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

Abstract

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.

Safety and Efficacy of Mini Percutaneous Nephrolithotomy in Paediatric age Patients: Paving the Way Towards Minimally Invasive Techniques in Resources Limited Areas

“…The mean hospital stay in the study conducted by Rehman et al was 4.3 + 2.2 days which shows longer hospital stay than our study 21 . In Arthy et al the mean hospital stay was 17.25 + 11.23 hours which is shorter than our study [22]. It was similar to hospital stay in study by Brodie et al which was 2.24 days 23 .…”

“…Our overall complication rate is similar to Baydilli et al which is 12.9 % 14 and much better than Ansari et al which is 49.1 % 17 . Arthy et al showed a complication rate of 8.7 %, lesser than our study including urosepsis in 2.9 % and hematuria in 5.7 % of the patients which did not require any blood transfusion 22 . This reduce rate of complication may be due to their small sample size (70) in comparison to our study (213).…”

Supine Versus Prone Percutaneous Nephrolithotomy (PCNL): A Single Surgeon’s Experience

“…In institutes performing PCNL as day-care procedures, post-operative pain score remains an integral part of the discharge criteria [ 17 ]. Our study reports lower pain scores in supine than prone PCNL.…”

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

“…Postoperatively, patients selected for day-care surgery were retained in the day-care area for 4 to 6 hours. They were encouraged to mobilize early and commence fluid intake (16). Postoperative analgesia was initiated in the recovery room, as effective pain management is crucial for the success of day-care surgeries.…”