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Drainage Systems After Percutanous Renal Procedures

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Difficult Cases in Endourology

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Abstract

Exit strategies following percutaneous renal surgery continue to evolve with the goal of decreasing perioperative morbidity and improving operative outcomes. Traditionally, a percutaneous nephrostomy tube has been utilized at the completion of the case to tamponade the access tract, drain blood and stone debris, and maintain renal access. In this chapter we review the wide array of catheters that are available to drain the collecting system following percutaneous renal surgery. The advantages and disadvantages of each type of catheter are detailed. Alternate percutaneous techniques such as the “mini-perc,” tubeless (stented), and totally tubeless are reviewed, with an emphasis on pertinent prospective studies evaluating their relative efficacy and safety. Lastly, adjuvant tract treatments such as hemostatic agents, electrocautery, and cryoablation are discussed.

We conclude that in complicated cases (multiple access tracts, significant hemorrhage, collecting system perforation, residual stone fragments), a large-bore nephrostomy tube should be utilized. A small-bore nephrostomy tube (e.g., Cope loop) or tubeless, stented approach may be employed in noncomplicated procedures. Although totally tubeless techniques have been reported, they are not recommended except in the most select of cases. The efficacy of adjuvant tract treatments has yet to be conclusively established.

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Author information

Authors and Affiliations

  1. Department of Urology, Smith Institute for Urology, Hofstra North Shore – Long Island Jewish Health System, 450 Lakeville Road, New Hyde Park, NY, 11042, USA

    Brian Duty M.D., Zhamshid Okhunov M.D., Arthur D. Smith M.D. & Zeph Okeke M.D.

Authors
  1. Brian Duty M.D.
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  2. Zhamshid Okhunov M.D.
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  3. Arthur D. Smith M.D.
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  4. Zeph Okeke M.D.
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Corresponding author

Correspondence to Brian Duty M.D. .

Editor information

Editors and Affiliations

  1. Fac. Medicine, Dept. Surgery, Kuwait University, Safat, Kuwait

    Ahmed M. Al-Kandari

  2. , Department of Urology, Muljibhai Patel Urological Hospital, Dr Virendra Desai Road, Nadiad, 387 001, India

    Mahesh Desai

  3. , Urology and Nephrology Center, Mansoura University, Gomhoria Street, Mansoura, 35516, Egypt

    Ahmed A. Shokeir

  4. , Urology and Nephrology Center, Mansoura University, Gomhoria Street, Mansoura, 35516, Egypt

    Ahmed M. Shoma

  5. , Smith Institute for Urology, Long Island Jewish Health System, New York, 11040, USA

    Arthur D. Smith

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Duty, B., Okhunov, Z., Smith, A.D., Okeke, Z. (2013). Drainage Systems After Percutanous Renal Procedures. In: Al-Kandari, A., Desai, M., Shokeir, A., Shoma, A., Smith, A. (eds) Difficult Cases in Endourology. Springer, London. https://doi.org/10.1007/978-1-84882-083-8_13

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  • DOI: https://doi.org/10.1007/978-1-84882-083-8_13

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  • Print ISBN: 978-1-84882-082-1

  • Online ISBN: 978-1-84882-083-8

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