title: The management of the access tract after percutaneous nephrolithotomy.
abstract: OBJECTIVE
  To describe the evolution of the current technique in percutaneous nephrolithotomy (PCNL) with a special focus on access tract closure techniques.
  
  
  METHODS
  A systematic review of outcomes and complications of tubeless PCNL was conducted using the MEDLINE and Pubmed databases between 1976 and 2014.
  
  
  RESULTS
  During the past decade, PCNL underwent fundamental modifications due to miniaturization of the instruments and advancements in technique. The routine use of the nephrostomy tube after PCNL has been subsequently questioned. Currently, the nephrostomy tube is increasingly omitted, and the access tract is usually sealed by haemostatic agents. An additionally ureteric stent is commonly inserted at the end of the procedure. However, the application of haemostatic sealants increases the immediate costs significantly. Still there are inconsistent data because of small study populations, lack of randomization, retrospective character and further more heterogeneous surgical techniques.
  
  
  CONCLUSIONS
  The current body of literature does not provide high-level evidence for the preferred treatment of the access tract in PCNL. However, most authors agree that a tract sealing can be omitted without increasing the risk of complication in uncomplicated procedures.
authors.affiliation: Department of Urology and Paediatric Urology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Tanja
authors.initials: T
authors.lastname: Hüsch
authors.affiliation: Department of Urology and Paediatric Urology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Reiter
authors.affiliation: Department of Urology and Paediatric Urology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: René
authors.initials: R
authors.lastname: Mager
authors.affiliation: Department of Urology and Paediatric Urology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Steiner
authors.affiliation: Department of Urology and Urologic Oncology, University Hospital Hannover, Hannover, Germany.
authors.forename: Thomas R W
authors.initials: TR
authors.lastname: Herrmann
authors.affiliation: Department of Urology and Paediatric Urology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Haferkamp
authors.affiliation: Department of Urology and Paediatric Urology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany. David.Schilling@kgu.de.
authors.forename: David
authors.initials: D
authors.lastname: Schilling
mesh_terms: D006490:Hemostatics; D006801:Humans; D009403:Nephrostomy, Percutaneous; D058106:Wound Closure Techniques
chemical_list: D006490:Hemostatics
keywords: Haemostatic sealant; Percutaneous nephrolithotomy; Totally tubeless; Tract sealing; Tubeless