PD7-02 PIONEERING AMBULATORY PCNL: THE CANADIAN EXPERIENCE (original) (raw)
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Outcome and Complications of PCNL –A Single Centre experience
Introduction: Kidney stones are a common problem affecting all population groups across the globe. Percutaneous extraction of renal stone has become a standard well-established procedure for the management of renal stones. Materials and methods: A total of 105 cases of renal calculi who underwent PCNL from August 1, 2016 to November 30,2017 were studied. Intraoperative findings and immediate postoperative complications were noted. They were followed up for 1 month after the surgical procedure. Results: Mean age of cases was 42.5 years. Multiple calculi were seen in 15.24%, while a staghorn calculus was seen in 9.5%. Stone clearance was done through a single tract in 85.71%. Additional tracts were made in 14.29%. Tubeless PCNL was done in 4.5%; 6.6% of the cases had urinary tract infection. Conclusion: This study reveals that PCNL is a safe procedure with less complications and higher stone-free rates without compromising patient safety in a short period.
Comparative outcomes and cost of ambulatory PCNL in select kidney stone patients
Urolithiasis
Limited hospital resources and access to care during the COVID-19 pandemic led us to implement a quality-improvement study investigating the feasibility, safety, and costs of same-day discharge after PCNL. The outcomes of 53 consecutive first-look PCNL patients included in a same-day discharge protocol during COVID-19 were compared to 54 first-look PCNL patients admitted for overnight observation. Control group had a similar comorbidity profile. Demographics, operative details, 30 day outcomes and readmissions, complications, and cost were compared between the two groups. Same-day discharge and one-day admission post-PCNL patients did not have significantly different baseline characteristics. The study group were more likely to have mini-PCNL (81% vs 50%, p < 0.01). Operative characteristics including median pre-operative stone burden (1.4 vs 1.7 cm 3 , p = 0.47) and post-operative stone burden (0.14 vs 0.18 cm 3 , p = 0.061) were similar between the two groups. Clavien-Dindo complication rates were lower in the study group compared to controls (0 vs 7%, p = 0.045). Readmission rates (2 vs 4%, p = 0.569) and ED visits (4 vs 6%, p = 0.662) were similar between the two groups. Total cost
Outcomes of PCNL in Patients With and Without Previous Ipsilateral Stone Surgery
Purpose: To compare the outcomes of PCNL in patients with and without previous renal stone surgery. Materials and methods: A total of 80 patients who underwent PCNL during the period from 1 st November, 2017 to 31 st October, 2019 at our institution were included in the study. Patients undergoing PCNL were classified into 2 groups. Group l included patients without previous ipsilateral renal stone surgery. Group 2 included patients with previous renal stone surgery (open or percutaneous). Age, sex, Body Mass Index, stone size, stone location and renal stone surgery, number of access tracts made during the operation, tract dilation time, operation time, length of hospital stay, stone free rate, and intra-and post-operative complication rates were compared between the two groups. Results: There were no significant differences between the two groups in terms of accessory tracts required, stone clearance rate, transfusion rate, ancillary procedures required, hospital stay and complications. The only differences noted between the groups were tract dilation time and operating time, which were statistically significant. Conclusion: PCNL in patients with previous open or percutaneous stone surgery is as safe and effective as PCNL in patients without renal stone surgery in the past.
