ReviewTherapeutic advances in urology
Insights and outcomes of day-case percutaneous nephrolithotomy: results of a systematic review and single-arm meta-analysis.
Review in Therapeutic advances in urology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
Background: Traditionally performed as an inpatient procedure, day-case or ambulatory percutaneous nephrolithotomy (PCNL) has emerged in recent years as a promising alternative offering the potential to reduce hospital admissions and healthcare costs, without compromising patient outcomes. Objectives: Conduct a systematic review and meta-analysis to critically evaluate the efficacy, safety and overall outcomes of day-case PCNL. Design: The systematic review was conducted in line with PRISMA guidelines (Preferred Reporting Items for Systematic reviews and Meta-Analyses). Data sources and methods: We conducted a comprehensive search of MEDLINE, Embase, Scopus, Web of Science, CENTRAL and Cochrane Databases from inception until January 2025 (CRD42024584357). The PICO statement for this systematic review is as follows: in patients with renal stones, what are the outcomes of day-case PCNL (intervention) compared with inpatient PCNL (comparator)? The authors included studies with more than 50 adult patients evaluating day-case PCNL (postoperative hospital stay ⩽ 24 h) written in the English language. Results: From an initial literature search of 2122 articles, 16 studies were identified, from which 3133 patients were included. A variety of standard, mini and ultra-mini techniques were used, with the majority opting for tubeless (61%) or totally tubeless PCNL (16%). The mean stone size was 21.5 ± 13.5 mm, with five studies including patients with renal structural abnormalities (3.6%). The pooled mean stone-free rate (SFR) was 90% (95% CI: 0.859-0.931), with a readmission rate of 3.2% (95% CI: 0.018-0.046). The overall complication rate was 10.7% (95% CI: 0.078-0.137), with most complications classified as minor with Clavien-Dindo Grade I-II (9.1%) and III-IV (1.6%). The quality assessment of the included literature revealed that all studies were of moderate to high quality. Conclusion: Day-case PCNL represents a safe and viable approach that has seen a growing adoption over recent years, driven in part by post-pandemic healthcare trends. Our review underscores its efficacy, marked by favourable outcomes and a low incidence of complications and readmissions. Moreover, detailed planning is paramount in order to establish clear criteria for potential surgical candidates and indications for inpatient admission, as well as a thorough follow-up plan.
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