Outcomes for Patients Undergoing Ambulatory Percutaneous Nephrolithotomy

Schoenfeld, Daniel; Tian, Zhuang; Stern, Joshua M.

doi:10.1089/end.2018.0579

Cited by 27 publications

(23 citation statements)

References 33 publications

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“…Six of 162 (3.7%) patients in Fahmy et al study [21], one of 50 (2%) patients in Beiko et al study [23], five of 84 patients (6%) of El-Tabey et al study [19] and one of 10 patients (10%) of WalidSharour et al study [9] had signs of sepsis requiring admission and higher antibiotics. The emergency department visit and readmission rates of ambulatory PCNL in a study done by Schoenfeld et al was 11% [25]. Bechis et al, in their study, found that the urologist performing daycare mPCNL should be prepared to admit 10% of well selected daycare mPCNL patients and approximately 18% of non-selected patients after the procedure [26].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Background To evaluate the safety, feasibility of mini-percutaneous nephrolithotomy (mPCNL) being carried out as a daycare surgery and to study the re-admission, stone clearance rate and complication rates following mPCNL. We also sought to find out the rate of requirement of ancillary procedure, after mPCNL. Methods In this prospective observational study, easily accessible patients above 18 years of age with renal and/or upper ureteric calculi, who underwent mPCNL between September 2018 and February 2020, were included. Seventy patients were selected, as per statistical methods. Preoperative evaluation including history, blood and urine investigations and radiological images was collected. Intra-operative and post-operative events were analyzed. Written consent was obtained from the patients to participate in the study and to publish their data. Institutional Ethical and scientific committee clearance was obtained. Results Out of 70 patients who underwent mPCNL in the study, in the age group ranging from 24–68 years, most of the cases were partial staghorn with maximum size of stone up to about 3.5 cm. Inferior calyx was most frequently punctured. Six cases had multipuncture mPCNL, four patients had bilateral procedure, and two had supra-costal puncture. Eighteen patients had tubeless mPCNL, of which four were totally tubeless procedures. Four patients had hematuria, none requiring transfusion. Two patients had sepsis, managed with higher antibiotics. Limitation of the study was the sample size. To derive a sturdy conclusion, large scale studies are recommended. Conclusions We can conclude that mPCNL can be safely done as daycare or ambulatory surgery in properly selected patients. In centers with experienced urologists, bilateral and multipuncture mPCNL can be done as an ambulatory surgery. Thus, this addresses the stone disease as well as cost containment, without patient safety being compromised. Bed occupancy rate is reduced, helping effective utilization of hospital resources.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…These stone free rates are comparable to other published results. 4,6,9,10 Stone burden >4cm and multiple tract dilations were identified as independent predictors of residual stones on multivariable analysis. These factors have been previously identified as predicting stone free rates and are variables in most predictive nomograms used for PCNL.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies, including one randomized controlled trial, have shown that ambulatory PCNL is safe and effective in highly selected patients with minimal comorbidities and low stone burden. [2][3][4][5][6][7][8][9][10] A barrier to uptake of ambulatory PCNL has been use of highly selective pre-operative inclusion criteria, which precludes the majority of patients undergoing PCNL. In the only randomized controlled trial to date comparing ambulatory to inpatient PCNL, strict inclusion criteria including body mass index (BMI) <30, American Society of Anesthesiologists (ASA) class 1-2, no bilateral stones, total stone burden <4 cm, and single dilation tract were used.…”

Section: Introductionmentioning

confidence: 99%

“…8 Similarly, stringent selection criteria have been used in most retrospective and prospective cohort studies published to date. 4,5,7,10 This led authors of a recent systematic review to recommend the following exclusion criteria be used in patients undergoing ambulatory PCNL: ASA >2, BMI >30, multiple stones, renal anatomic abnormalities (including transplant kidney and solitary kidney), multiple tract dilations, or staghorn calculi. 10 Consequently, the safety and efficacy of ambulatory PCNL in comorbid patients with large stone burden remains unknown.…”

