Preliminary Study of Percutaneous Nephrolithotomy on an Ambulatory Basis

Abstract

Objective: Preliminary study to assess the feasibility and safety of percutaneous nephrolithotomy (PCNL) as an ambulatory procedure. Patients and Methods: Between February 2011 and September 2012, 84 patients with renal calculi fulfilling the inclusion criteria were admitted to the Urology Department of Benha University Hospitals for PCNL. All patients were subjected to a full medical history, clinical, laboratory and radiological examinations. Tubeless PCNLs were done in the supine position, and an antegrade double-J stent was inserted. Operative time and intraoperative complications were recorded. Postoperatively, the hematocrit value, postoperative pain and analgesics, need of blood transfusion, stone-free rate, and length of hospital stay were recorded. Stable patients that could be safely discharged within 24 hours after surgery were considered ambulatory. Results: All cases of tubeless PCNL were successfully done and no cases converted to open surgery. The overall stone-free rate was 91.7%, the mean postoperative pain score measured by the visual analog scale was 4.4 ± 1.2, the mean overall hematocrit deficit was 4.8 ± 2.2% and the mean hospital stay was 33.4 ± 17.5 hours. Ambulatory PCNL was accomplished in 60 out of 84 patients (71.4%) and double-J stents were removed 7-10 days postoperatively. In the non-ambulatory cases, double-J stents were removed after auxillary procedures were done according to each case. Conclusion: PCNL can be safely done on an ambulatory basis under strict criteria, but further studies are needed to confirm and expand these findings.

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

“…The average operative time in our study was 80 ± 19.7 min (range of 50-120 min). The mean operative time was similar to the studies conducted by [19,24]. This higher mean operative time could be secondary to lengthier operative time taken for 4 cases of bilateral PCNL and 6 units of multipuncture PCNL.…”

“…In two patients, stone was there in upper and lower calyx and in two others, stone was in middle and inferior calyx. In the study done by El-Tabey et al, most of the stones were located in the renal pelvis -50% (42), followed by inferior calyx-28.6% (24) and then partial staghorn-21.4% [19].…”

Day care PNL using 'Santosh-PGI hemostatic seal' versus standard PNL: A randomized controlled study

“…7%, p = 0.36). Sufficient evidence exists to suggest tubeless PNL to be equivalent or even superior to standard PNL for a select group of patients [ 7 ]. Various adjuncts have been tried to enhance hemostasis of the percutaneous tract, one of which is insertion/ instillation of hemostatic agents into the tract including oxidized cellulose, gelatin sponge, gelatin granules plus thrombin and fibrin glue [ 8 – 11 ].…”

“…Alyami et al reported that 66% of their cases could be safely discharged after an overnight stay [ 20 ]. In the study by Tabey and colleagues, 71.4% of the cases could be safely discharged from the hospital within 24-hours postoperatively [ 7 ]. Relatively higher proportion of cases could be discharged within 24 hours of surgery in our series.…”

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.…”