Comparative Outcomes of Day-case Percutaneous Nephrolithotomy Versus Conventional Inpatient Surgery: A Systematic
Alejandro Calvillo-Ramirez1, Juan Carlos Angulo-Lozano2, Jessica Edith Acevedo-Rodriguez3
1Universidad Autonoma de Guadalajara, Facultad de Medicina, Zapopan, Jalisco, Mexico.
Urology
|September 23, 2024
Summary
Day-case percutaneous nephrolithotomy (PCNL) is a safe and effective alternative to inpatient surgery, reducing blood loss, complications, and costs. This approach is feasible for carefully selected patients without increasing readmission risks.
Area of Science:
- Urology
- Nephrology
- Surgical Innovation
Background:
- Percutaneous nephrolithotomy (PCNL) is a standard procedure for kidney stone removal.
- Traditionally, PCNL is performed as an inpatient procedure, necessitating overnight stays.
- The potential for day-case PCNL could offer benefits in terms of cost and patient convenience.
Purpose of the Study:
- To systematically review and meta-analyze the effectiveness and safety of day-case PCNL compared to inpatient PCNL.
- To evaluate key outcomes including complications, operative time, and costs.
Main Methods:
- A systematic review and meta-analysis of randomized and non-randomized studies were conducted.
- Studies comparing day-case PCNL with inpatient PCNL were included, with data searched up to January 27, 2024.
- Random-effects or fixed-effects models were used for data analysis, reporting results as OR, MD, or SMD with 95% CIs.
Main Results:
- The analysis included 1 RCT and 14 observational studies (1574 patients).
- Day-case PCNL showed significantly reduced blood loss, transfusion rates, overall and minor complications, operative time, and total costs.
- No significant differences were found in major complications, stone-free rates, ED visits, or readmission rates.
Conclusions:
- Day-case PCNL is a feasible and safe alternative for carefully selected patients.
- This approach does not increase complication or readmission risks.
- Day-case PCNL is likely to reduce overall healthcare costs.
Related Concept Videos
01:25Urinary 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...
01:22Imaging 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...