Section: Introductionmentioning

confidence: 99%

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Ambulatory percutaneous nephrolithotomy is safe and effective in patients with extended selection criteria

Hosier

Visram²,

McGregor³

et al. 2021

CUAJ

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Introduction: Ambulatory percutaneous nephrolithotomy (PCNL) has been limited to highly selected patients. The objective of our study was to compare complication and stone-free rates after ambulatory PCNL in standard selection criteria vs. extended criteria patients. Methods: We conducted a retrospective review of prospective data on all patients who underwent ambulatory PCNL at one academic center from 2007–2018. Extended criteria patients were defined as one or more of: age >75 years, body mass index (BMI) >30 kg/m2, American Society of Anesthesiologists (ASA) >2, bilateral stones, solitary kidney, transplant kidney, complete staghorn calculi, stone burden >40 mm, multiple tracts, or prior nephrostomy tubes/stents. Primary outcomes were complication rates (Clavien-Dindo classification) and stone-free rates. Results: We identified 118 patients, of which 92 (78%) met extended criteria. Mean BMI was 31 kg/m2 and 45% were ASA 3 or higher. Mean sum maximum stone diameter was 24 mm. Multiple stones were present in 25%, bilateral stones in 7%, and complete staghorn stones in 4% of patients. There was no difference in complication (12% vs. 18%, p=0.56), emergency department visit (12% vs. 18%, p=0.56), or re-admission (4% vs. 5%, p=1) rates between standard and extended criteria patients respectively. Of the complications, 85% were Clavien-Dindo grade 1. Stone-free rates were not different between standard (84%) and extended (83%) criteria patients (p=1). No extended criteria variables were associated with complications in multivariable analysis. Conclusions: Complication and stone-free rates were not different between standard and extended selection criteria patients undergoing ambulatory PCNL. This data indicates that many of the preoperative patient and stone factors that have previously been used as exclusion criteria for ambulatory PCNL are not strictly necessary.

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“…Complications after PCNL and the length of hospital stay have already been steadily declining mainly attributable to the less invasive approaches and advancements in postoperative pain management [50]. Discharging the day of procedure or no later than 24 hours following surgery is referred to as day-care PCNL [51-53] and is regarded as a potential viable option for some patients, supported by emerging evidence [51][52][53][54][55]. Grade I and II complications following PCNL are the most common and may usually be managed conservatively or in a brief course [56].…”

Section: Pcnl As a Day-care Procedure?mentioning

confidence: 99%

Guideline Based Algorithmic Approach for the Management of Renal and Ureteric Calculi

Singh¹,

Shah²,

Hameed³

2023

Nephrolithiasis - From Bench to Bedside

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Urolithiasis is a global pathology with increasing prevalence rate. The surgical management of kidney and ureteral stones is based on the stone location, size, the patient’s preference and the institutional availability of various modalities. To date, the available modalities in the management of urolithiasis includes external shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PNL), ureterorenoscopy (URS) including flexible and semirigid ureteroscopy. Tremendous technological advancement in the urological armamentarium has happened since its inception leading to multiple acceptable modalities for the treatment of a particular stone. In accordance with the available recommendations from various institutions and the newer evidence we recommend that the initial choice of modality for the treatment of a renal calculus depends on the stone size and whether the location is lower pole or not. For lower pole stones upto 20 mm PNL and RIRS is efficient irrespective of location while ESWL should only be considered for lower pole stones upto 10 mm. For stones larger than 20 mm mini PNL is effective for stones upto 40 mm while RIRS holds acceptable efficiency for stones not larger than 30 mm. For stones larger than 40 mm standard PNL only should be considered if single stage treatment is attempted.

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Outcomes for Patients Undergoing Ambulatory Percutaneous Nephrolithotomy

Cited by 27 publications

References 33 publications

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

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

Ambulatory percutaneous nephrolithotomy is safe and effective in patients with extended selection criteria

Guideline Based Algorithmic Approach for the Management of Renal and Ureteric Calculi

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