Modification of tubeless percutaneous nephrolithotomy with a ureteropelvic junction stent

Introduction: To introduce the ureteropelvic junction stent as a safe and effective modification to tubeless percutaneous nephrolithotomy for select patients to maintain antegrade access to the collecting system. Materials and methods: From April 2014 to December 2015, 31 patients underwent modified tubeless percutaneous nephrolithotomy with ureteropelvic junction (UPJ) stent left in situ and an extraction string coming out the nephrostomy tract. Primary study endpoints included complications, emergency department visits, or re-admissions. Secondary endpoints were perioperative parameters including mean operative time, blood loss, length of stay, and time to stent removal. Results: There were three Clavien grade III complications: one patient required exchange of her UPJ stent with a double-J stent due to distal ureteral obstruction and two patients required ureteroscopic retrieval of retained stents. Minor issues included one patient with stent discomfort and another who experienced a vasovagal response during stent removal. Patients stayed an average of 2.2 ± 1.5 days, including six discharged same day. Of 31 patients, 30 were successfully drained by ureteropelvic junction stent. Conclusions: UPJ stent is a safe and effective modification to percutaneous nephrolithotomy to maintain antegrade access and minimize stent discomfort. Further studies should be performed to determine optimal candidate selection and quantify stent-related symptoms.