Tomer Nir, Durbhakula Vinay, Gupta Kavita, Khargi Raymond, Gallante Blair, Atallah William M, Gupta Mantu
Department of Urology, Icahn School of Medicine at Mount Sinai, 425 W. 59th Street, Suite 4F, New York, NY 10019, USA.
J Clin Med. 2024 May 31;13(11):3261. doi: 10.3390/jcm13113261.
: Percutaneous nephrolithotomy is the gold standard treatment for large, complex intrarenal stones. Historically, this was performed using a nephrostomy tube (PCN) and/or internalized ureteral stent at the end of the procedure. However, totally tubeless nephrolithotomy (tt-PCNL) is a novel technique where no tubes (no stent nor nephrostomy tube) are left post-operatively. We review the literature on this subject regarding peri-operative outcomes, post-operative outcomes, and potential complications of the procedure, discuss our technique, and make recommendations on implementation for centers not currently utilizing the procedure. : We performed a comprehensive search of the literature on totally tubeless nephrolithotomy using MEDLINE database search. Our search included prior review articles, meta-analyses, systematic reviews, primary research articles, case reports, and case studies. : In comparison to prior approaches where a stent or nephrostomy tube is placed, tt-PCNL has a similar complication rate and better post-operative outcomes. Totally tubeless PCNL has similar operative times and similar changes in hemoglobin. However, it had shorter length of stays across all studies. The mean difference in length of stay in the studies reviewed was 1.96 days. Additionally, tt-PCNL had decreased post-operative analgesic requirements and pain scores. : This review highlights totally tubeless percutaneous nephrolithotomy as a safe and feasible surgical technique with improved outcomes in properly selected patients.
经皮肾镜取石术是治疗大型复杂肾内结石的金标准。从历史上看，该手术在结束时会使用肾造瘘管（PCN）和/或内置输尿管支架。然而，完全无管肾镜取石术（tt-PCNL）是一种新技术，术后不留任何管子（无支架也无肾造瘘管）。我们回顾了关于该手术围手术期结果、术后结果及潜在并发症的相关文献，讨论了我们的技术，并为目前未采用该手术的中心提出实施建议。：我们使用MEDLINE数据库搜索对完全无管肾镜取石术的文献进行了全面检索。我们的检索包括先前的综述文章、荟萃分析、系统评价、原始研究文章、病例报告和病例研究。：与先前放置支架或肾造瘘管的方法相比，tt-PCNL的并发症发生率相似，术后结果更好。完全无管PCNL的手术时间和血红蛋白变化相似。然而，在所有研究中其住院时间更短。所回顾研究中住院时间的平均差异为1.96天。此外，tt-PCNL术后镇痛需求和疼痛评分降低。：本综述强调完全无管经皮肾镜取石术是一种安全可行的手术技术，在适当选择的患者中能改善预后。
