Totally Tubeless Outpatient Percutaneous Nephrolithotomy: Initial Case Report

Beiko, Darren; Samant, Meghana; McGregor, Thomas

doi:10.1155/2009/295825

Cited by 31 publications

(47 citation statements)

References 9 publications

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“…11,12 This case report is the first to describe successful outpatient PCNL in a renal transplant patient.…”

Section: Introductionmentioning

confidence: 81%

“…9,10 Although hospitalization is standard practice after PCNL, reports have described success with outpatient management. 11,12 This case report is the first to describe successful outpatient PCNL in a renal transplant patient.…”

Section: Introductionmentioning

confidence: 81%

“…Recently, the ability to perform tubeless PCNL as an outpatient procedure has been reported. 11,12 The capacity to routinely complete PCNL as day surgery is highly attractive due to the anticipated healthcare cost savings and the potential reduction in nosocomial infections. Two case series published in 2010, described good outcomes with ambulatory PCNL in carefully selected patients.…”

Section: Discussionmentioning

confidence: 99%

“…Two case series published in 2010, described good outcomes with ambulatory PCNL in carefully selected patients. 11,12 Since then, outpatient management has been performed in more complex patients, including a case report on tubeless PCNL for bilateral staghorn stones. 18 As we continue to shift toward ambulatory surgery in urology, performing outpatient PCNL in a transplanted kidney is an extension of application of the ambulatory approach to increasingly complicated cases.…”

Section: Discussionmentioning

confidence: 99%

“…She met all of our previously published intra-operative and postoperative criteria for consideration of outpatient management. 11 After 2 hours and 17 minutes in the postanesthetic care unit, she was discharged in stable condition.…”

Section: Case Reportmentioning

confidence: 98%

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Outpatient percutaneous nephrolithotomy in a renal transplant patient: World’s first case

McAlpine

Leveridge

Beiko

2015

CUAJ

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Percutaneous nephrolithotomy (PCNL) is an established safe and effective surgical treatment option for renal calculi in renal allografts. The advent of tubeless PCNL has led to reports of ambulatory or outpatient PCNL. This case report describes the successful outpatient management of a 49-year-old female with a symptomatic renal pelvic calculus in her transplanted kidney. Tubeless PCNL successfully removed the stone, free of complication, and the patient was discharged 2 hours and 17 minutes after the procedure in stable condition with minimal pain. This is, to the best of our knowledge, the first successful case of outpatient tubeless PCNL in a transplanted kidney. IntroductionPercutaneous nephrolithotomy (PCNL) is an accepted and widely used approach to extract large renal calculi. Since its description in the 1970s, 1 surgical and technological advances have obviated the need for routine nephrostomy tube placement.2-8 Tubeless PCNL, with ureteral stenting, has been shown to decrease patients' analgesic requirements and hospital length of stay.9,10 Although hospitalization is standard practice after PCNL, reports have described success with outpatient management. 11,12 This case report is the first to describe successful outpatient PCNL in a renal transplant patient. Case reportA 49-year-old female presented to her community hospital with hematuria and lower abdominal pain over the preceding 48 hours. She had received her second cadaveric kidney transplant 6 years previously for end-stage renal disease of unknown etiology. On presentation she was afebrile and hemodynamically stable. Urine was positive for blood, but negative for nitrites or pyuria. Creatinine was 164 μmol/L (estimated glomular filtration rate 29 mL/min/1.73m 2 ), slightly elevated from her baseline of 150 μmol/L. An ultrasound scan showed a large renal stone in the lower pole of the allograft kidney. Intravenous antibiotics were initiated and the patient was transferred to our tertiary care centre.At our institution, a computed tomography scan revealed a 14 × 12 × 11-mm stone located in the renal pelvis (Fig. 1a, Fig. 1b). There was mild hydronephrosis, yet the parenchyma of the graft was preserved. There was no evidence of a urinary tract infection (UTI)/sepsis and the patient's pain responded to oral analgesia. The surgical options were discussed and a decision was made to proceed with the PCNL. Informed consent was obtained and a 1-week course of levofloxacin was prescribed for UTI prophylaxis.On the morning of the procedure, a stress dose of 100 mg intravenous (IV) hydrocortisone was administered. Cefazolin 1 g IV was given prior to induction of general anesthesia. Flexible cystourethroscopy was performed and a 5Fr openended ureteral catheter was passed up the left transplanted ureteral orifice over a 0.035" guidewire. A Foley catheter was placed to straight drainage and the patient was repositioned supine for percutaneous access. Retrograde ureteropyelography outlined the allograft kidney's collecting system, demonstrating renal...

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“…11,12 This case report is the first to describe successful outpatient PCNL in a renal transplant patient.…”

Section: Introductionmentioning

confidence: 81%