WCE 2017: Use of Various Entrance and Exit Strategies to Facilitate Percutaneous Nephrolithotomy as an Ambulatory Procedure

Vancouver, Canada (UroToday.com) Zhou et al. present a retrospective study of 392 patients who received either standard percutaneous nephrolithotomy (PCNL) with a 30F tract or mini PCNL with a 24F tract. A tubeless technique with a double-J stent left postoperatively was used in cases with evidence of ureteral edema and/or stricture. Otherwise, a totally tubeless technique was used. Patients were discharged on the same day if they demonstrated adequate pain control with oral analgesics and no evidence of anemia, acute kidney injury, or electrolyte abnormalities.  
Only 44 of the patients (11%) in this study were discharged on the same day. Of these patients, 20 (45%) were male. The mean age was 54 ± 11 years and the mean BMI was 31 ± 5. The mean stone diameter was 1.75 ± 0.72 cm. Standard PCNL was used in 34 of these patients (77%). The totally tubeless technique was used in 19 of these patients (43%). No patients required readmission and there were only two Clavien-Dindo grade I complications.  

These authors deserve praise for analyzing the outcomes from a subgroup of their PCNL and mini-PCNL patients. It is interesting that within this subgroup of patients who were discharged on the same day, standard PCNL was the predominant approach. In addition, there appeared to be no substantial difference in the number of patients on whom a tubeless versus a totally tubeless approach was used. However, with only an 11% rate of same day discharges in this study, it is clear that ambulatory PCNL is an option only for select patients. Further work is definitely needed to define guidelines in appropriate patient selection for ambulatory PCNL.

Presented by: Tian Cheng Zhou

Authors: Tian Cheng Zhou, Kedar Mahagaokar, and Joshua Stern
Affiliation: Montefiore Medical Center, New York City, NY

Written by: Michael Owyong (@ohyoungmike), LIFT Fellow, Department of Urology, UC Irvine Medical Center at 35th World Congress of Endourology – September 12-16, 2017, Vancouver, Canada