Keywords
Percutaneous Nephrolithotomy
Length of Stay
Postoperative Pain
Pain Intensity
Nephrolithiasis
How to Cite
Abstract
Percutaneous nephrolithotomy (PCNL) is the primary procedure for the management of large kidney stones. Enhanced Recovery After Surgery (ERAS) is a perioperative protocol that aims to accelerate patient recovery. This study compared the length of stay (LOS) and pain intensity of PCNL patients managed with the ERAS versus the non-ERAS protocol at Dr. Zainoel Abidin General Hospital, Banda Aceh. This prospective comparative observational study included 61 consecutively recruited PCNL patients, who were grouped into ERAS (n=30) and Non-ERAS (n=31) according to their willingness to follow the ERAS protocol, without random allocation. LOS was recorded in hours, and postoperative pain was assessed using the visual analog scale (VAS) 6 hours after surgery. Between-group comparisons used the Mann–Whitney U test (α=0.05). LOS was shorter in the ERAS group than in the Non-ERAS group (61.4 ± 19.6 vs 79.6 ± 26.3 hours; p=0.0042), a difference of 18.2 hours (22.9%), or about 0.8 days. VAS scores were lower in the ERAS group (4.4 ± 1.3 vs 6.2 ± 0.6; p<0.0001), a difference of 1.8 points (29.4%). Age and sex did not differ significantly between groups. ERAS was associated with shorter LOS and lower postoperative pain. Given the observational design and limited sample size, ERAS may be considered as an approach to perioperative management of PCNL, pending confirmation by further studies.
References
Cerantola, Y. et al. (2013) ‘Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced recovery after surgery (ERAS®) society recommendations’, Clinical Nutrition, 32(6), pp. 879–887. Available at: https://doi.org/10.1016/j.clnu.2013.09.014.
EAU Guidelines on Urolithiasis – Introduction (no date). Available at: https://uroweb.org/guidelines/urolithiasis (Accessed: 11 November 2025).
EAU Guidelines on Urolithiasis – Guidelines (no date). Available at: https://uroweb.org/guidelines/urolithiasis/chapter/guidelines (Accessed: 11 November 2025).
Gustafsson, U.O. et al. (2019) ‘Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018’, World Journal of Surgery, 43(3), pp. 659–695. Available at: https://doi.org/10.1007/s00268-018-4844-y.
Kallidonis, P. et al. (2020) ‘Minimally invasive percutaneous nephrolithotomy (PCNL): Techniques and outcomes’, Turkish Journal of Urology, 46(Suppl. 1), pp. S58–S63. Available at: https://doi.org/10.5152/tud.2020.20161.
Kelly, A.M. (2001) ‘The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain’, Emergency Medicine Journal, 18(3), pp. 205–207. Available at: https://doi.org/10.1136/emj.18.3.205.
Lei, J. et al. (2023) ‘Evaluating outcomes of patient-centered enhanced recovery after surgery (ERAS) in percutaneous nephrolithotomy for staghorn stones: An initial experience’, Frontiers in Surgery, 10, p. 1138814. Available at: https://doi.org/10.3389/fsurg.2023.1138814.
Li, Q. et al. (2020) ‘Clinical efficacy of enhanced recovery after surgery in percutaneous nephrolithotripsy: a randomized controlled trial’, BMC Urology, 20(1), pp. 1–8. Available at: https://doi.org/10.1186/s12894-020-00728-w.
Liu, J. et al. (2023) ‘The safety and efficacy of ultrasound-guided erector spinae plane block in postoperative analgesic of PCNL: A systematic review and meta-analysis’, PLOS ONE, 18(7), e0288781. Available at: https://doi.org/10.1371/journal.pone.0288781.
Liu, L. et al. (2024) ‘Safety and efficacy of enhanced recovery after surgery among patients undergoing percutaneous nephrolithotomy: a systematic review and meta-analysis’, International Journal of Surgery, 110(6), pp. 3768–3777. Available at: https://doi.org/10.1097/JS9.0000000000001158.
Liu, Z. et al. (2025) ‘Prospective study of the efficacy of PCNL under local anesthesia based on the ERAS concept’, Frontiers in Surgery, 12, p. 1595466. Available at: https://doi.org/10.3389/fsurg.2025.1595466.
Mishra, S. et al. (2014) ‘Staghorn classification: Platform for morphometry assessment’, Indian Journal of Urology, 30(1), pp. 80–83. Available at: https://doi.org/10.4103/0970-1591.124212.
Ripollés-Melchor, J. et al. (2019) ‘Association between Use of Enhanced Recovery after Surgery Protocol and Postoperative Complications in Colorectal Surgery: The Postoperative Outcomes Within Enhanced Recovery after Surgery Protocol (POWER) Study’, JAMA Surgery, 154(8), pp. 725–736. Available at: https://doi.org/10.1001/jamasurg.2019.0995.
Scott, M.J. et al. (2015) ‘Enhanced Recovery after Surgery (ERAS) for gastrointestinal surgery, part 1: Pathophysiological considerations’, Acta Anaesthesiologica Scandinavica, 59(10), pp. 1212–1231. Available at: https://doi.org/10.1111/aas.12601.
Thiele, R.H. et al. (2015) ‘Standardization of care: Impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery’, Journal of the American College of Surgeons, 220(4), pp. 430–443. Available at: https://doi.org/10.1016/j.jamcollsurg.2014.12.042.
Vicentini, F.C. et al. (2009) ‘Percutaneous nephrolithotomy: Current concepts’, Indian Journal of Urology, 25(1), pp. 4–10. Available at: https://doi.org/10.4103/0970-1591.44281.
Zhang, B. et al. (2023) ‘How I Do It: ERAS protocol featuring erector spinae plane block for percutaneous nephrolithotomy’, The Canadian Journal of Urology, 30(4), pp. 11639–11643.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2026 Muyasir