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
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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.

门诊全无管标准经皮肾镜取石安全有效吗?
简介和目的:经皮肾镜取石术(PCNL)是治疗大型复杂肾内结石的金标准。无管PCNL (t-PCNL),其中不放置肾造瘘管和完全无管PCNL (tt-PCNL)在选定的患者中得到了很好的描述。据我们所知,还没有研究表明患者出院当天完全没有输卵管。在这项研究中,我们描述了我们在完全门诊基础上使用tt-PCNL的经验-患者完全没有管,导管或支架回家,通过-à-vis与门诊t-PCNL患者出院时留置支架的比较来评估其安全性和有效性。方法:从2023年8月至2024年1月,我们前瞻性地收集了130例门诊PCNL患者的数据。比较人口统计学、结石特征和术中数据。结果包括术后疼痛、无结石率(SFR)、30天并发症、急诊科就诊或再入院。分类变量采用卡方检验或Fisher精确检验,连续变量采用Mann-Whitney U检验。结果:排除后,53例患者行tt-PCNL, 50例患者行t-PCNL。人口统计学和结石负担组间无差异。两组均未发生内脏或胸膜损伤。术后输血率、SFR、30天并发症、急诊科就诊和再入院率在两组之间也具有可比性。t-PCNL支架组的平均手术时间和Clavien-Dindo I并发症发生率均高于t-PCNL支架组(80分钟vs 58分钟,p < 0.001,16% vs 3.8%, p = 0.048)。术后疼痛评分和麻醉后护理单位停留时间相似。结论:在首次门诊t-PCNL与tt-PCNL的比较中,我们发现tt-PCNL患者当天出院是安全有效的。在我们的患者中,遗漏支架没有增加射频、急诊科就诊、并发症或再入院的风险。一项大型、多中心、随机、前瞻性对照试验将有助于证实我们的发现。
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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.
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