1. J Urol. 2010 Aug 17 R2 劉韋廷 / Vs 唐守宏大夫
Tubeless Percutaneous Nephrolithotomy—The New Standard
of Care?
D. E. Zilberman,* M. E. Lipkin,* J. J. de la Rosette,† M. N. Ferrandino,* C. Mamoulakis,* M. P. Laguna* and G. M. Preminger From the Comprehensive Kidney Stone Center, Division of Urology, Duke University Medical Center, Durham, North Carolina (DEZ, MEL, MNF, GMP), and Department of Urology, Academic Medical Center, Amsterdam, The Netherlands (JJR, CM, MPL)
J Urol Aug 17
R2 劉韋廷 / Vs 唐守宏大夫

2. PERCUTANEOUS NEPHROSTOLITHOTOMY--Indications
(1) Urinary obstruction not caused by the stone itself (eg, stone in a caliceal diverticulum)
(2) Large-volume stones (> 3 cm, stone surface > 500 mm2)
(3) Stones that cannot be positioned within the focus of the shock wave apparatus (eg, stones in kidneys with abnormal position due to anomalies of the urinary tract or skeleton, stones in transplanted kidneys).
(4) PNL may be of benefit for lower-pole caliceal calculi even under the 2–3 cm range. The overall stone-free rate for these stones with ESWL is only about 60%.
Smith General Urology, 16 edition

3. Diverticulum
Staghorn stone

4. PERCUTANEOUS NEPHROSTOLITHOTOMY--Indications
Large (>2 cm in diameter) or complex calculi (filling the majority of the intrarenal collecting system, such as staghorn calculi)
Cystine stones (relatively resistant to shock wave lithotripsy)
Anatomic abnormalities, including horseshoe kidneys or ureteropelvic junction obstruction
Stones within caliceal diverticula
UpToDate

5. Introduction
While nephrostomy tube placement at the conclusion of the case has been considered the standard of care for almost 20 years
It was not until 1997 that the concept of tubeless PNL was popularized, demonstrating few operative complications, lower cost, shorter hospital stay, lower analgesia requirements and a quicker return to normal activities.

6. Thanks for your attention!!