ObjectivesTo examine the safety and effectiveness of percutaneous nephrolithotomy (PCNL) as an outpatient procedure, as in most centres PCNL is performed as an inpatient procedure that necessitates postoperative hospital admission.Patients and methodsOur study included 186 patients undergoing PCNL for renal calculi. Only those who met strict inclusion criteria were discharged home on the same day. Preoperative eligibility criteria for outpatient management included no complex medical problem, normal renal function, and easy access to an emergency room. Patients were divided into two groups. The outpatient group (Group 1) included those patients discharged on the same day as the PCNL and the hospitalised group (Group 2) included those who were considered appropriate for outpatient management but needed to be hospitalised.ResultsIn all, 162 patients (87%) fulfilled the inclusion criteria for outpatient management and 146 of these patients (90.1%) planned for outpatient management were discharged on the same operative day (Group 1). The mean time to discharge home was 8.97 h. In all, 16 patients who opted for the outpatient approach subsequently required hospitalisation (Group 2). In the hospitalised group the mean operative time was longer, which was probably related to its higher stone burden.ConclusionPCNL can be safely performed with excellent outcomes as an outpatient procedure. Outpatient PCNL offers several advantages including a more rapid patient convalescence, reduced healthcare expenditure, decreased postoperative nosocomial infections with no additional morbidity for the patient, and with no compromising of the stone-free rate.

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BackgroundTransrectal ultrasound-guided prostate biopsies (TRUSBx), in spite of being one of the most frequently performed urological office procedures, are associated with a spectrum of complications, most significantly including infection. The aim of the study is to evaluate the prevalence of fluoroquinolone-resistant bacteria in rectal swabs from our local population prior to TRUSBx and to identify risk factors among a patient population harboring fluoroquinolone-resistant organisms.MethodsWe prospectively included 541 men who were submitted for TRUSBx in our center from March 2011 to June 2015. The indications for TRUSBx were an elevated prostate-specific antigen level and/or abnormal digital rectal exam. All patients were randomly divided into two groups: Group 1 (n = 279 cases) who received standard empirical prophylactic antibiotics and Group 2 who received targeted prophylaxis based on a rectal swab culture and susceptibility result. Differences in risk factors between quinolone-resistant and nonresistant patients were compared. Univariate and multivariate analyses were performed to identify independent potential risk factors associated with fluoroquinolone-resistant rectal flora.ResultsSixteen out of 271 men developed infectious complications after TRUSBx in the group receiving standard empirical prophylaxis (5.7%). No men in the group who received targeted prophylactic antibiotic guided by rectal swab developed infectious complications. Among the 262 patients who underwent prebiopsy rectal swab cultures, 76 men (29%) displayed fluoroquinolone-resistant rectal flora (29%). In the multivariate analysis, a history of antibiotic exposure before prostate biopsy was the only independent factor associated with an increased risk of fluoroquinolone resistance.ConclusionDetermining the prevalence of fluoroquinolone resistance in rectal flora has important implications in the selection of targeted prophylactic antibiotic regimens. Antimicrobial profiles guided by rectal swabs may prove useful to optimize prophylaxis prior to TRUSBx; this strategy is effective at reducing the rates of infectious complications, including sepsis, especially in men at higher risk of infectious complications.

INTRODUCTION AND OBJECTIVES: Definitive treatment of symptomatic post transplant lymphocele includes percutaneous aspiration with or without sclerotherapy, or open/laparoscopic transperitoneal lymphocele drainage. Some authors have demonstrated that lymphocele formation can virtually be prevented by placing an intraoperative drain. We herein prospectively investigated the effect of placing a retroperitoneal drain during renal transplantation surgery on the incidence of lymphocele formation in recipients compared to those who received no drain.METHODS: a total of 315 adult patients who underwent living renal transplantations in our institution were prospectively enrolled. The patient were randomly assigned to one of two groups on the basis of whether or not they received a Jackson Pratt drain in the retroperitoneal space during surgery; group 1 had a drain placed (n¼203) and group 2 did not (n¼112).Patient demographic and clinical data known to affect transplant outcomes were compared between group 1 (drain) and group 2 ( no drain), including recipient age, gender, body mass index (BMI) at transplantation, cause of end-stage renal disease, dialysis before transplantation, donor age, anastomotic time, delayed graft function and acute rejection episodes. This was correlated with lymphocele incidence rate and the need for lymphocele intervention (operative or percutaneous radiological).RESULTS: Individual risk factors were analyzed for their association with lymphocele formation in a univariate model. The most important factors associated with an increased risk of lymphocele formation were no drain (P¼0.002), high BMI (p¼0.003) and diabetic nephropathy as an underlying cause of end stage renal failure (0.0426). The presence of diabetic nephropathy and anastomotic time was associated with increased risk but was not significant (P ¼0.264 and 0.690, respectively).CONCLUSIONS: In conclusion, placing of a retroperitoneal drain during renal transplant surgery significantly decreases the incidence of lymphocele formation. Furthermore, it significantly reduces the need for surgical intervention as a treatment modality for clinically significant lymphoceles. We recommend routine placement of a retroperitoneal drain during kidney transplant surgery in all patients.

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