Safety and Cost-effectiveness of Mini Percutaneous Nephrolithotomy as Day Care Surgery in Paediatric Patients

Abstract

Background: The increasing prevalence of urolithiasis in paediatric populations necessitates the exploration of efficient and safe treatment modalities. Mini percutaneous nephrolithotomy (PCNL), traditionally an inpatient procedure, has evolved with advancements in surgical techniques and pain management, prompting its consideration as a day care surgery. Objective: This study aims to evaluate the safety, efficacy, and cost-effectiveness of day care mini PCNL in paediatric patients with kidney stones. Methods: This prospective quasi-experimental study was conducted in a pediatric urology department. Patients aged 3 months to 14 years presenting with kidney stones were included. The procedure involved using a 16Fr mini PCNL nephroscope under general anesthesia and fluoroscopic guidance. Stone fragmentation was achieved using a pneumatic lithoclast, and fragmented stones were retrieved with wash and bifrong forceps. Inclusion criteria were stringent, considering factors like stone size, surgery duration, and patient recovery. Postoperative management included early mobilization, oral antibiotics, and analgesics. Follow-up was scheduled at 1 week and 1 month postoperatively. Data analysis employed SPSS version 20, focusing on variables like age, operative time, readmission rates, and cost comparisons. Results: The study involved 92 patients, with a gender distribution of 71.7% male and 28.3% female. The average stone size was 2.2 ± 0.7 cm, and the mean operative time was 74 ± 16 minutes. The mean hospital stay was 11 hours, with readmission rates of 6.7%. The cost savings in day care mini PCNL were significant, with an average reduction of 8000 PKR per procedure compared to inpatient care. The success rate of day care surgery was 93.7%. Conclusion: Day care mini PCNL is a viable, safe, and cost-effective treatment option for pediatric patients with kidney stones. It offers reduced hospital stay, lower costs, and high patient satisfaction without compromising on safety or treatment efficacy.