Are Nephrostomy and Ureteral Stent Necessary after Multi-Access Percutaneous Nephrolithotomy?

Ambulatory Percutaneous Nephrolithotomy in a Free-Standing Surgery Center: An Analysis of 500 Consecutive Cases

INTRODUCTION

Percutaneous Nephrolithotomy (PCNL) is an effective procedure for removal of large kidney stones; however, PCNL has traditionally been reserved for inpatient surgery. Certain cases are being performed entirely at an ambulatory surgery center (ASC), known as ambulatory PCNL (aPCNL).

MATERIALS AND METHODS

Five hundred consecutive PCNL procedures performed at a free-standing ASC between April 2015 and February 2019 were analyzed. Patient demographics, stone characteristics, operative characteristics, and post-operative data including transfer to hospitals, 30-day readmissions, and complications > Clavien I were recorded.

RESULTS

The mean age of patients undergoing PCNL at the ASC was 57 (range: 16-86) and BMI 30 (16-49). ASA compositions are as follows: ASA 1 (6.5%), ASA 2 (56.2%), ASA 3 (37.2%) and ASA 4 (0. 1%). The mean stone burden was 30 mm (5-140). Standard tract dilation (24-30 French) comprised 77% of cases. 92% of cases were performed with a single tract and 99% of cases had a ureteral stent as the only form of drainage (tubeless PCNL). The mean operative time was 104 minutes (32-305) and post anesthesia care unit (PACU) time was 97 minutes (37-247). The predicted stone free rate was 84%. Twelve patients (2.4%) required transfer to hospital and the 30-day readmission rate was 4.2%.

CONCLUSION

aPCNL is a safe and feasible procedure if performed by a high volume endourologist, even within the confines of a free-standing ASC. It is our opinion that the utilization of ECIRS facilitates high stone free rates with minimal morbidity and low readmission rates.

Comparison of safety and efficacy between single-tract and multiple-tract percutaneous nephrolithotomy treatment of complex renal calculi: a systematic review and meta-analysis

BACKGROUND

A systematic review and meta-analysis was conducted to explore the safety and efficacy of single-tract and multiple-tract percutaneous nephrolithotomy (PCNL) in complex renal calculi treatment.

METHODS

PubMed, Web of Science, Embase, EBSCO, and Cochrane library databases (updated November 2020) were searched for studies assessing the effect of different numbers of tracts on cases that underwent PCNL. The search strategy and study selection process were managed according to the PRISMA statement.

RESULTS

Five comparative studies were included in the meta-analysis. The multiple-tract PCNL group had a significantly increased total complications rate than the single-tract group (OR = 2.35, 95% CI = 1.71, 3.25; P < 0.00001) with insignificant heterogeneity (I2 = 0%, P = 0.52). Subgroup analysis showed there were different incidence of complications, mainly because the multiple-tract PCNL group was significantly associated with a higher rate of blood transfusion (OR = 2.99, 95% CI = 1.95, 4.57; P < 0.00001) with insignificant heterogeneity (I2 = 9%, P = 0.35). There were no differences in operation time (MD = 12.04, 95% CI = 6.36, 17.72; P < 0.0001) or hospitalization (MD = 0.54, 95% CI = 0.14, 0.95, p = 0.008). However, the singletract group had a higher stone-free rate (OR = 0.37, 95% CI = 0.19, 0.74; P = 0.005) with heterogeneity (I2 = 51%, P = 0.08), as stones in the single-tract group were smaller than those in the multiple-tract group.

CONCLUSIONS

The current research did not find that the multiple-tract group had a higher stone-free rate. Additionally, multiple-tract PCNL was associated with a higher incidence of blood transfusion and negative impact on renal function.