Exit strategies following percutaneous renal surgery continue to evolve with the goal of decreasing perioperative morbidity and improving operative outcomes. Traditionally, a percutaneous nephrostomy tube has been utilized at the completion of the case to tamponade the access tract, drain blood and stone debris, and maintain renal access. In this chapter we review the wide array of catheters that are available to drain the collecting system following percutaneous renal surgery. The advantages and disadvantages of each type of catheter are detailed. Alternate percutaneous techniques such as the mini-perc, tubeless (stented), and totally tubeless are reviewed, with an emphasis on pertinent prospective studies evaluating their relative efficacy and safety. Lastly, adjuvant tract treatments such as hemostatic agents, electrocautery, and cryoablation are discussed. We conclude that in complicated cases (multiple access tracts, significant hemorrhage, collecting system perforation, residual stone fragments), a large-bore nephrostomy tube should be utilized. A small-bore nephrostomy tube (e.g., Cope loop) or tubeless, stented approach may be employed in noncomplicated procedures. Although totally tubeless techniques have been reported, they are not recommended except in the most select of cases. The efficacy of adjuvant tract treatments has yet to be conclusively established.
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