Percutaneous nephrolithotomy in supine position with less than 24-hour hospital stay; a single-center experience

Morshed Salah; Bela Tallai; Tawiz Gul; Omar Aboumarzouk; Maged Alrayashi; Mohamed Abdelkareem; Hatem Kamkoum; Mohammed Ibrahim; Mohammed Ebrahim; Hossameldin Alnawasra; Salvan Alhabash; Ahmed Ismail; Maged Alghashmi; Abdulla Al-Ansari

doi:10.1080/2090598X.2023.2234254

Percutaneous nephrolithotomy in supine position with less than 24-hour hospital stay; a single-center experience

Arab J Urol. 2023 Jul 16;22(1):54-60. doi: 10.1080/2090598X.2023.2234254. eCollection 2024.

Authors

Morshed Salah^{1

2}, Bela Tallai¹, Tawiz Gul^{1

2}, Omar Aboumarzouk^{1

2

3}, Maged Alrayashi¹, Mohamed Abdelkareem¹, Hatem Kamkoum¹, Mohammed Ibrahim¹, Mohammed Ebrahim¹, Hossameldin Alnawasra¹, Salvan Alhabash¹, Ahmed Ismail⁴, Maged Alghashmi¹, Abdulla Al-Ansari^{3

5}

Affiliations

¹ Urology Section, Surgery Department, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar.
² College of Medicine, Qatar University, Doha, Qatar.
³ Urology Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
⁴ Anesthesiology Section, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar.
⁵ Weill Cornell Medicine-Qatar, Doha, Qatar.

Abstract

Objectives: To report our initial experience of day care percutaneous nephrolithotomy (PCNL) with early hospital discharge within less than 24 hours of the procedure.

Patients and methods: The files of patients treated with PCNL between 1st January 2020 till 31st December 2022 were retrospectively reviewed. Day care PCNL was defined as the discharge of patients either on the same day or within 24 hours after surgery. Patient age, ASA score, body mass index, stone diameter, laterality, stone burden, Hounsfield unit, and Guy's score were analyzed. Operative time, size of the access tract, method of lithotripsy, estimated blood loss, and length of hospital stay were also recorded. Postoperative complications were stratified according to the Dindo-Clavien classification. The primary outcome was to evaluate the feasibility and safety of early discharge within 24 hours after PCNL compared to the in-patients who were kept in hospital for at least 2 days after surgery.

Results: A total of 85 patients underwent PCNL at our center of whom 36 patients were discharged within 24 hours (day care PCNL) of the procedure and 49 patients were kept for at least 2 days (in-patient PCNL). In the day care group, median stone burden was 465 mm2 (360-980) and 18 patients (50%) had Guy's stone score ≥ III. The median tract size was 24 (13-30) and endoscopic combined intrarenal surgery (ECIRS) was performed in 7 cases in the day care group. Tubeless PCNL was carried out in 88.8% of the day care surgery group compared to 37.5% in the in-patient group (p < 0.0001). The postoperative complication rate was comparable between both groups (13.8% vs 22.4% for day care vs in-patient group, respectively, p = 0.08).

Conclusions: Day care PCNL is feasible and safe for selected patients including those having large stone burden without increasing the risk of complications or readmission rate.

Keywords: Day care; PCNL; ambulatory; nephrolithotomy; percutaneous.