Abstract: PD30-07
Sources of Funding: none

Introduction

Percutaneous nephrolithotomy (PCNL) for the treatment of renal calculi has traditionally been an inpatient procedure often requiring a multi-day hospitalization. Large-bore nephrostomy tubes and ureteral stents have also been traditionally placed for control of bleeding and urinary drainage. Currently, more advanced technology as well as smaller operating nephroscopes and lithotripters have made PCNL a less morbid procedure with the possibility of being done on an outpatient basis. Our aim is to show that mini-PCNL can be safely performed in a tubeless fashion on an outpatient basis.

Methods

We performed a retrospective chart review of patients that underwent mini-PCNL at our institution by a single fellowship-trained endourologist. Only those patients who were discharged home the same day without nephrostomy tubes or ureteral stents were included. Cases were performed using mini-nephroscopes with an outer diameter of 15 to 17.5-Fr.

Results

There were 15 patients included for analysis. Average age was 51.3 years. The group was 53% female and 47% male. Mean BMI and ASA score were 29.31 and 2.4, respectively. Total operative time averaged 55.6 minutes [range 27 - 106]. Mean estimated blood loss was 12.87-mL [range 3-30-mL]. Stone size ranged from 1.3-cm to 3-cm. Left and right sided stones were split evenly. There were multiple stones in 47% of patients. Primary stone location varied, but the majority were in the renal pelvis or the lower pole. Renal access was obtained in a middle or interpolar calyx 53% of the time, and 47% in the lower pole. Laser or ultrasonic lithotripsy was utilized. FLOSEAL was administered in the tract, and no stents or nephrostomy tubes were left. All patients were discharged home. No patients were readmitted or had unplanned ER visits so far. All patients with follow-up were stone free on KUB and RUS imaging.

Conclusions

Mini-PCNL using operating nephroscopes up to 17.5-Fr can be safely performed on an outpatient basis in a tubeless fashion without nephrostomy tubes or ureteral stents. Some of our patients went home with Foley catheters that were removed the following morning. With the advent of improved optics and smaller ultrasonic lithotripters, mini-PCNL is a worthwhile option for patients with renal calculi that can be accomplished safely in a cost-saving outpatient basis, all while rendering patients stone free with one procedure. With changes in reimbursement for hospitals and physicians in the future, outpatient mini-PCNL could serve as a sound option for those with moderate to large renal stones who wish to be rendered stone free in one operation and avoid ureteral stents.

Funding

none