Safety and Efficacy of Day-case Percutaneous Nephrolithotomy: A Systematic Review from European Society of Uro-technology

Jones, Patrick; Bennett, Grace; Dosis, Alexios; Pietropaolo, Amelia; Geraghty, Robert; Aboumarzouk, Omar; Skolarikos, Andreas; Somani, Bhaskar K.

doi:10.1016/j.euf.2018.04.002

Cited by 38 publications

(24 citation statements)

References 28 publications

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“…The role of PCNL has also expanded for both adult and paediatric stone disease [26][27][28][29][30]. Saad et al reported on their randomised trial of URS versus PCNL in 38 children under 16 years old with large renal stones (> 2 cm) [31].…”

Section: Role Of Swl and Pcnlmentioning

confidence: 99%

Outcomes of ureteroscopy (URS) for stone disease in the paediatric population: results of over 100 URS procedures from a UK tertiary centre

et al. 2019

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Purpose To report the outcomes of paediatric ureteroscopy (URS) for stone disease from a specialist endourology centre in the UK. Ureteroscopy for management of stone disease has increased worldwide and is now being done more commonly in the paediatric age group. Methods Data were analysed retrospectively from a database maintained between April 2010 and May 2018. Consecutive patients ≤ 16 years of age undergoing semi-rigid or flexible URS for stone disease were included. Stone size and stone-free rate (SFR) were routinely assessed using an ultrasound (USS) and/or plain KUB XR. Complications were graded according to the Clavien-Dindo classification and recorded within 30 days post-procedure and readmissions within 90 days after the procedure were also captured. Results Over the 8-year period between April 2010 and April 2018, 81 patients with a mean age of 8.8 years (range 18 months-16 years) and a male to female ratio 1:1.1 underwent 102 procedures (1.28 procedure/patient to be stone free). Of the 81 patients, 29 (35.8%) had comorbidities, with 26 (32%) having multiple comorbidities. The mean (± SEM) single and overall stone size was 9.2 mm (± 0.48, range 3-30 mm) and 11.5 mm (± 0.74, range 4-46 mm) respectively, with 22 (27.1%) having multiple stones. Thirty-five (34.7%) had stent in situ pre-operatively. The stone location was in the ureter (26.6%), lower pole (35.4%), and renal pelvis (16.5%), with 22/81(27%) having multiple stones and 21/102 (20.5%) where a ureteral access sheath (UAS) was used. With a mean hospital stay of 1.2 days, the initial and final SFR was 73% and 99%, respectively, and 61/102 (60%) had ureteric stent placed at the end of the procedure. While there were no intra-operative complications, the readmission rate was less than 1% and there were only three early complications recorded. This included a case each of prolonged admission for pain control (grade I), urinary retention (grade II) and post-operative sepsis requiring a brief ITU admission (grade IV). Conclusion Our study demonstrates that in appropriate setting a high stone-free rate can be achieved with minimal morbidity for paediatric patients. There is potentially a need to factor the increasing role of URS in future paediatric urolithiasis guidelines.

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Section: Role Of Swl and Pcnlmentioning

confidence: 99%

Outcomes of ureteroscopy (URS) for stone disease in the paediatric population: results of over 100 URS procedures from a UK tertiary centre

et al. 2019

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“…14 Two recent systematic reviews of ambulatory PCNL trials reported complication rates of 13% with readmission rates of 3%. 9,10 All studies included in these reviews except one used strict selection criteria. From this review, authors recommended that 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.…”

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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“…The study included all types of PCN access, postoperative drainage modality was not specified and the daycase was defined as discharge within 23 hours of admission. The mean hospital stay was 17.5 hours, the stone-free rate 95% and the complication rate, mainly Clavien-Dindo I and II, 13.5% 10 .…”

mentioning

confidence: 97%

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

Auer¹,

Abdelqader

Glassey³

et al. 2020

Journal of Endoluminal Endourology

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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.

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Safety and Efficacy of Day-case Percutaneous Nephrolithotomy: A Systematic Review from European Society of Uro-technology

Abstract: Day-case percutaneous nephrolithotomy procedure seems to be a safe procedure with good outcomes, and low risk of complications and readmissions. Detailed preoperative protocol and planning are paramount, with indications for inpatient admission as well as a thorough follow-up plan.

Cited by 38 publications

References 28 publications

Outcomes of ureteroscopy (URS) for stone disease in the paediatric population: results of over 100 URS procedures from a UK tertiary centre

Outcomes of ureteroscopy (URS) for stone disease in the paediatric population: results of over 100 URS procedures from a UK tertiary centre

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

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

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