Volume 7, Issue 4 (12-2025)
Tabari Biomed Stu Res J 2025, 7(4): 37-47 |
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Younesi Rostami M, Deilami A, Rohaninia E. A Functional Approach to Drainage Selection After Percutaneous Nephrolithotomy: A Narrative Review. Tabari Biomed Stu Res J 2025; 7 (4) :37-47
URL: http://tbsrj.mazums.ac.ir/article-1-3917-en.html
URL: http://tbsrj.mazums.ac.ir/article-1-3917-en.html
1- Associate Professor of Endourology, Department of Urology, School of Medicine, Sari Imam Khomeini Hospital, Mazandaran University of Medical Sciences
2- Assisted Professor of Urology, Mazandaran University of Medical Sciences
3- Medical Student, Department of Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
2- Assisted Professor of Urology, Mazandaran University of Medical Sciences
3- Medical Student, Department of Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
Abstract:
Background and Objectives: Postoperative drainage influences recovery after percutaneous nephrolithotomy (PCNL). This narrative review compares nephrostomy, internal ureteral stenting, short-term externalized ureteral catheterization, and totally tubeless strategies to inform drainage selection.
Methods: Targeted searches of accessible scholarly records, publisher websites, and guidelines were undertaken through 12 September 2026, with reference-list checking. Randomized trials, systematic reviews, and relevant observational studies were prioritized. No new meta-analysis was performed.
Results: Shorter hospitalization is the most consistent benefit of avoiding nephrostomy in selected patients. Pain outcomes vary with the comparator and assessment time. Evidence for sepsis, major hemorrhage, and readmission remains insufficient to establish equivalence across patient groups. Externalized ureteral catheters may reduce stent-related symptoms when brief drainage is sufficient. Recent trials sometimes change access and drainage simultaneously, limiting attribution of benefit.
Conclusion: Selection should consider hemostasis, collecting-system integrity, ureteral patency, residual stones, infection, and repeat-access requirements. Nephrostomy remains appropriate when a protective function is needed; tubeless and totally tubeless approaches are reasonable after uncomplicated procedures. Future studies should assess recovery through device removal and unplanned interventions.
Methods: Targeted searches of accessible scholarly records, publisher websites, and guidelines were undertaken through 12 September 2026, with reference-list checking. Randomized trials, systematic reviews, and relevant observational studies were prioritized. No new meta-analysis was performed.
Results: Shorter hospitalization is the most consistent benefit of avoiding nephrostomy in selected patients. Pain outcomes vary with the comparator and assessment time. Evidence for sepsis, major hemorrhage, and readmission remains insufficient to establish equivalence across patient groups. Externalized ureteral catheters may reduce stent-related symptoms when brief drainage is sufficient. Recent trials sometimes change access and drainage simultaneously, limiting attribution of benefit.
Conclusion: Selection should consider hemostasis, collecting-system integrity, ureteral patency, residual stones, infection, and repeat-access requirements. Nephrostomy remains appropriate when a protective function is needed; tubeless and totally tubeless approaches are reasonable after uncomplicated procedures. Future studies should assess recovery through device removal and unplanned interventions.
Keywords: Nephrolithotomy, Percutaneous, Nephrostomy, Percutaneous, Ureteral Stents, Kidney Calculi, Postoperative Complications
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