Editorial Comment on: Outpatient Percutaneous Nephrolithotomy: The UC San Diego Health Experience by Bechis et al.

Percutaneous nephrolithotomy (PCNL) performed as a same-day surgery is not a new idea. More than 30 years ago, it was described as an outpatient procedure, although in select patients and perhaps without the knowledge of all its potential complications or regard to patient morbidity, as patients were sent home with a large nephrostomy tube in place. ¹

As has been the case with many procedures in urology, the evolution to an outpatient or same-day surgery for more than the most highly selected and ideal patients has required an enormous expansion of knowledge, experience, and improvement in equipment and technique. The urologist's ability to achieve useful, stable, and safe access to the renal collecting system has come only with widely available and adjustable fluoroscopy and ultrasound equipment, atraumatic, stiff, and kink-resistant wires, and reliable renal dilating systems. Likewise, the evolution of optical technology has brought huge improvements from dimly lit eyepieces to high-definition wide-screen video. Intracorporeal lithotripsy itself has evolved from nearly blind manual mechanical crushing to lithotrites with ultrasonic, ballistic, and suction actions to simultaneously break and evacuate stones of nearly all types. Miniaturized equipment has helped to decrease morbidity such that even complex cases experience few complications.

Of course, the most important progression of this evolution is the knowledge brought by those pioneers in endourology who were brave and savvy enough to apply and improve new technologies, share their Successes and failures, and further expand on that experience. Such experience brought the widespread use of tubeless and totally tubeless PCNL, which arguably provides the foundation for outpatient and same-day surgery.

The authors should be congratulated for presenting their practical experience in providing safe and efficacious same-day PCNL for a majority of their patients. Although we suspect that many urologists will continue to plan overnight observation for most of their post-PCNL patients, as reimbursement schedules continue their seemingly relentless push to shorter and shorter stays, such experience is priceless in helping shape practice standards. Further innovations in renal access, stone fragmentation, and postoperative drainage (or lack thereof) will continue to drive the performance of short-stay or same-day PCNL.