International braz j urol, 2011
Re-procedure in patients with history of open stone surgery is usually challenging due to the alteration in the retroperitoneal anatomy. The aim of this study was to determine the possible impact of open renal surgery on the efficacy and morbidity of subsequent percutaneous nephrolithotomy (PCNL). Materials and Methods: From March 2009 until September 2010, 120 patients underwent PCNL. Of these, 20 patients were excluded (tubeless or bilateral simultaneous PCNL). Of the remaining 100, 55 primary patients were categorized as Group 1 and the remaining (previous open nephrolithotomy) as Group 2. Standard preoperative evaluation was carried out prior to intervention, Statistical analysis was performed using SPSS v. 11 with the chi-square test, independent samples t-test, and Mann-Whitney U test. A p-value < 0.05 was taken as statistically significant. Results: Both groups were similar in demographic profile and stone burden. Attempts to access the PCS was less in Group 1 compared to Group 2 (1.2 + 1 2 vs 3 + 1.3 respectively) and this was statistically significant (p < 0.04). However, the mean operative time between the two groups was not statistically significant (p = 0.44). Blood transfusion rate was comparable in the two groups (p = 0.24). One patient in Group 2 developed hemothorax following a supra-11th puncture. Remaining complications were comparable in both groups. Conclusion: Patients with past history of renal stone surgery may need more attempts to access the pelvicaliceal system and have difficulty in tract dilation secondary to retroperitoneal scarring. But overall morbidity and efficacy is same in both groups.
Changing practice to stented percutaneous nephrolithotomy (PCNL): a 2 year experience
British Journal of Medical and Surgical Urology, 2009
Introduction: Stented PCNL is an increasingly practiced technique in which PCNL is performed without leaving a post-operative nephrostomy tube. We present our results from one of the biggest UK series to assess the impact of this technique on the safety, efficacy, length of hospital stay and analgesic requirement, to guide our future practice in terms of patient selection. Patients and methods: Case notes of 56 stented PCNLs between October 2005 and 2007 were reviewed retrospectively and compared to a similar group of 50 conventional PCNLs (only a nephrostomy post-operatively) in terms of co-morbidities (ASA grade), stone burden, intra-operative details, complications, length of stay (LOS) and analgesic requirement. The stented technique was employed in complex stones and in anatomical abnormalities (e.g. horseshoe, solitary, and duplex systems). The use of a stent rather than a nephrostomy was decided at the time of surgery when satisfactory haemostasis and stone clearance were achieved at the end of the procedure. Results: Co-morbidities, anatomical abnormalities, stone burden, operative time, number of punctures, access and infection rates were comparable. The stented technique was employed in complex stones (staghorn n = 13, multiple stones n = 11) and in patients with anatomical abnormalities (n = 9). Overall stone free rate was 92.8% and 82% for the stented and the conventional groups, respectively. No haemorrhage or ureteric obstruction was reported in the stented group. All stent removals were uneventful. Mean LOS and analgesic requirement of diclofenac were markedly less in stented group. The number of stented procedures tripled from year 1 (n = 14) to year 2 (n = 42). Mean LOS dropped steadily * Changing practice to stented percutaneous nephrolithotomy (PCNL) 239 from 68.6 h in the first 6 months (n = 5) to 47.4 h in the last 6 months (n = 22) with increased experience. Twenty-four patients (42%) were fit for discharge within 35 h. Conclusion: In our experience, the stented technique was well tolerated and has reduced the length of hospital stay with no evidence of loss of efficacy or increased morbidity even in complex stones or patients with anatomical abnormalities.
Is an overnight stay after percutaneous nephrolithotomy safe?
Arab Journal of Urology, 2012
Objectives: To establish a clinical care pathway that plans for hospital discharge the day after percutaneous nephrolithotomy (PCNL), to evaluate the safety, effectiveness and feasibility of this pathway, and to identify factors associated with a postoperative length of hospital stay (LOS) of >1 day. PCNL is the treatment of choice for patients with large kidney stones and those in whom extracorporeal shockwave lithotripsy has failed, and the mean LOS is typically 2-5 days.
