Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine , Bronx, New York.
J Endourol. 2019 Mar;33(3):189-193. doi: 10.1089/end.2018.0579. Epub 2019 Jan 2.
Multiple studies have concluded that ambulatory percutaneous nephrolithotomy (aPCNL) is safe. However, selection criteria remain vague and no investigators have assessed the practicality of using various post-procedural drainage strategies in the ambulatory setting. In this study we establish a set of inclusion and exclusion criteria for aPCNL, compare outcomes between aPCNL patients and those admitted following PCNL, and incorporate a variety of "exit" strategies including Double-J stent, ureteropelvic junction (UPJ) stent and totally tubeless techniques.
We developed inclusion and exclusion criteria to determine patient eligibility for aPCNL. Between January 2014 and December 2016, 52 out of 145 patients met criteria for aPCNL and 47 of these patients were ultimately discharged on the same day. Forty-seven of the remaining 98 patients who were admitted following PCNL were randomly selected as a control group. Primary outcomes included stone-free status, emergency department (ED) visits and hospital readmissions within the 6-week post-operative period. Statistical analysis was performed using Student's t-tests, chi square tests, and Fischer's exact tests.
Both groups had similar age (P = 0.91), sex (P = 0.68), body mass index (P = 0.91), and stone burden (P = 0.12). Patients in the ambulatory group had a lower Charlson Comorbidity score (aPCNL CCS = 0.11, inpatient PCNL CCS = 0.62, P = 0.002). Seventy three percent of ambulatory patients and 62% of standard PCNL patients had no residual stone burden 6 weeks following PCNL (P = 0.33). The average residual stone fragment in our ambulatory and standard PCNL group was 3.5 and 3.2 mm, respectively. Five patients (11%) from the aPCNL group and 4 (9%) from the standard PCNL group presented to the ED (P = 0.76). One aPCNL (2%) and three standard PCNL (6%) patients were re-admitted to the hospital (P = 0.62).
In this study we establish specific inclusion and exclusion criteria for aPCNL. Using these criteria we then demonstrated the practicality of using various exit strategies to facilitate aPCNL. Future randomized control trials would be beneficial in confirming the safety and efficacy of aPCNL in select patients.
多项研究已经得出结论，经皮肾镜取石术（PCNL）是安全的。然而，选择标准仍然模糊，没有研究人员评估在门诊环境中使用各种术后引流策略的实际情况。在这项研究中，我们为 PCNL 制定了一套纳入和排除标准，比较了 PCNL 患者和接受 PCNL 治疗后住院患者的结果，并纳入了各种“出院”策略，包括双 J 支架、肾盂输尿管连接部（UPJ）支架和完全无管技术。
我们制定了纳入和排除标准，以确定患者是否适合接受 PCNL。2014 年 1 月至 2016 年 12 月，145 名患者中有 52 名符合 PCNL 标准，其中 47 名患者最终在同一天出院。其余 98 名接受 PCNL 治疗后住院的患者中有 47 名符合入选标准，并被随机选为对照组。主要结局包括结石清除状态、术后 6 周内急诊就诊和住院再入院。使用学生 t 检验、卡方检验和 Fischer 精确检验进行统计学分析。
两组患者的年龄（P=0.91）、性别（P=0.68）、体重指数（P=0.91）和结石负荷（P=0.12）相似。门诊组患者的 Charlson 合并症评分较低（PCNL 门诊 CCS=0.11，住院 PCNL CCS=0.62，P=0.002）。73%的门诊患者和 62%的标准 PCNL 患者在 PCNL 后 6 周时无残余结石负担（P=0.33）。我们的门诊和标准 PCNL 组的平均残余结石碎片分别为 3.5 和 3.2mm。5 名（11%）门诊组患者和 4 名（9%）标准 PCNL 组患者因症状到急诊就诊（P=0.76）。1 名门诊组（2%）和 3 名标准 PCNL 组（6%）患者因症状再次住院（P=0.62）。
在这项研究中，我们为 PCNL 制定了具体的纳入和排除标准。然后，我们使用这些标准证明了使用各种出院策略来促进 PCNL 的实用性。未来的随机对照试验将有助于证实在选定患者中 PCNL 的安全性和有效性。
