A Multicenter Randomized Controlled Trial of Ambulatory Versus Inpatient Percutaneous Nephrolithotomy.

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrolithiasis Management

Background:

• Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stone removal.
• Ambulatory PCNL has been proposed to improve patient recovery and reduce healthcare costs compared to inpatient PCNL.

Purpose of the Study:

• To conduct a high-quality randomized controlled trial comparing ambulatory versus inpatient PCNL.
• To evaluate the noninferiority of ambulatory PCNL regarding complication rates.

Main Methods:

• A multicenter noninferiority randomized controlled trial was performed.
• Patients were randomized and stratified by ASA status, BMI, stone size, and study site.
• The primary outcome was complication rates within 4 weeks post-surgery.

Main Results:

• Complication rates were 6% for ambulatory PCNL and 14% for inpatient PCNL (p=0.4).
• Stone-free rates were 77% for ambulatory and 71% for inpatient PCNL (p=0.6).
• No significant difference in complication rates, readmission, or stone-free status was observed between groups.

Conclusions:

• Ambulatory PCNL demonstrated noninferiority to inpatient PCNL in terms of complications, stone-free rates, and readmissions.
• The findings support the use of ambulatory PCNL in experienced centers.
• Ambulatory PCNL offers a viable alternative for kidney stone treatment, potentially enhancing patient recovery and cost-effectiveness.