Insights and outcomes of day-case percutaneous nephrolithotomy: results of a systematic review and single-arm meta-analysis

Journal article : Review

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.

Authors: Suresh, S; Ling, S; Vankayalapati, DK; Ganegoda, SM; Somani, B

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: SAGE Publications
• Journal: Therapeutic Advances in Urology
• Volume: 17
• Article number: 17562872251389084
• Publication date: 2025-10-23
• Acceptance date: 2025-10-01
• DOI: 10.1177/17562872251389084
• EISSN: 1756-2880
• ISSN: 1756-2872
• Language: English
• Keywords: outcomes; ambulatory; percutaneous nephrolithotomy; day case; safety
• Subtype: Review