Editorial Comment on: Management of Colon Perforation During Percutaneous Nephrolithotomy: 12 Years of Experience in a Referral Center by Maghsoudi et al. (From: Maghsoudi R,Etemadian M,Kashi AH,et al. J Endourol 2017;31:1032–1036)

The authors report an experience with 17 cases of colon injury during percutaneous nephrolitotomy. Aside from the references provided in the report, other notable recent reports include 11 cases in the series of AslZare et al. ¹ and 22 cases in the multiinstitutional report by Akbulut et al. ² The authors of this work report an incidence of 0.15%. This is remarkably similar to the 0.21% rate in the series of AslZare and colleagues ¹ and 0.35% in the study of Akbulut and colleagues. ²

Established management principles of colon injury during percutaneous nephrolitotomy include separate drainage of the colon and urinary collecting system. Although there have been some sporadic reports of omitting colon drainage, the authors of this work are the first to describe routinely managing colon injury during percutaneous nephrolitotomy without colon drainage. Importantly, they did continue with urinary collecting system drainage (by internal or external ureteral catheter). Their approach was generally effective, with only two cases requiring placement of a colonic or pericolonic drain among the 14 patients in their experience once they established their current protocol.

The concept of avoiding external (colon) drainage while maintaining internal (urinary tract) drainage for a colon injury is consistent with the move from nephrostomy tubes after percutaneous nephrolithotomy to “tubeless” procedures with only an internal ureteral stent. I congratulate the authors on further reducing the inconvenience of percutaneous nephrolitotomy to patients.