Related Experiment Video

Updated: Oct 16, 2025

A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy
03:56

A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy

Published on: September 13, 2022

2.5K

Ambulatory Percutaneous Nephrolithotomy May Be Cost-Effective Compared to Standard Percutaneous Nephrolithotomy

Matthew S Lee1, Mark A Assmus1, Deepak K Agarwal2

  • 1Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.

Journal of Endourology
|October 19, 2021
PubMed

Insights

Ambulatory percutaneous nephrolithotomy (aPCNL) is a safe alternative to standard PCNL, with no increase in complications or hospital readmissions. This approach offers significant cost savings and improved stone-free rates, making it a viable option for delayed surgical care.

Area of Science:

  • Urology
  • Health Economics
  • Surgical Innovation

Background:

  • The COVID-19 pandemic led to cancellations of elective surgeries, causing financial strain on healthcare systems and delaying patient care.
  • Ambulatory percutaneous nephrolithotomy (aPCNL) presents a potential solution for managing delayed surgical care, optimizing resource use, and improving cost-effectiveness.
  • Comparing the safety and economic impact of aPCNL versus standard PCNL (sPCNL) is crucial for guiding clinical practice.

Purpose of the Study:

  • To compare the safety and cost-effectiveness of ambulatory percutaneous nephrolithotomy (aPCNL) against standard percutaneous nephrolithotomy (sPCNL).
  • To evaluate 30-day emergency department visits, readmissions, and complication rates between aPCNL and sPCNL.
  • To assess cost savings and stone-free rates (SFRs) for both procedures.

Main Methods:

  • A retrospective study of 98 patients undergoing PCNL at a tertiary referral center from January to September 2020.
  • Propensity score matching was used to balance patient groups for comparison of outcomes.
  • Statistical analysis included independent t-tests and chi-square analyses to compare primary outcomes (30-day ED visits, readmissions, complications) and secondary outcomes (cost, SFRs).

Main Results:

  • After propensity score matching, 42 patients (19 sPCNL, 23 aPCNL) were analyzed.
  • No significant differences were observed in 30-day emergency department visits, readmissions, or complications between aPCNL and sPCNL groups.
  • aPCNL demonstrated cost savings of $5327 ± $442 per case and achieved higher stone-free rates compared to sPCNL.

Conclusions:

  • Ambulatory percutaneous nephrolithotomy (aPCNL) is a safe procedure with comparable rates of emergency visits and readmissions to standard PCNL (sPCNL).
  • aPCNL offers significant cost-effectiveness and potentially better stone clearance compared to sPCNL.
  • aPCNL is a viable strategy for providing timely surgical care while optimizing healthcare resources.

Keywords:
cost-effectivenesskidney stonespercutaneous nephrolithotomy

More Related Videos

Technical Modification of the Terminal Ureter During Total Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma06:39

Technical Modification of the Terminal Ureter During Total Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma

Published on: November 22, 2019

7.9K
Author Spotlight: Developing a Bedside Protocol for Kidney and Genitourinary Ultrasonography03:19

Author Spotlight: Developing a Bedside Protocol for Kidney and Genitourinary Ultrasonography

Published on: June 21, 2024

1.5K

Related Concept Videos

Urinary Tract Calculi VI: Surgical Management01:25

Urinary Tract Calculi VI: Surgical Management

Procedures for Kidney StonesMedical intervention is necessary when kidney stones or renal calculi are too large to pass spontaneously (typically greater than 5 millimeters) when stones are accompanied by symptomatic infection (such as fever or pyelonephritis), when they impair kidney function, or when they cause persistent symptoms like severe pain, nausea, or urinary retention. Additionally, patients with only one kidney or those who cannot be treated with medical management also require...
72
Imaging Studies V: Intravenous Urography and Retrograde Pyelography01:22

Imaging Studies V: Intravenous Urography and Retrograde Pyelography

IntroductionIntravenous Urography (IVU) and Retrograde Pyelography (RP) are important diagnostic imaging techniques used to evaluate the urinary system. These methods help identify structural abnormalities, obstructions, and functional issues in the kidneys, ureters, and bladder. Both procedures use iodine-based contrast media to enhance the visibility of urinary tract structures on X-ray images, though they differ in their methods and indications.1. Intravenous Urography (IVU)Intravenous...
278
Acute Pyelonephritis II: Diagnostic Studies and Management01:28

Acute Pyelonephritis II: Diagnostic Studies and Management

Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
73
Urinary Tract Calculi III: Medical Management01:30

Urinary Tract Calculi III: Medical Management

The diagnosis of renal calculi involves several imaging techniques, including non-contrast CT scans and ultrasound. These methods help visualize kidney stones, assess their size and location, and detect possible obstructions. Additionally, Measuring urine pH is useful for diagnosing specific stone types, such as struvite (alkaline pH) and uric acid stones (acidic pH). Cystine stones are primarily linked to cystinuria, a genetic condition. A urinalysis helps detect blood in the urine (hematuria)...
50
Urinary Tract Calculi V: Nursing Management01:28

Urinary Tract Calculi V: Nursing Management

AssessmentSubjective Data: Obtain a detailed health history, including any recent or chronic urinary tract infections, periods of immobilization, previous episodes of renal calculi, and medical conditions such as gout, benign prostatic hyperplasia, or hyperparathyroidism. Review the medication history for drugs that may influence stone formation, including allopurinol, analgesics, loop diuretics, or thiazide diuretics. Document the use of long-term indwelling catheters and any past surgical...
67
Acute Kidney Injury V: Interprofessional Care01:20

Acute Kidney Injury V: Interprofessional Care

Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
69