Outpatient percutaneous nephrolithotomy: the primary outcomes analysis

Introduction. Nephrolithiasis is one of the most common diseases of the genitourinary system. Surgical strategy is dictated by the location and burden of calculi. Percutaneous nephrolithotomy (PCNL) has established itself as the optimal treatment for large renal calculi exceeding 20 mm.

Objective. To retrospectively evaluate outcomes of PCNL performed in an outpatient setting.

Materials & methods. We conducted a retrospective analysis of PCNL outcomes in 25 patients aged 27–68 years managed on an outpatient basis. Indications for PCNL were symptomatic calculi. Recurrent nephrolithiasis was present in 16 (64%) patients, and 9 (36%) had undergone prior surgical interventions. Stone disintegration was performed using a thulium fibre pulsed laser (Urolaser U2). The final step in all procedures was placement of a nephrostomy tube. We assessed the efficacy and safety of PCNL (including mini PCNL and standard 36 Ch access) by analysing stone free rates, operative time and length of hospital stay, and the spectrum and severity of complications.

Results. No repeat percutaneous procedures were required in this cohort. A single stage procedure was performed in 17 (68%) cases, whereas 8 (32%) patients underwent PCNL against the background of a previously placed nephrostomy. Mini PCNL was performed in 18 (72%) patients, and standard 36 Ch access was used in 7 (28%). Total operative time ranged from 30 to 105 minutes, with a median of 45 minutes. Overall complete stone-free was achieved in 23 (92%) patients. Nephrostomy tubes were removed at a mean of three days post procedure. Mean length of stay in the facility was 13 ± 2.5 hours. No patients required blood transfusion. Fever lasting more than 24 hours was recorded in one patient. All observed complications were managed conservatively and did not exceed Clavien — Dindo II.

Conclusion. Analysis of our series and the published literature suggest that, in selected patient groups, outpatient PCNL is a safe procedure associated with comparable rates of emergency presentations, reduced healthcare costs and potentially a lower risk of nosocomial infection; however, these findings warrant confirmation in larger multicentre studies. The decision on the site of PCNL should be driven primarily by patient related factors rather than stone complexity. Appropriate patient selection is paramount to the success and safety of outpatient PCNL.

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