Tubeless Ureterorenoscopy. A Dangerous Adventure or “Fresh Wind” Relied on Skills, Technique and New Technology?

Upper urinary tract endoscopic stone treatment includes intracorporeal lithotripsy, usually using Holmium laser fiber, and temporary drainage of the upper urinary tract postoperatively. Almost absolute endourologic routine is to leave Double-J stent (DJS) for several weeks or ureteral catheter attached to urethral catheter for 24–72 hours. The reason for that is to prevent postoperative pain and infection due to local edema at the ureteral orifice, and upper urinary tract obstruction. On the other hand, postoperative tubing is known to cause lower urinary tract symptoms (LUTS), abdominal and flank pain. Postoperative tubing may cause additional emergency department visits, analgesics use, preliminary interventions and in case of DJS, usually demands invasive procedure, sometimes under general anesthesia in order to retrieve the stent after predetermined period of carriage. At the end of Tubeless Ureterorenoscopy (URS) for treatment of kidney and ureteral stones – no drainage left. Patient comfort advantages of tubeless approach are obvious, but fear of obstruction precluded urologist all over the world from leaving upper tracts undrained for decades. These days, technological achievements enable endourologists to use miniaturized flexible or semirigid ureteroscopes and novel high-power laser machines, minimizing upper urinary tract damage during the procedure and promoting a very effective stone dusting never seen before. These factors permit, in selected cases, to avoid postoperative tubing, reduce LUTS, and shorten hospitalization period facilitating ambulatory nature of the procedure with overall decreasing costs. A tubeless approach is safe in properly selected uncomplicated cases. The postoperative period is at least the same as in drained patients, avoiding long term postoperative stent related symptoms. More RCT are needed to point the place for safe tubeless endourologic procedures.