MP06-03 AMBULATORY PERCUTANEOUS NEPHROLITHOTOMY IS SAFE AND EFFECTIVE IN EXTENDED SELECTION CRITERIA PATIENTS

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy I (MP06)1 Sep 2021MP06-03 AMBULATORY PERCUTANEOUS NEPHROLITHOTOMY IS SAFE AND EFFECTIVE IN EXTENDED SELECTION CRITERIA PATIENTS Gregory Hosier, Kashif Visram, Michael Di Lena, Naji Touma, and Darren Beiko Gregory HosierGregory Hosier More articles by this author , Kashif VisramKashif Visram More articles by this author , Michael Di LenaMichael Di Lena More articles by this author , Naji ToumaNaji Touma More articles by this author , and Darren BeikoDarren Beiko More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001973.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ambulatory tubeless percutaneous nephrolithotomy (aPCNL) has been shown to be safe and effective in highly selected patients. However, these selection criteria preclude the vast majority of patients that undergo PCNL. The objective of our study was to compare complication and stone free rates after aPCNL in standard selection criteria vs. extended criteria patients. METHODS: Retrospective review of prospective data on all patients who underwent aPCNL at one academic center from 2007-2018. Extended criteria patients were defined as any: Age >75 years, BMI >30 kg/m2, ASA >2, bilateral stones, solitary kidney, staghorn calculi, stone burden >40 mm, multiple tracts, or pre-existing nephrostomy tubes/stents. Primary outcomes were complication rates (Clavien-Dindo classification) and stone free rates (no fragments >/=3 mm). All patients were discharged with a ureteric stent and no nephrostomy tube after meeting discharge criteria which included hemodynamic stability, no fever, and no significant pain. RESULTS: We identified 118 patients of which 92 (78%) met extended criteria. Mean BMI was 31 kg/m2 and 45% were ASA 3 or higher. Mean sum maximum stone diameter was 24 mm. Multiple stones were present in 25%, bilateral stones in 7%, staghorn stones in 4%, and pre-existing tubes/stents in 4%. There was no difference in complication (12% vs. 18%, p=0.56), Emergency department visit (12% vs 18%, p=0.56), or readmission (4% vs. 5%, p=1) rates between standard and extended criteria patients respectively (Table 1). Of the complications, 85% were Clavien-Dindo grade 1. Stone free rates were not different between standard (84%) and extended (83%) criteria patients (p=1). No extended criteria variables were associated with complications in univariate analysis. Stone burden >40 mm (OR 5.8, 95% CI 1.4-25.2, p=0.018) and multiple tracts (13.1, 95% CI 1.1-154.7, p=0.041) were associated with residual stone fragments. CONCLUSIONS: Complication and stone free rates were not different between standard and extended selection criteria patients undergoing aPCNL. This data supports the safety and efficacy of aPCNL in patients using extended selection criteria. As the COVID-19 pandemic continues to strain hospital resources, aPCNL offers a solution to deal with a growing backlog of patients with complex stone disease. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e89-e90 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gregory Hosier More articles by this author Kashif Visram More articles by this author Michael Di Lena More articles by this author Naji Touma More articles by this author Darren Beiko More articles by this author Expand All Advertisement Loading ...