Comparison of the Prone Split-Leg Position with the Traditional Prone Position in Percutaneous Nephrolithotomy: A Propensity Score-Matching Study.

Background and Objective: Several positions have been described for percutaneous nephrolithotomy (PCNL). The aim of this study was to compare the safety and effectiveness of the traditional prone position PCNL (TP-PCNL) and the prone split-leg position PCNL (PSL-PCNL). Patients and Methods: A retrospective review was made of the data of 212 patients who underwent prone PCNL in PSL or TP between January 2017 and November 2019. The demographic and preoperative clinical data were used for propensity score-matching (PSM). Following the PSM based on a multivariable logistic regression model, the PSL-PCNL and TP-PCNL groups were compared in preoperative, perioperative, and postoperative parameters. All surgical procedures were performed by an experienced endourologist. Results: After PSM, 51 patients from the PSL-PCNL group were matched to 51 TP-PCNL patients. The stone burden was not statistically significant between the two groups (p = 0.388). The mean operation time of the two groups was significantly different (81.5 ± 32.4 minutes vs 93.1 ± 25.9 minutes, respectively, p = 0.026). The hemoglobin decrease in the PSL-PCNL group was greater than that in the TP-PCNL group (-17.7 ± 16.9 g/L vs 13.1 ± 10.9 g/L, p < 0.001). Both groups had similar stone-free rates after 2 weeks (p = 0.49). No significant difference was observed between the groups in the total complication rate (p = 1). Conclusions: The application of PSL in PCNL simplifies the surgical procedure and shortens the operating time. Another important advantage is that it allows retrograde intrarenal surgery and ureteroscopy to be performed simultaneously. We recommend the PSL to be applied in PCNL for renal stone patients.

Multiple-tract percutaneous nephrolithotomy as a day surgery for the treatment of complex renal stones: an initial experience.

PURPOSE: The purpose of this study was to evaluate the safety and efficiency of multiple-tract percutaneous nephrolithotomy (PCNL) as a day surgery for the treatment of complex renal stones. PATIENTS AND METHODS: A mature protocol for day surgery was implemented. Forty-six patients who underwent planned day-surgery PCNL via multiple tracts for the treatment of complex renal stones were retrospectively reviewed. All procedures were performed by an experienced surgeon. The outcomes were recorded. RESULTS: The mean stone size and burden were 4.8 cm and 990.2 mm2, respectively. There were 26 (56.5%) and 20 (43.5%) patients with staghorn stones and multiple stones, respectively. Totals of two, three, and more than three tracts (with up to 7 tracts) were established in 22, 11, and 13 patients, respectively. The tract sizes ranged from 14 to 24 Fr. One to four nephrostomy tubes were placed in most patients, and a tubeless process was accomplished in only 3 (6.5%) patients. The mean surgery time was 116 min with a hemoglobin drop of 22.1 ± 16.8 g/L. Eight (17.4%) patients developed postoperative complications, with severe complications (Clavien grades III-IV) in two cases (4.4%). 39 (84.8%) patients were discharged within 24 h after surgery, and 7 (15.2%) patients were fully admitted. Only 1 (2.2%) patient required readmission. The stone clearance rate was 84.8%. CONCLUSIONS: Day-surgery PCNL can be safely performed via multiple percutaneous tracts by experienced surgeons and is an efficient strategy for the treatment of complex renal stones.

The feasibility of multiple-tract mini-percutaneous nephrolithotomy as an overnight surgery for the treatment of complex kidney stones.

To demonstrate the feasibility of applying multiple-tract percutaneous nephrolithotomy (PCNL) as an overnight surgery for treatment of complex kidney stones. We reviewed a prospectively collected database of all multiple-tract PCNL planned as overnight surgery performed by a single surgeon since 2018. A clinical pathway including the removal of nephrostomy tube and discharge on the morning after surgery was carried out. A definition for tube removal was outlined. Ability to adhere to the pathway and achieving the described parameters and whether any resulting complications occurred were determined. A total of 136 consecutive patients were enrolled with mean stone burden of 960.5 mm2 and 5.1 cm. Mean operative time was 71.7 ± 30.7 min. The average hemoglobin drop was 17.6 ± 12.2 g/L, and the incidence of drop > 25 g/L was 21.9%. Overall, 125 patients (91.9%) but 11 patients were discharge on postoperative day 1. One case required readmission. Among the 11 patients, 7 patients (5.1%) underwent a delayed tube removal (≥ 2 days) and 4 patients underwent complications after next-day nephrostomy tube removal, including renal colic (2 cases), hydrothorax (1 case), and fever (1 case). Postoperative fever or severe hematuria was the major reason for delayed nephrostomy tube removal. The total complication rate was 8.8% (n = 12). Multiple-tract PCNL as an overnight surgery can be safely performed by experienced surgeons in most patients. An early nephrostomy tube removal could be achieved in nearly 95% patients.

Day-surgery percutaneous nephrolithotomy: a high-volume center retrospective experience.

PURPOSE: Percutaneous nephrolithotomy (PCNL) is traditionally performed on an inpatient basis. We determine the safety and outcome of day-surgery PCNL by experienced surgeon hands. PATIENTS AND METHODS: A protocol for day-surgery PCNL was undertaken. A retrospective analysis of all 86 cases of planned day-surgery PCNL accomplished by an experienced surgeon who followed this protocol between May 2017 and March 2019 was performed. Patient demographics, operative data, complications, and readmission rates were recorded. Day-surgery PCNL was defined as discharge of patients either the same day or within 24 h after surgery. RESULTS: The average stone burden was 361.1 mm2 and 70 (81.4%) of patients had multiple stones or staghorn stones. 82 (95.4%) patients achieved same-day discharge or received overnight observation prior to discharge, and 4 patients (4.6%) required full admission (longer than 24 h). The readmission rate was 2.3% (2 patients). The postoperative complications occurred in 10 (11.6%) patients, including 7, 2, 2 of grade I, II, III complications. The average operation time was 64 min and the hemoglobin drop was 15.7 ± 16.9 g/L. The established tracts size ranged from 16 to 22Fr. The stone clearance rate was 90.7%. The tubeless without nephrostomy tube was performed in 60.5%. Eight cases were performed by multiple-tracts PCNL with 2-4 tracts, with only two case required full admission. CONCLUSION: Experienced surgeons who performed day-surgery PCNL experience excellent patient outcomes in appropriately selected patients. Most complications can be treated conservatively and only a few required intervention or readmission.