PCNL and particularly tubeless PCNL have become the standard treatment for removing large kidney stones in Dr. Davalos' practice. In fact, he is one of the pioneers of the tubeless PCNL procedure and now performs many of these intricate surgeries successfully in one of Chesapeake Urology's Ambulatory Surgery Centers.
Pioneering The Tubeless Technique
The tubeless PCNL procedure is performed as a PCNL surgery; however, Dr. Davalos eliminates the need for the nephrostomy (drainage) tube, which exits the surgical site through the patient's skin and is used to drain excess fluid from the kidney such as urine and blood post-operatively, or provide access if re-entry into the kidney is necessary.
Dr. Davalos has found through his extensive training and research that this nephrostomy tube, which is often a source of great discomfort for patients, is not necessary in most cases.
How Tubeless PCNL Works:
- PCNL is performed to remove the stone(s) from the kidney in a minimally invasive fashion. (See PCNL step-by-step for more details on the procedure.)
- There is no need for Dr. Davalos' patients to first have the nephrostomy tube inserted by an interventional radiologist; what makes Dr. Davalos unique is that he gains his own renal access during the procedure.
- In tubeless PCNL surgery, rather than leaving the drainage tube in the patient following extraction of the stone, the renal access tract leading from the outside of the body (the skin, or percutaneous) through to the kidney is sealed using a specially designed plug that Dr. Davalos researched and developed.
- This hemostatic plug is made from a novel gelatin matrix sealant. In addition to developing this special plug, Dr. Davalos has created special techniques for delivering and placing the sealing agent as a plug in the renal access tract following the tubeless PCNL procedure.
- In place of an external drainage tube, most patients receive a urinary stent that dilates the urinary tract and maximizes the drainage of the kidney. This gives the kidney time to heal from the procedure and also allows small stone fragments to easily pass through the urinary system without causing a blockage. The stent is usually removed in Dr. Davalos' office in three to five days following your surgery.
- Typically, a CT scan will be performed post-operatively to ensure all stone fragments have been removed and to ensure the renal access tract is completely sealed with the special plug.
Advantages of Tubeless PCNL
Utilizing this tubeless approach and the placement of the hemostatic plug to seal the renal access tract following the surgery (in place of the nephrostomy tube), patients benefit from:
- Minimized post-operative pain
- No leakage of fluids from the nephrostomy tube (urine, blood)
- A quicker recovery following the tubeless PCNL procedure
- Shorter length of hospital stay
Totally Tubeless PCNL- A Newer Approach for Select Patients
Similar to Tubeless PCNL, Dr. Davlos is one of only a few experts nationwide with experience performing the Totally Tubeless PCNL surgery. Totally tubeless means no nephrostomy tube, no ureteral stent and no foley catheter is used or needed to drain excess fluid from the kidney following PCNL. Only a few select patients are eligible for such a procedure.