Introduction: Percutaneous Nephrolithotomy (PNL) is a procedure that has traditionally been performed in an inpatient setting with at least an overnight stay. Many surgical procedures have evolved over time from an inpatient setting to an ambulatory surgery center (ASC) setting. Feasibility of Ambulatory PNL (aPNL) was shown in our initial pilot series of 25 cases . This 650 case series is reviewed to further evaluate outcomes with a more robust data set.
Methods: We present our series of 650 patients who underwent PNL in an ASC from April 2015 to October 2019. Each aPNL was performed by one of two surgeons with the same operative team. All procedures were performed with the urologist obtaining renal access and all procedures were performed tubeless (ureteral stent without a nephrostomy tube). All patients also had hemostatic plugs placed into the access tract with a local intercostal block to aid with pain control. All cases were reviewed and demographic data and case details were analyzed.
Results: 650 consecutive aPNL cases were reviewed, identifying 294 men and 356 women, 304 right side and 346 left, mean age 57.3 years (16-86), mean BMI 31.0 (16-49), mean ASA of 2.3 (1-4) and mean stone burden 30.6 mm (6-160), mean fluoroscopy time 87 sec (0-322). Mean OR time was 101 min (32-305) and mean treatment time was 21 min (1-262). Mean PACU time was 94 min (range 37-247). A mini-PNL (mPNL) procedure was conducted in 149 (23%) patients. Stone free rate was 81%. Twenty six patients had complications ranging from Clavien I-IVa, of which 13 were hospital transfers.
Conclusions: This consecutive 650 case series further demonstrates the safety of aPNL. While twenty six patients experienced complications, the site of service did not lead to an alteration in the outcomes of the adverse events. Each complication that occurred was managed in an appropriate fashion without notable treatment delay. Our complication rate in the ASC is lower than reported in large cohort studies. This is likely due to preselection of healthier patients and inherent challenges monitoring patients in an ambulatory setting. With an experienced surgeon, well trained operative team and with modifications to the procedure focusing on post-operative pain control, PNL can be safely and effectively performed in an ASC.
1. Davalos JG, Abbott JE. Ambulatory PCNL: Initial Case Series. J Urology. April 2016. Vol. 195 (4), Supplement 1: MP51-20, e688-e689. 2 2. Abbott JE, Cicic, A, Jump III RW, Davalos JG. Hemostatic Plug: Novel Technique for Closure of Percutaneous Nephrostomy Tract. J Endourol. March 2015, 29(3): 263-269. Source of