AMBULATORY MINI PERCUTANEOUS NEPHROLITHOTOMY (MINI-PCNL): FEASIBILITY AND OUTCOMES IN 1000 CASES IN PAKISTAN
Keywords:Ambulatory care facility, Hematuria, Kidney stones,, Percutaneous nephrolithotomy, Renal calculi, Therapeutic chemoembolization, Thoracotomy
Objective: To review the outcomes of a consecutive cohort of 1000 patients with renal stones managed with mini-percutaneous nephrolithotomy at our institute.
Study Design: Prospective observational study.
Place and Duration of Study: Armed Forces Institute of Urology Rawalpindi, Pakistan, from Jan 2016 to Dec 2018.
Methodology: Surgery was carried out under general anesthesia in prone position. Access was made by single step dilatation by 14-17 French sheath, pneumatic lithoclast was used for stone disintegration and fragments removed. Foley and ureteric catheters were removed following morning of surgery after confirming stone clearance on plain X-Ray kidney ureter and bladder.
Results: Mean stone size was 3.1 ± 2.1cm (2-6). Upper pole access was utilized in 398 (39.8%) while lower pole in 587 (58.7%) cases. Mean operative time was 67 ± 15.4 minutes (45-120) while the mean hospital stay was 22 ± 13.2 hours (20-120). A complete clearance rate of 93.3% was achieved as assessed by plain X-Ray kidney ureter & bladder. Residual stones were treated with either shock wave lithotripsy or redo mini-Percutaneous Nephrolithotomy. 910 (91%) of patients were discharged within 24 hours of surgery.
Conclusion: Mini Percutaneous nephrolithotomy was found as a safe and feasible alternative contemporary established technique for treatment of nephrolithiasis which can be offered as a day case surgery except for complete staghorn calculi.