery that allows a second percutaneous procedure using the same nephrostomy tract.
  
  
  METHODS
  Twenty patients underwent percutaneous nephrolithotomy from September 2012 to May 2013 at our institution. Inclusion criteria were: absence of urinary infection, single puncture and operative time less than 2 h. Following the procedure the initially placed ureteral catheter was exteriorized through the working sheath by tying a non-absorbable suture to its end. On postoperative day 1 all patients were studied with non-enhanced CT or X-ray film. If the patient was rendered stone free, the stent was removed along with the urethro-vesical catheter. If a residual stone was present, we recovered the ureteral catheter and used the same nephrostomy tract for a second endoscopic procedure. Patients were assessed for pain, postoperative complications, length of stay, stone free rate, hematocrit and creatinine variations.
  
  
  RESULTS
  Thirteen patients met the inclusion criteria. No major complications related to the stent placement and its exteriorization were seen. Two patients required a second percutaneous procedure successfully achieved recovering the ureteral catheter through the nephrostomy tract.
  
  
  CONCLUSIONS
  We present a safe and simple modification of tubeless percutaneous nephrolithotomy, with its well-known clinical benefits but maintaining a safe path for an eventual second look procedure if necessary.
authors.affiliation: Servicio de Urología, Hospital Militar de Santiago, Santiago, Chile; Facultad de Medicina, Universidad de los Andes, Santiago, Chile.
authors.forename: A
authors.initials: A
authors.lastname: Domenech
authors.affiliation: Servicio de Urología, Hospital Militar de Santiago, Santiago, Chile; Facultad de Medicina, Universidad de los Andes, Santiago, Chile. Electronic address: bvivaldi@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Vivaldi
authors.affiliation: Servicio de Urología, Hospital Militar de Santiago, Santiago, Chile; Facultad de Medicina, Universidad de los Andes, Santiago, Chile.
authors.forename: J F
authors.initials: JF
authors.lastname: López
authors.affiliation: Servicio de Urología, Hospital Militar de Santiago, Santiago, Chile; Facultad de Medicina, Universidad de los Andes, Santiago, Chile.
authors.forename: P
authors.initials: P
authors.lastname: Pizzi
authors.affiliation: Servicio de Urología, Hospital Militar de Santiago, Santiago, Chile; Facultad de Medicina, Universidad de los Andes, Santiago, Chile.
authors.forename: R
authors.initials: R
authors.lastname: Chacón
authors.affiliation: Servicio de Urología, Hospital Militar de Santiago, Santiago, Chile; Facultad de Medicina, Universidad de los Andes, Santiago, Chile.
authors.forename: A
authors.initials: A
authors.lastname: Figueroa
authors.affiliation: Servicio de Urología, Hospital Militar de Santiago, Santiago, Chile; Facultad de Medicina, Universidad de los Andes, Santiago, Chile.
authors.forename: J
authors.initials: J
authors.lastname: Durruty
authors.affiliation: Servicio de Urología, Hospital Militar de Santiago, Santiago, Chile; Facultad de Medicina, Universidad de los Andes, Santiago, Chile.
authors.forename: N
authors.initials: N
authors.lastname: Zambrano
authors.affiliation: Servicio de Urología, Hospital Militar de Santiago, Santiago, Chile; Facultad de Medicina, Universidad de los Andes, Santiago, Chile.
authors.forename: F
authors.initials: F
authors.lastname: Coz
mesh_terms: D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D024162:Second-Look Surgery; D018666:Ureteroscopy
keywords: Nefrolitectomía percutánea; Nefrostomía; Nefrostomía percutánea; Nephrolithiasis; Percutaneous nephrolithotomy; Percutaneous nephrostomy