Methods for improving the safety of tubeless percutaneous nephrolithotripsy: current state of the problem

Despite the growing popularity and expanding indications for retrograde intrarenal surgery (RIRS) in the treatment of urolithiasis, percutaneous nephrolithotripsy (PCNL) remains the method of choice for removing large kidney stones due to its high efficiency and safety. Modern approaches, such as tubeless or totally tubeless PCNL, allow faster recovery and improve patients’ postoperative quality of life. However, successful implementation of these procedures requires strict patient selection. The primary criterion is atraumatic nature, an absence of urinary tract infection and residual fragments.

To analyze modern instrumental techniques and technologies potentially capable of reducing the incidence of intra- and postoperative complications during tubeless PCNL, we carried out a literature search in PubMed, Scopus, ResearchGate, and eLibrary. The review included articles in Russian and English published between 1973 and 2024.

According to the literature, the frequency of tubeless PCNL can be increased by precise, atraumatic transpapillary puncture through the avascular zone. These conditions can be achieved not only by the surgeon’s experience, but also through the use of new atraumatic instruments for puncturing the collecting system and creating percutaneous access, such as the MG puncture needle, as well as imaging technologies that significantly improve puncture accuracy. To obtain more reliable evidence, prospective randomized studies including patients undergoing tubeless and totally tubeless PCNL are required.

Conclusion. The use of additional imaging technologies and atraumatic instruments for percutaneous access may reduce the complication rate after tubeless and totally tubeless PCNL. However, further prospective randomized studies are necessary in this field.