Safety and efficacy of day-case percutaneous nephrolithotomy: A systematic review from European Society of Uro-technology

Jones, Patrick, Bennett, Grace, Dosis, Alexios, Pietropaolo, Amelia, Geraghty, Robert, Aboumarzouk, Omar, Skolarikos, Andreas and Somani, Bhaskar K. (2018) Safety and efficacy of day-case percutaneous nephrolithotomy: A systematic review from European Society of Uro-technology. European Urology Focus. (doi:10.1016/j.euf.2018.04.002).

Abstract

CONTEXT: Day case or ambulatory percutaneous nephrolithotomy (PCNL) has risen over the last few years with the aim of discharging patients within 24h.

OBJECTIVE: We perform a systematic review of literature to evaluate the outcomes of day-case PCNL surgery.

EVIDENCE ACQUISITION: A 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 24h were included.

EVIDENCE SYNTHESIS: Based on the literature search of 97 articles, nine (502 patients) met the inclusion criteria (mean age: 47 yr), with a mean stone size of 20.5mm. The mean operating time was 66min, and over a mean hospital stay of 17.5h, the stone-free rate was 95%. The overall complication rate was 13.5%; the vast majority of these complications were Clavien I-II complications, with a readmission rate of 3%.

CONCLUSIONS: Day-case PCNL is a safe and feasible strategy in carefully selected cases. However, for its success, detailed planning and adherence to surgical protocol are paramount with strict criteria for inpatient admission and a thorough follow-up plan.

PATIENT SUMMARY: Day-case percutaneous nephrolithotomy procedure seems to be a safe procedure with good outcomes, and low risk of complications and readmissions. Detailed preoperative protocol and planning are paramount, with indications for inpatient admission as well as a thorough follow-up plan.

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