Day Case Mini Percutaneous Nephrolithotomy (PCN): First UK Experience

Abstract

Background and ObjectiveTo investigate the safety, efficacy, and feasibility of performing mini PCN (MIP-M Karl Storz) as a day case procedure. We report our experience and outcomes from our case series which to our knowledge is the first reported in the UK.
 Material and MethodsTen patients appropriate for mini PCN and day-case surgery were selected prospectively. All 10 patients underwent a mini PCN procedure in a prone position. Access was achieved by the operating surgeon under fluoroscopic guidance in 9 cases and by a consultant uroradiologist under ultrasound guidance in 1 patient with a ureterosigmoidostomy using a Kellet needle and the MIP-M system (Karl Storz, Germany). Stones were fragmented with a 550um laser fibre and retrieved by both the Vortex effect and a grasper. Drainage was achieved with a 6 Fr antegrade stent in 9 cases and a 10 Fr nephrostomy tube in one patient. Stone related outcomes, duration of surgery, length of stay and complications were recorded.
 ResultsAll cases were completed as planned. The mean operating time was 93 minutes. A day case rate of 80% was achieved. Two patients were admitted overnight for social reasons; one lived on a nearby island and was not ready for discharge in time to catch the last ferry and another no longer had a responsible adult at home to monitor him overnight. All patients were deemed radiologically stone free. No readmissions, transfusion, infections or other complications were recorded at 90 days postoperatively.
 ConclusionWe have shown that day-case mini PCN is a feasible and safe procedure in selected patients. A larger number of cases are needed to establish our patient selection criteria and corroborate our early outcomes.