الفهرس 
• Renal AnatomyOnly 14 pages are availabe for public view
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Abstract
The technique of percutaneous renal surgery has revolutionized in treatment of renal stones, it has become increasingly clear in the last several years that a percutaneous approach is optimal for many patients.
The field of endourology has developed rapidly during the last years from a multistage to a single stage procedure, Also the morbidity of a percutaneous procedure has decreased because of improvement and modifications to the technique.
Although percutaneous renal surgery offers a lower morbidity compared with that of open surgery, many features such as presence of a post operative percutaneous drainage tube still causes discomfort and prolongs hospitalization for patients so modifications have been made in order to change the standard technique to tubeless procedure.
Starting from 1984 several reports have challenged the “Tubeless percutaneous renal surgery”. Many of these reports confirmed the safety and efficacy of this technique.
Advances in the technique, better selection of patients, refinements in the instruments, greater attention to terminal hemostasis by direct cauterization of the tract and use of fibrin/gelatin glue, sealants and use of antegrade internal Double-J stents for internal drainage have all contributed to transforming tubeless PCNL into a minimally morbid and safe procedure. This may ultimately have the way for making 1 day care PCNL a feasible option.
After reviewing literature regarding the tubeless percutaneous renal surgery and reporting several studies, it would be possible to come to the following conclusions and recommendations:
1) There are no standard criteria for tubeless procedure; however the decision is taken at conclusion of the procedure depending on smoothness of operation and experience of the surgeon.
2) An out-coming percutaneous nephrostomy is mandatory in cases of major perforation of collecting system or significant bleeding during operation
3) Tubeless percutaneous renal surgery is a safe and effective procedure that provides an alternative to the standard percutaneous renal surgery with the same indications, limitations and outcome.
4) Tubeless procedure have been extended to be used not only in percutaneous nephrolithotomy but also percutaneous antegrade endopyelotomy and the technique also successfully applied to morbidly obese, pediatric population, patient with complicated stones or recurrent stones following previous open surgery
5) Tubeless percutaneous renal surgery provide a high patient satisfaction with a significant decrease in postoperative analgesia requirements, shorter hospital stay as well as more rapid return to work and normal activity compared to standard PCNL. This would have a definitive impact on the overall cost reduction.
6) The tubeless technique is not a technique for young inexperienced urologist in the training period. It is only technique for experienced percutaneous surgeons and although reported results are encouraging, yet it is not still considered the standard practice. A large randomised multicenter controlled study is required to confirm these preliminary results.
7) Practicing the tubeless percutaneous technique makes the surgeon more cautious and refine during the procedure and this may minimize the complications.