Category: New Technology: Stones

MP7-14 - Is day case PCNL safe and effective? Systematic Review from European Society of Uro-technology

Fri, Sep 21
10:00 AM - 12:00 PM

Introduction & Objective : Delivery of day case or ambulatory PCNL has risen over recent years. This is possible largely due to advances in technology and surgeon expertise. However, critical evaluation remains under-reported. We performed a systematic review of world literature to evaluate the outcomes of day-case PCNL surgery.


Methods : Cochrane style search was performed and the following bibliographic databases were accessed: PubMed, Science Direct, Scopus, and Web of Science. This was carried out in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. All studies in the English language reporting on PCNL patients discharged within 24 h were included.


Results : The search and review process yielded, nine studies (502 patients) meeting the inclusion criteria. Mean age was 47 years with a mean stone size of 20.5 mm. Mean operating time was 66 mins, mean hospital stay of 17.5 hrs and stone-free rate (SFR) was 95.3% (range 88.8– 100%). Overall complication rate was 13.5% and the vast majority of these complications (>90%) were Clavien I–II complications. Mean re-admission rate of 3% (range 0-10) was recorded. Results were further sub-analysed according to those patients admitted for an overnight stay. There was no significant difference in SFR, major complications or re-admisison rates between the group of patients discharged same day post surgery and those admitted for an overnight stay and discharged the following morning.


Conclusions : Day-case PCNL is a safe and feasible strategy in carefully selected cases. However, its success is determined by detailed planning. Strict adherence to surgical protocol is paramount as is pre-defined criteria for inpatient admission and a thorough follow-up plan.

Patrick Jones

Resident
University Hospital Southampton
Southampton, England, United Kingdom

Amelia Pietropaolo

Urology senior fellow
University Hospital Southampton
Southampton, England, United Kingdom

Robert Geraghty

Resident
University Hospital Southampton
Southampton, England, United Kingdom

Andreas Skolarikos

Consultant
National and Kapodistrian, University of Athens, Athens, Greece
Athens, Attiki, Greece

Bhaskar K. Somani

Consultant Urologist, Associate Professor
University Hospital Southampton , U.K
Southampton, England, United Kingdom

Bhaskar is an Endourologist and Associate Professor in Southampton, and is an active member of European School of Urology 'Training and Research group' and ESUT Endourology group. He has been teaching on EUREP hands-on-training for the last 5 years and is the senior author in the new ‘Endoscopic stone treatment (EST)’ curriculum established for training and examinations. He has performed live surgery in EAU with presentations and moderations in EULIS, WCE and SIU. He is also a member of EAU ‘Train the Trainer’ committee.

He is research active and has published more than 200 papers with over 300 published abstracts/presentations. He is on the editorial board of 3 journals, a reviewer for 14 journals and Investigator for 5 trials. He sits on the MCQ panel for FRCS examinations and is a ‘Specialist advisor’ to National Institute of Clinical Excellence (NICE) Interventional procedures and ‘Invited expert’ to NICE urological infections. He is an elected member of BAUS Academic section and was recently selected as a Fellow of Faculty of Surgical Trainers.