Ambulatory Percutaneous Nephrolithotomy in a Free-Standing Surgery Center: An Analysis of 500 Consecutive Cases

Chong, Julio; Dunne, Meagan; Magnan, Brenden; Abbott, Joel E.; Davalos, Julio G.

doi:10.1089/end.2021.0159

Cited by 16 publications

(12 citation statements)

References 27 publications

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“…We could not identify if intraoperative tract infiltration for pain management is now a common trend, but this could aid in immediate postoperative pain management and analgesic requirements, especially if a patient is being considered for same-day discharge [ 25 ]. Same-day discharge PCNL is indeed a reality today as shown recently by a 500-patient study by Chong et al, where they reported the use of a standard tract dilation (24–30 Fr) in 77% of cases, and 99% of cases had a ureteral stent as the only form of drainage [ 46 ]. However, 2.4% required early readmission, and the 30-day readmission rate was 4.2% [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

“…Same-day discharge PCNL is indeed a reality today as shown recently by a 500-patient study by Chong et al, where they reported the use of a standard tract dilation (24–30 Fr) in 77% of cases, and 99% of cases had a ureteral stent as the only form of drainage [ 46 ]. However, 2.4% required early readmission, and the 30-day readmission rate was 4.2% [ 46 ]. While systematic reviews in the past have shown that Tubeless PCNL allowed for a faster return to work, and this is an important aspect to take into account if patients are getting readmitted which defeats the purpose of a day surgery [ 2 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

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Complications and outcomes of tubeless versus nephrostomy tube in percutaneous nephrolithotomy: a systematic review and meta-analysis of randomized clinical trials

et al. 2022

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We aimed to perform a systematic review of randomized trials to summarize the evidence on the safety and stone-free rate after Tubeless percutaneous nephrolithotomy (PCNL) (ureteral stent/catheter, no nephrostomy) compared to Standard PCNL (nephrostomy, with/without ureteral stent/catheter) to evaluate if the tubeless approach is better. The inverse variance of the mean difference with a random effect, 95% Confidence Interval (CI), and p values was used for continuous variables. Categorical variables were assessed using Cochran–Mantel–Haenszel method with the random effect model, and reported as Risk Ratio (RR), 95% CI, and p values. Statistical significance was set at p < 0.05 and a 95% CI. 26 studies were included. Mean operative time was significantly shorter in the Tubeless group (MD—5.18 min, 95% CI − 6.56, − 3.80, p < 0.00001). Mean postoperative length of stay was also significantly shorter in the Tubeless group (MD—1.10 day, 95% CI − 1.48, − 0.71, p < 0.00001). Incidence of blood transfusion, angioembolization for bleeding control, pain score at the first postoperative day, the number of patients requiring postoperative pain medication, fever, urinary infections, sepsis, perirenal fluid collection, pleural breach, hospital readmission, and SFR did not differ between the two groups. Incidence of postoperative urinary fistula was significantly lower in the Tubeless group (RR 0.18, 95% CI 0.07, 0.47, p = 0.0005). This systematic review shows that tubeless PCNL can be safely performed and the standout benefits are shorter operative time and hospital stay, and a lower rate of postoperative urinary fistula.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Complications and outcomes of tubeless versus nephrostomy tube in percutaneous nephrolithotomy: a systematic review and meta-analysis of randomized clinical trials

et al. 2022

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“…Complications: Twelve of the included studies commented on complications following ambulatory PCNL. In these twelve studies, the com-plication rates of outpatient PCNL ranged from 0-20% [11][12][13][14][15][16][17][18][19][20][21][22]. This is in line with the overall PCNL complication rate of 20.5% found in the widely referenced Clinical Research Office of the Endourological Society (CROES) Percutaneous Nephrolithotomy Global Study -a worldwide, multi-center analysis of more than fivethousand patients who underwent percutaneous nephrolithotomy [5].…”

Section: Safety Outcomesmentioning

confidence: 73%

Review of efficacy and safety of same-day discharge after percutaneous nephrolithotomy

