Outcomes for Patients Undergoing Ambulatory Percutaneous Nephrolithotomy

Area of Science:

• Urology
• Nephrolithotomy
• Minimally Invasive Surgery

Background:

• Ambulatory percutaneous nephrolithotomy (aPCNL) is recognized as safe, but clear selection criteria and post-procedural management strategies are lacking.
• Assessing the practicality of various drainage techniques in the ambulatory setting is crucial for optimizing patient recovery and hospital resource utilization.

Purpose of the Study:

• To establish specific inclusion and exclusion criteria for patient selection in aPCNL.
• To compare outcomes between patients undergoing aPCNL and those admitted after standard percutaneous nephrolithotomy (PCNL).
• To evaluate the feasibility of different post-procedural drainage strategies (Double-J stent, UPJ stent, totally tubeless) in the ambulatory setting.

Main Methods:

• Development of strict inclusion/exclusion criteria for aPCNL eligibility.
• Retrospective comparison of 47 aPCNL patients discharged same-day with 47 inpatient PCNL patients (control group).
• Primary outcome measures included stone-free status, emergency department visits, and hospital readmissions within 6 weeks post-procedure.

Main Results:

• Both groups showed similar stone burden and stone-free rates (73% ambulatory vs. 62% inpatient).
• Ambulatory patients had a lower Charlson Comorbidity score (0.11 vs. 0.62).
• Emergency department visits (11% vs. 9%) and hospital readmissions (2% vs. 6%) were comparable between aPCNL and inpatient PCNL groups.

Conclusions:

• The established criteria facilitate the safe and practical application of aPCNL.
• Various drainage strategies can be effectively employed in the ambulatory setting.
• Further randomized controlled trials are warranted to confirm the safety and efficacy of aPCNL in carefully selected patients.