“Ambulatory PCNL” (Tubeless PCNL under Regional Anesthesia) – A Preliminary Report of 10 Cases
International Urology and Nephrology, 2005
Aim: We report the technique, safety, outcome and efficacy of ''tubeless percutaneous nephrolithotomy (PCNL) performed under regional anesthesia'' in selected cases. Methods: Patients satisfying the entry criteria for the regional block (spinal low-dose anesthesia with low-dose Bupivacaine plus Fentanyl) and tubeless procedure were subjected to a tubeless spinal PCNL The patients were followed up the next day for an ultrasonography and an x-ray of the KUB region. Results: All the ten patients were discharged uneventfully the next day (mean hospital stay-40 h). No blood transfusion and postoperative analgesics (mean post op visual analogue pain score was 2.4) were required. The mean time to return of S 1 sensation, motor block and walking were 183,118 and 196.6 min respectively. There was complete stone clearance in all the cases with a mean collection of 14.5 cc was seen on the post op ultrasound. Conclusions: The present cases were reported to highlight that in a select group of patients tubeless PCNL under regional block is technically feasible and viable option. Regional block has the advantage of avoidance of general anesthesia and anaphylaxis due to use of multiple drugs. Tubeless PCNL has the advantage of avoidance of nephrostomy tube related postoperative pain discomfort and urosepsis. This synergistically (spinal + tubeless PCNL) speeds up the recovery, shortens the length of hospitalization and the analgesic requirement.
Urolithiasis, 2013
The conventional technique for percutaneous nephrolithotomy (PNL) ends by placing a nephrostomy tube within the access tract. However, feasibility and safety of tubeless PNL have been widely demonstrated. In this modification, a ureteral stent is usually left in place instead of the nephrostomy tube. The aim of this study is to compare the use of a postoperative indwelling double-J stent versus an overnight-externalized ureteral catheter in patients undergoing tubeless PNL. Sixty-eight patients undergoing tubeless PNL were randomized either for a postoperative double-J stent (group 1) or for an overnightexternalized ureteral catheter (group 2). Outcomes evaluated included postoperative pain, hospital stay length, incidence of hemorrhagic complications, residual lithiasis and urinary leakage. Groups were similar according to age, sex, body mass index and stone burden. There were no significant differences in terms of postoperative pain, incidence of perirenal hematomas, residual lithiasis and urinary leakage. However, patients in group 1 presented longer hospital stays (3.7 ± 1.7 vs. 1.9 ± 0.3 days; p \ 0.001) and greater hematocrit drops (4.9 ± 2.2 vs. 2.1 ± 1.8 %; p \ 0.001). Our results confirm that among patients undergoing tubeless PNL, both alternatives (i.e. leaving a double-J stent or an overnight-externalized ureteral catheter) are reliable and safe. However, further considerations, like the need of double-J stent removal under cystoscopy, need to be taken into account when deciding which modality to use.
Percutaneous nephrolithotomy (PCNL) in patients with previous open stone surgery
International Urology and Nephrology, 2008
Objectives Our objective was to investigate the effects of previous open nephrolithotomy on technical features, outcomes, and morbidities of subsequent percutaneous nephrolithotomy (PCNL). Methods One hundred and sixty patients underwent PCNL between December 2004 and September 2006. The patients were divided into those who had previous open nephrolithotomy on the same kidney (group 1: 55 patients) and those who had no previous open surgery (group 2: 105 patients). Technical features encountered during operation and outcomes were compared between groups. Results There were no significant differences between groups with respect to mean age (group 1: 42.6 ± 10 years vs. group 2: 45.5 ± 9.6 years), body mass index (24.8 ± 2.11 vs. 24.6 ± 2.14), and stone burden (385.6 ± 140.6 mm 2 vs. 401.05 ± 142 mm 2). In group 1, 28 and 27 stones were located in the right and left kidney, respectively, whereas the location was 51 and 54 for the right and left kidney, respectively, in group 2. When the groups were compared, the mean operative time was significantly longer (155 ± 30 min vs. 137 ± 30 min) in group 1. But there was no significant difference with respect to requirement for secondary intervention (11% vs. 10%). Sepsis developed in two patients in group 1 and one patient in group 2. One patient in group 1 died due to septic shock. Ten (18.2%) patients in group 1 and 13 (12.4%) patients in group 2 required blood transfusion. Conclusions When PCNL is performed after previous open nephrolithotomy, the operative time lengthens. But there is no difference with respect to success rate and morbidities.