Day Case Mini Percutaneous Nephrolithotomy (PCN): First UK Experience

Main Article Content

Andreas Auer
Bushra Abdelqader
Abigail Glassey
Carl Rowbotham
Mohamed Ismail

Abstract

Background and Objective
To investigate the safety, efficacy, and feasibility of performing mini PCN (MIP-M Karl Storz) as a day case procedure. We report our experience and outcomes from our case series which to our knowledge is the first reported in the UK.


Material and Methods
Ten patients appropriate for mini PCN and day-case surgery were selected prospectively. All 10 patients underwent a mini PCN procedure in a prone position. Access was achieved by the operating surgeon under fluoroscopic guidance in 9 cases and by a consultant uroradiologist under ultrasound guidance in 1 patient with a ureterosigmoidostomy using a Kellet needle and the MIP-M system (Karl Storz, Germany). Stones were fragmented with a 550um laser fibre and retrieved by both the Vortex effect and a grasper. Drainage was achieved with a 6 Fr antegrade stent in 9 cases and a 10 Fr nephrostomy tube in one patient. Stone related outcomes, duration of surgery, length of stay and complications were recorded.


Results
All cases were completed as planned. The mean operating time was 93 minutes. A day case rate of 80% was achieved. Two patients were admitted overnight for social reasons; one lived on a nearby island and was not ready for discharge in time to catch the last ferry and another no longer had a responsible adult at home to monitor him overnight. All patients were deemed radiologically stone free. No readmissions, transfusion, infections or other complications were recorded at 90 days postoperatively.


Conclusion
We have shown that day-case mini PCN is a feasible and safe procedure in selected patients. A larger number of cases are needed to establish our patient selection criteria and corroborate our early outcomes.

Downloads

Download data is not yet available.

Article Details

How to Cite
Auer, A., Abdelqader, B., Glassey, A., Rowbotham, C., & Ismail, M. (2020). Day Case Mini Percutaneous Nephrolithotomy (PCN): First UK Experience. Journal of Endoluminal Endourology, 3(1), e23-e29. https://doi.org/10.22374/jeleu.v3i1.76
Section
Original Article

References

1. Fernstrom I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol 1976;10(3):257–9.
2. Türk C, Neisius A, Petřík A, Seitz C, Thomas K, Skolarikos A. European Association of Urology Guide-lines. 2018 Edition. In The European Association of Urology Guidelines Office; 2018. Available at: http:// uroweb.org/guideline/urolithiasis/
3. Mishra S, Sharma R, Garg C, Kurien A, Sabnis R, Desai M. Prospective comparative study of Miniperc and standard PNL for treatment of 1 to 2 cm size renal stone. BJU Int [Internet] 2011 Sep 1;108(6):896–900. Available from: https://doi.org/10.1111/j.1464-410X.2010.09936.x
4. Wright A, Rukin N, Smith D, De la Rosette J, Somani BK. ‘Mini, ultra, micro’ – nomenclature and cost of these new minimally invasive percutaneous nephroli-thotomy (PCNL) techniques. Ther Adv Urol [Internet]. 2016 Apr 26;8(2):142–6. Available at: http://journals .sagepub.com/doi/10.1177/1756287215617674
5. Kruck S, Anastasiadis AG, Herrmann TRW, Walcher U, Abdelhafez MF, Nicklas AP, et al. Minimally invasive percutaneous nephrolithotomy: an alternative to ret-rograde intrarenal surgery and shockwave lithotripsy. World J Urol 2013 Dec;31(6):1555–61.
6. Abdelhafez MF, Amend B, Bedke J, Kruck S, Nagele U, Stenzl A, et al. Minimally invasive percutaneous nephrolithotomy: a comparative study of the manage-ment of small and large renal stones. Urology 2013 Feb;81(2):241–5.
7. Section of Endourology - PCNL Outcome Data 2015-2017. Br Assoc Urol Surg Sect Endourol. 2017;
8. National Institute for Health and Care Excellence. Minimally in invasive percutaneous nephrolitholapaxy medium ( MIP-M ) for remo removing kidney stones. 2018;1–13.
9. British Medical Association. State of the Health System Beds in the NHS: England; 2017.
10. Jones P, Bennett G, Dosis A, Pietropaolo A, Geraghty R, Aboumarzouk O, et al. Safety and Efficacy of Day-case Percutaneous Nephrolithotomy: A Systematic Review from European Society of Uro-technology. Eur Urol Focus 2018 Apr;
11. Smith TK, Hegarty N, Glass JM. The Guy’s stone score--grading the complexity of percutaneous nephro-lithotomy procedures. Urology 2011 Aug;78(2):277–81.
12. Istanbulluoglu MO, Ozturk B, Gonen M, Cicek T, Ozkardes H. Effectiveness of totally tubeless percutane-ous nephrolithotomy in selected patients: a prospective randomized study. Int Urol Nephrol 2009;41(3):541–5.
13. Shahrour W, Andonian S. Ambulatory percutaneous nephrolithotomy: Initial series. Urology [Internet] 2010;76(6):1288–92. Available at: http://dx.doi. org/10.1016/j.urology.2010.08.001
14. Beiko D, Lee L. Outpatient tubeless percutaneous nephrolithotomy: The initial case series. J Can Urol Assoc 2010;4(4):86–90.
15. Beiko D, Elkoushy MA, Kokorovic A, Roberts G, Robb S, Andonian S. ambulatory percutaneous nephrolithotomy: what is the rate of readmission? J Endourol [Internet] 2015 Apr;29(4):410–4. Available at: http://www .liebertpub.com/doi/10.1089/end.2014.0584
16. El-Tabey MA, Abd-Allah OA-W, Ahmed AS, El-Barky EM, Noureldin YA-S. Preliminary study of percutaneous nephrolithotomy on an ambulatory basis. Curr Urol [Internet] 2013;7(3):117–21. Available at: https://www .karger.com/Article/FullText/356261
17. Lavan L, Kyriazis G, Mbiabjeu D, Gormley R, Hall S, Robinson R, et al. Day-case surgery is possible in the majority of men undergoing transurethral resec-tion of the prostate – a report on over 1000 cases. J Clin Urol [Internet] 2018 Nov 23;11(6):403–8. Available at: http://journals.sagepub.com/doi/ 10.1177/2051415818786667
18. Austin T, Menzies-Wilson R, Robinson R, Forshaw C, Wilby D. 740 - Day case primary transurethral resection of bladder tumour (TURBT) as standard protocol in a single UK centre. Should this be the new standard? Eur Urol Suppl [Internet] 2018;17(2):e1067. Available at: http://www.sciencedirect.com/science/article/pii/ S1569905618315756