Day case mini percutaneous nephrolithotomy (mini-PCNL): feasibility, safety, efficacy and patient acceptability study

ABSTRACT

Introduction: The objective was to investigate the feasibility, safety, efficacy, and patient acceptability of performing mini-PCNL as a day case procedure. To our knowledge, this is the first reported series in the UK. Method Mini-PCNL data was prospectively collected between April- December 2021. Renal access was achieved by the operating surgeon under fluoroscopic guidance in the prone position. The MIP-M system (Karl Storz, Germany) was used. Stones were fragmented using holmium LASER and retrieved by the Vortex effect and basket. Drainage was via a 6 Fr antegrade stent or 10 Fr nephrostomy tube. Patients suitable for same day discharge were identified using defined preoperative selection criteria. Stone related outcomes, duration of surgery, length of stay, readmission rate and complications were recorded. Results: Fifty patients underwent mini-PCNL (34 male,16 female) with a mean age of 60 years. Mean stone size was 24 mm with a mean operating time of 90 minutes. Twenty patients were suitable for same day discharge. Thirty patients stayed overnight (15 for social reasons, 13 for medical comorbidities and 2 for complications). We recorded 1 case of post-operative sepsis and bleeding requiring embolization. The readmission rate was 0% and 85% were stone free on post-operative CT KUB. Conclusion: Our study shows that day case mini-PCNL is safe, feasible and acceptable in selected group of patients. With the ever-rising pressures on stone services to drive efficiency particularly pertinent with the COVID pandemic, day case mini-PCNL represents an ideal therapeutic option in suitable cases.