Mp78-14 Ambulatory Percutaneous Nephrolithotomy Is a New Standard of Care: An Analysis of Over 2000 Cases

You have accessJournal of UrologyStone Disease: Surgical Therapy (Including ESWL) V (MP78)1 May 2024MP78-14 AMBULATORY PERCUTANEOUS NEPHROLITHOTOMY IS A NEW STANDARD OF CARE: AN ANALYSIS OF OVER 2000 CASES Natalia L. Arias Villela, Max R. Drescher, Suneet Waghmarae, Daniel C. Rosen, Meagan M. Dunne, Joel E. Abbott, and Julio G. Davalos Natalia L. Arias VillelaNatalia L. Arias Villela , Max R. DrescherMax R. Drescher , Suneet WaghmaraeSuneet Waghmarae , Daniel C. RosenDaniel C. Rosen , Meagan M. DunneMeagan M. Dunne , Joel E. AbbottJoel E. Abbott , and Julio G. DavalosJulio G. Davalos View All Author Informationhttps://doi.org/10.1097/01.JU.0001008856.05210.73.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Percutaneous nephrolithotomy (PCNL) has traditionally been considered an inpatient surgery due to the risk of bleeding and systemic infection. The evolution of technology and surgical approaches, such as endoscopic combined intrarenal surgery (ECIRS) and mini-PCNL (mPCNL), have facilitated the adaptation of ambulatory PCNL (aPCNL). In this series, we show that aPCNL may be safely and efficaciously performed in most patients. METHODS: We analyzed patients who underwent aPCNL, including standard PCNL (24-30Fr) and mPCNL (14-23Fr), at two free-standing ambulatory surgery centers (ASCs) between 2015-2023. Patient exclusion criteria for the ASC included BMI>50, severe cardiopulmonary conditions, and prior anesthetic complication. Patients were positioned either prone or in the Galdakao-modified Valdivia supine position. Standard practices included ECIRS technique for renal access, ureteral stent for drainage with a hemostatic plug in the access tract, and surgeon-administered rib block for pain control. Patients were observed in the post-anesthesia care unit (PACU) until discharge criteria was met and were sent home without a Foley catheter. Patient demographic, pre-operative, and post-operative data were prospectively collected. Descriptive statistics were used for data analysis. RESULTS: 2106 cases were available for analysis (Table 1). The mean age of patients was 57, mean BMI was 30, and mean ASA score was 2. 27% of patients had diabetes and 59% had hypertension. 18% of patients had a positive urine culture treated pre-operatively. The mean stone burden was 31mm. Standard tract PCNL was used in 60% of cases and 91% of cases were done through a single tract. 98% of cases had only a ureteral stent for drainage. The mean treatment time was 18 minutes and mean PACU time was 82 minutes. There was no planned second look in 91% of cases. The average estimated blood loss was 35mL. 1.9% of patients had a Clavien-Dindo complication>grade 2, but none were grade 5. Only 1.7% of patients required hospital transfer. CONCLUSIONS: aPCNL is efficacious and safe in appropriately selected patients. In our high-volume series, we found a low morbidity rate and low risk for hospital transfer. Unless there are medical or social factors precluding same day discharge, PCNL should be routinely performed as an ambulatory procedure. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1269 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Natalia L. Arias Villela More articles by this author Max R. Drescher More articles by this author Suneet Waghmarae More articles by this author Daniel C. Rosen More articles by this author Meagan M. Dunne More articles by this author Joel E. Abbott More articles by this author Julio G. Davalos More articles by this author Expand All Advertisement PDF downloadLoading ...