Safety and Cost-effectiveness of Mini Percutaneous Nephrolithotomy as Day Care Surgery in Paediatric Patients

Main Article Content

Muhammad Kamran Khan
Naqib Ullah
Majid Khan Kakakhel
Arshad

Abstract

Background: The increasing prevalence of urolithiasis in paediatric populations necessitates the exploration of efficient and safe treatment modalities. Mini percutaneous nephrolithotomy (PCNL), traditionally an inpatient procedure, has evolved with advancements in surgical techniques and pain management, prompting its consideration as a day care surgery.


Objective: This study aims to evaluate the safety, efficacy, and cost-effectiveness of day care mini PCNL in paediatric patients with kidney stones.


Methods: This prospective quasi-experimental study was conducted in a pediatric urology department. Patients aged 3 months to 14 years presenting with kidney stones were included. The procedure involved using a 16Fr mini PCNL nephroscope under general anesthesia and fluoroscopic guidance. Stone fragmentation was achieved using a pneumatic lithoclast, and fragmented stones were retrieved with wash and bifrong forceps. Inclusion criteria were stringent, considering factors like stone size, surgery duration, and patient recovery. Postoperative management included early mobilization, oral antibiotics, and analgesics. Follow-up was scheduled at 1 week and 1 month postoperatively. Data analysis employed SPSS version 20, focusing on variables like age, operative time, readmission rates, and cost comparisons.


Results: The study involved 92 patients, with a gender distribution of 71.7% male and 28.3% female. The average stone size was 2.2 ± 0.7 cm, and the mean operative time was 74 ± 16 minutes. The mean hospital stay was 11 hours, with readmission rates of 6.7%. The cost savings in day care mini PCNL were significant, with an average reduction of 8000 PKR per procedure compared to inpatient care. The success rate of day care surgery was 93.7%.


Conclusion: Day care mini PCNL is a viable, safe, and cost-effective treatment option for pediatric patients with kidney stones. It offers reduced hospital stay, lower costs, and high patient satisfaction without compromising on safety or treatment efficacy.

Article Details

How to Cite
Khan, M. K., Ullah, N., Khan Kakakhel, M., & Arshad. (2023). Safety and Cost-effectiveness of Mini Percutaneous Nephrolithotomy as Day Care Surgery in Paediatric Patients. Journal of Health and Rehabilitation Research, 3(2), 836–841. https://doi.org/10.61919/jhrr.v3i2.281
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Articles

References

Skolarikos A, Neisius A, Petřík A, Somani B, Thomas K, Gambaro G, et al., editors. Urolithiasis. EAU Guidelines Edn presented at the EAU Annual Congress Amsterdam; 2022.

Madaminov M, Shernazarov F. Causes, symptoms, diagnosis and treatment of kidney stones (urolithiasis). Science and Innovation. 2022;1(8):760-5.

Panzarino V. Urolithiasis in children. Advances in Pediatrics. 2020;67:105-12.

Zampini A, Nguyen AH, Rose E, Monga M, Miller AW. Defining dysbiosis in patients with urolithiasis. Scientific reports. 2019;9(1):5425.

Petrides N, Ismail S, Anjum F, Sriprasad S. How to maximize the efficacy of shockwave lithotripsy. Turkish journal of urology. 2020;46(Suppl 1):S19.

Qian X, Wan J, Xu J, Liu C, Zhong M, Zhang J, et al. Epidemiological trends of urolithiasis at the global, regional, and national levels: a population-based study. International Journal of Clinical Practice. 2022;2022.

Baatiah NY, Alhazmi RB, Albathi FA, Albogami EG, Mohammedkhalil AK, Alsaywid BS. Urolithiasis: Prevalence, risk factors, and public awareness regarding dietary and lifestyle habits in Jeddah, Saudi Arabia in 2017. Urology annals. 2020;12(1):57.

Setthawong V, Srisubat A, Potisat S, Lojanapiwat B, Pattanittum P. Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database of Systematic Reviews. 2023(8).

