Safety and efficacy of mini-percutaneous nephrolithotomy as daycare procedure: a prospective observational study

Abstract

BackgroundTo evaluate the safety, feasibility of mini-percutaneous nephrolithotomy (mPCNL) being carried out as a daycare surgery and to study the re-admission, stone clearance rate and complication rates following mPCNL. We also sought to find out the rate of requirement of ancillary procedure, after mPCNL.MethodsIn this prospective observational study, easily accessible patients above 18 years of age with renal and/or upper ureteric calculi, who underwent mPCNL between September 2018 and February 2020, were included. Seventy patients were selected, as per statistical methods. Preoperative evaluation including history, blood and urine investigations and radiological images was collected. Intra-operative and post-operative events were analyzed. Written consent was obtained from the patients to participate in the study and to publish their data. Institutional Ethical and scientific committee clearance was obtained.ResultsOut of 70 patients who underwent mPCNL in the study, in the age group ranging from 24–68 years, most of the cases were partial staghorn with maximum size of stone up to about 3.5 cm. Inferior calyx was most frequently punctured. Six cases had multipuncture mPCNL, four patients had bilateral procedure, and two had supra-costal puncture. Eighteen patients had tubeless mPCNL, of which four were totally tubeless procedures. Four patients had hematuria, none requiring transfusion. Two patients had sepsis, managed with higher antibiotics. Limitation of the study was the sample size. To derive a sturdy conclusion, large scale studies are recommended.ConclusionsWe can conclude that mPCNL can be safely done as daycare or ambulatory surgery in properly selected patients. In centers with experienced urologists, bilateral and multipuncture mPCNL can be done as an ambulatory surgery. Thus, this addresses the stone disease as well as cost containment, without patient safety being compromised. Bed occupancy rate is reduced, helping effective utilization of hospital resources.