Tubeless Percutaneous Nephrolithotomy (PCNL) with Reversed Polaris™ Loop Stent: Reduced Postoperative Pain and Narcotic Use

Purpose: Two disadvantages of tubeless PCNL are the morbidity of a ureteral stent and subsequent cystoscopy for removal. We present a use of the Polaris™ Loop stent to facilitate tubeless PCNL and minimize pain and narcotic use. Patients and Methods: The Polaris stent has two fine loops distally to minimize bladder irritation. Following PCNL, we place the Polaris stent antegrade in reverse orientation. The pigtail rests in the bladder and the loops in the nephrostomy tract with the string tether secured at the skin for simple, atraumatic removal. Twenty-four patients underwent tubeless PCNL since October 2006 through January 2007. Comparison was made with 29 patients who underwent standard PCNL June 2006 through September 2006 for equal indications. Pain (visual analog scale), narcotic use (milligrams morphine equivalents), and length of stay were analyzed. Results: Pain was significantly less in the tubeless group, mean 1.6 versus 2.5 (p = 0.01). Narcotic use was much greater for standard patients (26.9mg versus 13.4mg, p = 0.01). These differences were independent of percutaneous approach (subcostal versus intercostal). Tubeless patients were more likely to be discharged postoperative day 1 compared to standard patients (96% versus 72%, p = 0.02). No tubeless patient required blood transfusion. One standard patient developed pseudoaneurysm requiring transfusion and arterial embolization. Conclusions: Tubeless PCNL with the Polaris stent results in decreased postoperative pain and narcotic use, and earlier hospital discharge. Our novel use of the Polaris Loop stent in tubeless PCNL redefines state-of-the-art for minimally invasive endoscopic surgery in patients with heavy stone burden.