Talati VM, Soares RM, Khambati A, Nadler RB, Perry KT. Trends in urinary calculi composition from 2005 to 2015: a single tertiary center study. Urolithiasis. 2020;48:305-11.

Kim CH, Shin DS, Kim TB, Jung H. The efficacy of early extracorporeal shockwave lithotripsy for the treatment of ureteral stones. Urology Journal. 2019;16(4):331-6.

Liu Y, Cai C, Aquino A, Al‐Mousawi S, Zhang X, Choong SK, et al. Management of large renal stones with super‐mini percutaneous nephrolithotomy: an international multicentre comparative study. BJU international. 2020;126(1):168-76.

Wishahi M, El Feel A, Elkhouly A, Fahmy A, Roshdy M, Elbaz AG, et al. Concerns about stone free rate and procedure events of percutaneous nephrolithotripsy (PCNL) for 2–4 cm kidney stones by standard-PCNL vs mini-PCNL-comparative randomised study. BMC urology. 2023;23(1):96.

Shahait M, Farkouh Aa, Mucksavage P, Somani B. Outcome of Mini-PCNL Under Loco-Regional Anesthesia: Outcomes of a Systematic Review. Current Urology Reports. 2023;24(9):417-26.

Krishna HM, Nagesh SK. Anesthesia in Mini-PCNL. Minimally Invasive Percutaneous Nephrolithotomy: Springer; 2022. p. 77-81.

Rai A, Kozel Z, Hsieh A, Aro T, Smith A, Hoenig D, et al. Conservative Management of liver perforation during percutaneous Nephrolithotomy: Case Couplet presentation. Journal of Endourology Case Reports. 2020;6(4):260-3.

Aarthy P, Thangarasu M, Prakash JS, Raghavan D, Jain N, Balakrishnan A, et al. Safety and efficacy of mini-percutaneous nephrolithotomy as daycare procedure: a prospective observational study. African Journal of Urology. 2021;27(1):1-6.

DiBianco JM, Ghani KR. Precision stone surgery: current status of miniaturized percutaneous nephrolithotomy. Current Urology Reports. 2021;22:1-11.

Schoenfeld D, Zhou T, Stern JM. Outcomes for patients undergoing ambulatory percutaneous nephrolithotomy. Journal of endourology. 2019;33(3):189-93.

Vanwesemael T, Boussery K, Dilles T. Self-administration of medication in hospital: a literature review. Nursing Science Quarterly. 2020;33(3):249-57.

Hurst JR, Quint JK, Stone RA, Silove Y, Youde J, Roberts CM. National clinical audit for hospitalised exacerbations of COPD. ERJ Open Research. 2020;6(3).

Walrave Y, Carles M, Evain J-N, Ikonomoff T, Marie A, Ludot H, et al. A follow-up of pain reported by children undergoing outpatient surgery using a smartphone application: AlgoDARPEF multicenter descriptive prospective study. Pain. 2022:10.1097.

Mulchandani D. Potential of day care/ambulatory surgery. Day Surgery Australia. 2018;17(1):18-21.

Fahmy A, Saad K, Sameh W, Elgebaly O. Planned percutaneous nephrolithotomy in patients who initially presented with urosepsis: Analysis of outcomes and complications. Arab Journal of Urology. 2022;20(1):36-40.

Kroczak T, Pace KT, Andonian S, Beiko D. Ambulatory percutaneous nephrolithotomy in Canada: A cost-reducing innovation. Canadian Urological Association Journal. 2018;12(12):427.

Zhao Z, Sun H, Wu X, Cai C, Liu Y, Zeng G. Evaluation of day-care versus inpatient mini-percutaneous nephrolithotomy: a propensity score-matching study. Urolithiasis. 2020;48:209-15.

Gao M, Zeng F, Zhu Z, Zeng H, Chen Z, Li Y, et al. Day care surgery versus inpatient percutaneous nephrolithotomy: A systematic review and meta-analysis. International Journal of Surgery. 2020;81:132-9.