Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Surgery, Kowsar Hospital, Semnan University of Medical Sciences, Semnan, Iran.
Urol J. 2020 Jun 23;17(4):352-357. doi: 10.22037/uj.v0i0.5314.
To evaluate the safety and efficacy of discharging patients on the first postoperative day after an uncomplicated percutaneous nephrolithotomy (PCNL).
after an uncomplicated successful PCNL without significant residual stone (>5mm) or any complication up to the first postoperative day, we randomly assigned patients into two groups-Group 1: overnight surgery, and Group 2: routine discharge after three days. Patients with significant residual stone on control fluoroscopy were excluded. Ninety eight and 102 patients were assigned to groups 1 and 2, respectively. Serum Hemoglobin and Cr were evaluated before the operation as well as the first postoperative day. Stone free status was evaluated using ultrasound and KUB radiography at the first postoperative day.
The stone and patient characteristics were not different in two groups. The preoperative and change in the hemoglobin and creatinine levels were not significantly different between the two groups. Nine patients (9.2%) in Group 1 and five (4.9%) in Group 2 were readmitted because of complications (mainly hematuria) (p=.23). Of the readmitted patients, five in Group 1 (55%), and three in Group 2 (60%) received blood transfusion (p=.87). in these patients, group 1 received 1.6±0.51 units of blood compared with 1.93±0.25 in group 2 (p=.07). All the readmitted patients did well with conservative therapy with no need for angioembolization.
In uncomplicated PCNL with no significant residual stone, discharging the patient on the first postoperative day is safe. The outcome is comparable to a routine three-day hospital stay.
评估经皮肾镜碎石取石术（PCNL）后无并发症的患者在术后第 1 天出院的安全性和疗效。
在无明显残留结石（>5mm）或任何并发症的情况下成功完成 PCNL 后，直至术后第 1 天，我们将患者随机分为两组-组 1：过夜手术，组 2：常规术后第 3 天出院。排除在控制透视下有明显残留结石的患者。分别有 98 名和 102 名患者被分配到组 1 和组 2。在手术前以及术后第 1 天评估血清血红蛋白和 Cr。在术后第 1 天使用超声和 KUB 放射线评估结石清除情况。
两组患者的结石和患者特征无差异。两组之间血红蛋白和肌酐水平的术前和变化没有显著差异。组 1 中有 9 名（9.2%）患者和组 2 中有 5 名（4.9%）患者因并发症（主要为血尿）而再次入院（p=.23）。在再次入院的患者中，组 1 中有 5 名（55%）患者和组 2 中有 3 名（60%）患者需要输血（p=.87）。在这些患者中，组 1 接受了 1.6±0.51 单位的血液，而组 2 接受了 1.93±0.25 单位的血液（p=.07）。所有再次入院的患者均通过保守治疗康复，无需进行血管栓塞。
在无明显残留结石且无并发症的 PCNL 中，患者在术后第 1 天出院是安全的。结果与常规 3 天住院时间相当。
