Is Outpatient Totally Tubeless Standard Percutaneous Nephrolithotomy Safe and Efficacious?

IF 2.9 2区 医学 Q1 UROLOGY & NEPHROLOGY
Kavita Gupta, Nir Tomer, Christopher Connors, Susan Gong, Raymond Khargi, Blair Gallante, William M Atallah, Mantu Gupta
{"title":"Is Outpatient Totally Tubeless Standard Percutaneous Nephrolithotomy Safe and Efficacious?","authors":"Kavita Gupta, Nir Tomer, Christopher Connors, Susan Gong, Raymond Khargi, Blair Gallante, William M Atallah, Mantu Gupta","doi":"10.1089/end.2024.0441","DOIUrl":null,"url":null,"abstract":"<p><p><b><i>Introduction and Objectives:</i></b> Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for large, complex intrarenal stones. Tubeless PCNL (t-PCNL) where no nephrostomy tube is placed and totally tubeless PCNL (tt-PCNL) in selected patients have been well described. There has been no study to our knowledge discharging patients the same day totally tubeless. In this study, we describe our experience with tt-PCNL on a totally outpatient basis-with the patient going home with absolutely no tube, catheter, or stent, evaluating its safety and efficacy vis-à-vis a comparison with outpatient t-PCNL patients discharged with an indwelling stent. <b><i>Methods:</i></b> We prospectively collected data from 130 consecutive patients scheduled for outpatient PCNL from August 2023 to January 2024. Demographics, stone characteristics, and intraoperative data were compared. Outcomes included postoperative (post-op) pain, stone-free rate (SFR), 30-day complications, and ED visits or readmissions. Categorical variables were compared using Chi-square or Fisher's exact tests and continuous variables via Mann-Whitney U tests. <b><i>Results:</i></b> After exclusions, 53 patients underwent tt-PCNL and 50 had t-PCNL. Demographics and stone burden did not differ between groups. No visceral or pleural injuries occurred in either group. Post-op transfusion rates, SFR, 30-day complications, ED visits, and readmissions were also comparable between the two groups. The mean operative (OR) time and incidence of Clavien-Dindo I complications were higher with t-PCNL with stent (80 minutes <i>vs</i> 58 minutes, <i>p</i> < 0.001,16% <i>vs</i> 3.8%, <i>p</i> = 0.048). Post-op pain scores and postanesthesia care unit stay times were similar. <b><i>Conclusions:</i></b> In this first ever comparison of outpatient t-PCNL to tt-PCNL, we found the same-day discharge of tt-PCNL patients to be safe and effective. Stent omission in our patients did not increase the risk of RF, ED visits, complications, or readmissions. A large, multicenter, randomized prospective controlled trial will help to confirm our findings.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":""},"PeriodicalIF":2.9000,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of endourology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1089/end.2024.0441","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Introduction and Objectives: Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for large, complex intrarenal stones. Tubeless PCNL (t-PCNL) where no nephrostomy tube is placed and totally tubeless PCNL (tt-PCNL) in selected patients have been well described. There has been no study to our knowledge discharging patients the same day totally tubeless. In this study, we describe our experience with tt-PCNL on a totally outpatient basis-with the patient going home with absolutely no tube, catheter, or stent, evaluating its safety and efficacy vis-à-vis a comparison with outpatient t-PCNL patients discharged with an indwelling stent. Methods: We prospectively collected data from 130 consecutive patients scheduled for outpatient PCNL from August 2023 to January 2024. Demographics, stone characteristics, and intraoperative data were compared. Outcomes included postoperative (post-op) pain, stone-free rate (SFR), 30-day complications, and ED visits or readmissions. Categorical variables were compared using Chi-square or Fisher's exact tests and continuous variables via Mann-Whitney U tests. Results: After exclusions, 53 patients underwent tt-PCNL and 50 had t-PCNL. Demographics and stone burden did not differ between groups. No visceral or pleural injuries occurred in either group. Post-op transfusion rates, SFR, 30-day complications, ED visits, and readmissions were also comparable between the two groups. The mean operative (OR) time and incidence of Clavien-Dindo I complications were higher with t-PCNL with stent (80 minutes vs 58 minutes, p < 0.001,16% vs 3.8%, p = 0.048). Post-op pain scores and postanesthesia care unit stay times were similar. Conclusions: In this first ever comparison of outpatient t-PCNL to tt-PCNL, we found the same-day discharge of tt-PCNL patients to be safe and effective. Stent omission in our patients did not increase the risk of RF, ED visits, complications, or readmissions. A large, multicenter, randomized prospective controlled trial will help to confirm our findings.

求助全文
约1分钟内获得全文 求助全文
来源期刊
Journal of endourology
Journal of endourology 医学-泌尿学与肾脏学
CiteScore
5.50
自引率
14.80%
发文量
254
审稿时长
1 months
期刊介绍: Journal of Endourology, JE Case Reports, and Videourology are the leading peer-reviewed journal, case reports publication, and innovative videojournal companion covering all aspects of minimally invasive urology research, applications, and clinical outcomes. The leading journal of minimally invasive urology for over 30 years, Journal of Endourology is the essential publication for practicing surgeons who want to keep up with the latest surgical technologies in endoscopic, laparoscopic, robotic, and image-guided procedures as they apply to benign and malignant diseases of the genitourinary tract. This flagship journal includes the companion videojournal Videourology™ with every subscription. While Journal of Endourology remains focused on publishing rigorously peer reviewed articles, Videourology accepts original videos containing material that has not been reported elsewhere, except in the form of an abstract or a conference presentation. Journal of Endourology coverage includes: The latest laparoscopic, robotic, endoscopic, and image-guided techniques for treating both benign and malignant conditions Pioneering research articles Controversial cases in endourology Techniques in endourology with accompanying videos Reviews and epochs in endourology Endourology survey section of endourology relevant manuscripts published in other journals.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信