Ambulatory percutaneous nephrolithotomy: initial series.
OBJECTIVE
To assess the safety and feasibility of ambulatory percutaneous nephrolithotomy (PCNL). PCNL is the gold standard for the management of large renal stones. Although tubeless PCNL has been previously described, no case series have been published of ambulatory PCNL.


METHODS
The criteria for ambulatory PCNL were: single tract, stone-free status documented by flexible nephroscopy, adequate pain control, and satisfactory postoperative hematocrit level and chest radiographic findings. Patient information, including operating room and fluoroscopy times, stone size and Hounsfield units, and number of needle punctures, were collected prospectively. The time spent in the recovery room, in addition to the amount of narcotics used in the recovery room and at home, was documented.


RESULTS
Of 10 patients, 8 had nephrostomy tracts established intraoperatively by the urologist and 2 had preoperative nephrostomy tubes placed. The median operating and fluoroscopy time was 83.5 and 4.45 minutes, respectively. The median stone diameter was 20 mm (800 Hounsfield units) in addition to a patient with a staghorn calculus. The patients spent a median of 240 minutes in the recovery room and had received a median of 19.25 mg of morphine equivalents. Only 3 patients (30%) used narcotics at home. No intraoperative complications occurred, and none of the patients required transfusions. Two postoperative complications developed: a deep vein thrombosis requiring outpatient anticoagulation and multiresistant Escherichia coli infection requiring intravenous antibiotics.


CONCLUSIONS
In highly selected patients, ambulatory PCNL is safe and feasible. More patients are needed to verify the criteria for patients undergoing the ambulatory approach.
Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
Walid
W
Shahrour
Sero
S
Andonian
D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000379:methods* / Q000592:standards; D004927:Escherichia coli Infections / Q000209:etiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D009294:Narcotics / Q000008:administration & dosage / Q000627:therapeutic use; D009403:Nephrostomy, Percutaneous / Q000379:methods* / Q000706:statistics & numerical data; D010149:Postoperative Pain / Q000188:drug therapy; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D013924:Thrombophlebitis / Q000209:etiology
D009294:Narcotics; D009020:Morphine