Analysis of the Feasibility and Efficacy of Ambulatory/Day Care Percutaneous Nephrolithotomy: An Initial Experience

Abstract

Purpose: Tubeless percutaneous nephrolithotomy (PCNL) is a well-accepted procedure for uncomplicated renal calculi. We prospectively evaluated the safety, feasibility, and efficacy of day care/ambulatory PCNL (totally tubeless, discharge within 24 hours) for selected patients for which only few case series have been reported. Materials and Methods: Total tubeless PCNL was planned in 40 easily accessible patients with uncomplicated renal calculi, with single infracostal punctures, normal intraoperative events, and acceptable postoperative parameters (visual analogue pain score, parenteral analgesic requirement, bleeding, urinary soakage, hemodynamic stability), allowing an early discharge within 24 hours. Parameters like pain score and analgesic requirement, any complications, and return date to normal work were evaluated at follow-up. Ultrasonography was performed after a week to document stone clearance. results: Mean patient age was 38.6 years (22 to 62), stone size was 21.4 mm (15.4 to 30), and operating time was 72 minutes (42 to 106) without blood transfusion. Regional anesthesia was used in 13 cases while general anesthesia was used in the rest of the patients. Average pain score after 6 hours of surgery was 2.3 (1.8 to 3.6) with vitals in the normal range, and hospital stay was 12.5 hours (5.5 to 23.5). Six patients were excluded due to periand postoperative events (2: multiple punctures, 1: hematuria, 1: urine leak, 2: pain). This data was taken with the intention to treat the analysis with a successful application of study protocol in 34 (85%) of preoperatively selected cases. Out of 34 patients that qualified for a complete study protocol, 11 were discharged on the same day of surgery while the rest were discharged the next morning. Postoperative USG confirmed no residual calculus, and all patients had uneventful recoveries. Three patients had minor complications (mild hematuria/ urine leaks), which were managed conservatively. conclusion: Our experience with ambulatory PCNL in properly selected cases suggests it as a feasible and effective option that can safely be offered to patients, providing uncomplicated surgery and favorable postoperative parameters. KEYWOrDs: Percutaneous nephrolithotomy, nephrolithiasis, kidney calculi cOrrEsPONDENcE: Adittya K. Sharma, MCh, Institute of Nephro-Urology, Victoria Hospital Campus, Bangalore, Karnataka, India (dradityaonline@gmail.com, dradityaks@gmail.com) cItAtION: UroToday Int J. 2013 August;6(4):art 44. http://dx.doi.org/10.3834/uij.1944-5784.2013.08.03 UroToday International Journal® ©2013 Digital Science Press, Inc. UIJ / Vol 6 / Iss 4 / August / http://dx.doi.org/10.3834/uij.1944-5784.2013.08.03 http://www.urotodayinternationaljournal.com ISSN 1944-5792 (print), ISSN 1944-5784 (online) INtrODuctION Renal calculi pose major health issues in our society with percutaneous nephrolithotomy (PCNL) and shock wave lithotripsy (SWL) being standard treatments of choice. SWL is the procedure of choice for most renal stones up to 2 cm except selected cases with unfavorable factors. PCNL is the choice for calculi larger than 2 cm without any absolute contraindication to the procedure [1]. While the former gives the advantage of being noninvasive, day care later gives predictable stone clearance in a single sitting. Various modifications (supine PCNL, lateral PCNL) [2,3] in conventional prone PCNL have been tried to reduce operative time, postoperative morbidity, and allows for early discharge. After the first report of outpatient PCNL by Preminger et al. [4], in the past few years there have been various case series reporting day care/ambulatory PCNL with discharge on the same or following day within 24 hours [5-8]. We decided to evaluate the feasibility and efficacy of