Can percutaneous nephrolithotomy be performed as an outpatient procedure?

Abstract

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.

Safety and efficacy of mini-percutaneous nephrolithotomy as daycare procedure: a prospective observational study

“…In our study, 18 patients underwent mPCNL without PCN insertion, amongst whom, stenting was also not done in 4 patients (5.7%)-completely tubeless PCNL. In Ahmed Fahmy et al study, 128 patients (79%) underwent tubeless PCNL and 34 patients (21%) had PCN deployed, which is almost similar to our study [21].…”

“…In our study, 91.4% of patients were completely cleared off the stone, which was similar to studies by Ahmed Fahmy et al (SFR-90.7%) and El Taby et al (SFR-91.7%) [19,21]. In studies by Iqbal Singh et al, and Sharma et al, 100% stone clearance was achieved [22,24].…”

“…The mean hospital stay in our study was 17.25 ± 11.23 h with the earliest discharge at 7 h and maximum being 60 h. The mean hospital stay in El-Tabey et al and Iqbal Singh et al studies was 33.4 ± 17.5 h (24-96 h) and 40 h which showed longer hospital stay than our study [19,24]. In Sharma et al (12.5 h, range 5.5-23.5) and Ahmed et al (9 h), the average hospital stay was shorter as they excluded the duration of stay of the re-admitted patients and calculated the average from the patients discharged as day-care [21,22].…”

Assessment of lower calyceal single-access percutaneous nephrolithotomy for staghorn stones: A single-surgeon and a single-center experience at KAMC, Riyadh

“…They compared the outcome between PCNL versus retrograde intrarenal surgery and PCNL as an outpatient procedure versus inpatient PCNL. [2123] In addition, Sohail et al . compared PCNL in both supine and prone positions and revealed consistent results with our data in terms of operative time (130 min).…”

Safety and Efficacy of Day-case Percutaneous Nephrolithotomy: A Systematic Review from European Society of Uro-technology

“…From a total of 97 articles, nine (n = 502) were selected, which satisfied our predefined search criteria (Tables 1 and 2) [8][9][10][11][12][13][14][15][16]. Four studies (n = 209) discharged patients on the same day as surgery (group 1) [8][9][10][11], and five studies (n = 293) discharged patients after an overnight stay (group 2) [12][13][14][15][16]. These included three case series, five cohort studies, and one randomised trial.…”