Gassmann

2024

Am J Clin Exp Urol

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Purpose: Prior literature reviews have assessed the efficacy and safety of outpatient percutaneous nephrolithotomy (PCNL) with "outpatient" defined as discharge within twenty-four hours of surgery. To our knowledge, this is the first literature review analyzing ambulatory PCNLs (aPCNL) defined as hospital discharge on the same day as surgery. This review aims to assess the efficacy and safety of same-day discharge after PCNL. Methods: We conducted a search in the PubMed database for key search terms including "ambulatory PCNL", "ambulatory percutaneous nephrolithotomy", "outpatient PCNL", "outpatient percutaneous nephrolithotomy", and "day surgery percutaneous nephrolithotomy". We reviewed articles defining "ambulatory" as discharge the same day the PCNL was performed. 13 papers were identified in our search. Results: Overall, we found no difference in complication rates, emergency department visits, and postoperative admissions when comparing outpatient PCNL to inpatient PCNL, and to previously published statistics for inpatient PCNL. Some studies even showed lower rates of adverse outcomes in ambulatory cohorts when compared to inpatient cohorts. Additionally, ambulatory PCNL conferred significant healthcare savings over inpatient PCNL. Conclusion: This literature review suggests that ambulatory PCNL can be safely performed in both optimal and suboptimal surgical candidates with no significant increase in complications. Additional high-quality studies are warranted to further the evidence surrounding outpatient PCNL and its outcomes.

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“…Although the majority of the included studies reported two surgeons for ECIRS, several authors have demonstrated the feasibility of performing ECIRS with a single surgeon. A recent analysis of 500 patients demonstrated safety and efficacy of ECIRS in a free-standing surgical center with only a single surgeon [ 30 ]. While the feasibility, safety, and efficacy of single-surgeon ECIRS have been demonstrated, we acknowledge that there may be a significant learning curve [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…Percutaneous nephrolithotomy (PCNL) has been the standard treatment for upper-and midpole stones >20 mm and lower pole stones >10 mm for nearly 45 years [1,2]. Although standard PCNL (24)(25)(26)(27)(28)(29)(30) Fr access sheath) has demonstrated the highest stone-free rate (SFR) of all stoneextraction procedures, caution is still exercised surrounding its use because it is the most invasive of the surgical options [3]. In consideration of the perioperative risks of standard PCNL, minimally invasive PCNL (mini-PCNL, 14-20 Fr access sheath) is now commonly used as an alternative [4].…”

Section: Introductionmentioning

confidence: 99%

The Safety and Efficacy of Endoscopic Combined Intrarenal Surgery (ECIRS) versus Percutaneous Nephrolithotomy (PCNL): A Systematic Review and Meta-Analysis

Abdullatif

Sur

Abdullatif

et al. 2022

Advances in Urology

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Purpose. Our aim is to evaluate the safety and efficacy of endoscopic combined intrarenal surgery compared to percutaneous nephrolithotomy to guide practitioners and inform guidelines. Materials and Methods. A detailed database search was performed in PubMed, OVID, Scopus, and Web of Science in October 2021 to identify articles pertaining to ECIRS published between 2001 and 2021. Results. Four nonrandomized comparative studies and one RCT were identified, yielding five studies with a total of 546 patients (ECIRS/mini-ECIRS, n = 277; PCNL/mini-PCNL, n = 269). Subjects in these five studies met the predefined inclusion criteria established by two reviewers (J.E.A. and R.L.S.) and were therefore eligible for analysis. The results demonstrated that ECIRS was associated with a higher SFR (OR: 4.20; 95% CI: 2.79, 6.33; p < 0.00001 ), fewer complications (OR: 0.63; 95% CI: 0.41, 0.97; p = 0.04 ), and a shorter hospital stay (WMD: −1.27; 95% CI: −1.55, −0.98; p < 0.00001 ) when compared to PCNL. There were no statistically significant differences in blood transfusions (OR: 0.45; 95% CI: 0.12, 1.68; p = 0.24 ), operative time (SMD: −1.05; 95% CI: −2.42, 0.31; p = 0.13 ), or blood loss (SMD: −1.10; 95% CI: −2.46, 0.26; p = 0.11 ) between ECIRS and PCNL. Conclusions. ECIRS may be a more suitable approach for the surgical management of large and complex kidney stones currently indicating PCNL due to its superior efficacy with comparable surgical time and complication rate, though it is thought that a lack of resources and properly trained personnel may preclude ECIRS from becoming the standard. It is our impression that ECIRS may become the preferred technique in the endourologic community corresponding to the evolutionary sequence of percutaneous stone surgery.

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Ambulatory Percutaneous Nephrolithotomy in a Free-Standing Surgery Center: An Analysis of 500 Consecutive Cases

Cited by 16 publications

References 27 publications

Complications and outcomes of tubeless versus nephrostomy tube in percutaneous nephrolithotomy: a systematic review and meta-analysis of randomized clinical trials

Complications and outcomes of tubeless versus nephrostomy tube in percutaneous nephrolithotomy: a systematic review and meta-analysis of randomized clinical trials

Review of efficacy and safety of same-day discharge after percutaneous nephrolithotomy

The Safety and Efficacy of Endoscopic Combined Intrarenal Surgery (ECIRS) versus Percutaneous Nephrolithotomy (PCNL): A Systematic Review and Meta-Analysis

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