1
|
Kingma RA, Doppen C, Bus MTJ, Altobelli E, de Jong IJ, Roemeling S. The significance of clinically insignificant residual fragments after percutaneous nephrolithotomy: an analysis into the relevance of complete stone clearance. World J Urol 2024; 42:78. [PMID: 38353780 PMCID: PMC10866741 DOI: 10.1007/s00345-024-04774-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/03/2024] [Indexed: 02/16/2024] Open
Abstract
PURPOSE After treatment for kidney stones, residual fragments with a diameter of ≤ 4 mm are traditionally referred to as 'clinically insignificant residual fragments'. We hypothesize that patients with these fragments are at an increased risk for stone-related morbidity, such as complaints, hydronephrosis, and stone regrowth, when compared to stone-free patients. This study aimed to investigate the relevance of complete stone clearance in surgical treatment of urolithiasis. METHODS We conducted a single-center retrospective cohort study. Patients who underwent percutaneous nephrolithotomy between 2015 and 2020 were included if a CT-scan was available within 6 months after the procedure, and the follow-up duration was at least 1 year. The stone-free status at the end of the first stone episode during the study period was categorized as fully stone-free, not stone-free with small residual fragments (≤ 4 mm) and not stone-free with large residual fragments (> 4 mm). Follow-up data were collected, including stone-related events and re-intervention rates. RESULTS A total of 103 subjects were included with a median follow-up of 21.4 months. Stone-related events occurred in 10 (29.4%) of the fully stone-free subjects, 20 (58.8%) of the subjects with small residual fragments and 25 (71.4%) of the subjects with large residual fragments. The stone-related event-free survival per subgroup resulted in a significantly different survival distribution in a log rank test (p = 0.008). CONCLUSION A complete stone-free status seems to be of fundamental importance for decreasing stone-related morbidity. Further developments and research should focus on optimizing the full clearance of stone material during PCNL.
Collapse
Affiliation(s)
- Riemer A Kingma
- Department of Urology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | - Carleen Doppen
- Department of Urology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Mieke T J Bus
- Department of Urology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Emanuela Altobelli
- Department of Urology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Igle Jan de Jong
- Department of Urology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Stijn Roemeling
- Department of Urology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| |
Collapse
|
2
|
Hartung FO, Müller KJ, Herrmann J, Grüne B, Michel MS, Rassweiler-Seyfried MC. Comparison of endoscopic versus CT assessment of stone-free status after percutaneous nephrolithotomy (PCNL). Urolithiasis 2023; 51:120. [PMID: 37801124 PMCID: PMC10558392 DOI: 10.1007/s00240-023-01495-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/20/2023] [Indexed: 10/07/2023]
Abstract
This study is aimed to determine whether postoperative low dose computed tomography (LDCT) imaging is necessary after percutaneous nephrolithotomy (PCNL), or the surgeon's intraoperative assessment of residual fragments (RF) is sufficient and avoidance of postoperative imaging with reduction of radiation exposure can be achieved. Data of all 610 patients who underwent PCNL in prone position in our institution from February 2009 to September 2020 was collected. Parameters such as age, gender, BMI, ASA-Classification, stone related parameters and the surgeon's assessment of stone-free status were analyzed. The LDCT performed postoperatively was compared to the intraoperative assessment of the surgeon regarding RF. The mean age of patients was 52.82 years; the mean BMI was 28.18 kg/m2. In 418 cases, the surgeon made a clear statement about the presence of RF and postoperative LDCT was carried out. The discrepancy between the two methods (surgeon´s assessment vs. LDCT) was significant at p < 0.0001. The sensitivity, specificity, positive and negative predictive value of the surgeon when assessing RF were 24.05%, 99.45%, 98.28% and 50%. Stone free rate (SFR) after primary PCNL was 45.57%. The overall SFR at discharge was 96.23%. Although the surgeon´s assessment of RF was reliable, postoperative LDCT imaging should still be performed if endoscopic stone clearance is suspected due to the high false negative rate and the low negative predictive value. The optimal timing of postoperative imaging following PCNL remains unclear.
Collapse
Affiliation(s)
- F. O. Hartung
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - K. J. Müller
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - J. Herrmann
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - B. Grüne
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - M. S. Michel
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - M. C. Rassweiler-Seyfried
- Department of Urology and Urologic Surgery, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| |
Collapse
|
3
|
Zeng G, Zhong W, Mazzon G, Choong S, Pearle M, Agrawal M, Scoffone CM, Fiori C, Gökce MI, Lam W, Petkova K, Sabuncu K, Gadzhiev N, Pietropaolo A, Emiliani E, Sarica K. International Alliance of Urolithiasis (IAU) Guideline on percutaneous nephrolithotomy. Minerva Urol Nephrol 2022; 74:653-668. [PMID: 35099162 DOI: 10.23736/s2724-6051.22.04752-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The International Alliance of Urolithiasis (IAU) would like to release the latest guideline on percutaneous nephrolithotomy (PCNL) and to provide a clinical framework for surgeons performing PCNLs. These recommendations were collected and appraised from a systematic review and assessment of the literature covering all aspects of PCNLs from the PubMed database between January 1, 1976, and July 31, 2021. Each generated recommendation was graded using a modified GRADE methodology. The quality of the evidence was graded using a classification system modified from the Oxford Center for Evidence-Based Medicine Levels of Evidence. Forty-seven recommendations were summarized and graded, which covered the following issues, indications and contraindications, stone complexity evaluation, preoperative imaging, antibiotic strategy, management of antithrombotic therapy, anesthesia, position, puncture, tracts, dilation, lithotripsy, intraoperative evaluation of residual stones, exit strategy, postoperative imaging and stone-free status evaluation, complications. The present guideline on PCNL was the first in the IAU series of urolithiasis management guidelines. The recommendations, tips and tricks across the PCNL procedures would provide adequate guidance for urologists performing PCNLs to ensure safety and efficiency in PCNLs.
Collapse
Affiliation(s)
- Guohua Zeng
- Department of Urology, Guangdong Key Laboratory of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wen Zhong
- Department of Urology, Guangdong Key Laboratory of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Simon Choong
- University College Hospital of London, Institute of Urology, London, UK
| | - Margaret Pearle
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Madhu Agrawal
- Department of Urology, Center for Minimally Invasive Endourology, Global Rainbow Healthcare, Agra, India
| | | | - Cristian Fiori
- Department of Urology, San Luigi Hospital, University of Turin, Turin, Italy
| | - Mehmet I Gökce
- Department of Urology, Faculty of Medicine, University of Ankara, Ankara, Turkey
| | - Wayne Lam
- Division of Urology, Queen Mary Hospital, Hong Kong, China
| | - Kremena Petkova
- Military Medical Academy, Department of Urology and Nephrology, Sofia, Bulgaria
| | - Kubilay Sabuncu
- Department of Urology, Karacabey State Hospital, Karacabey-Bursa, Turkey
| | - Nariman Gadzhiev
- Department of Urology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Esteban Emiliani
- Department of Urology, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Kemal Sarica
- Medical School, Department of Urology, Biruni University, Istanbul, Turkey -
| |
Collapse
|
4
|
Jannello LMI, Turetti M, Silvani C, Galbiati G, Garbagnati S, Pozzi E, Malfatto M, Zanetti SP, Longo F, De Lorenzis E, Albo G, Salonia A, Montanari E, Boeri L. Urologists are optimistic surgeons: prevalence and predictors of discordance between intraoperative stone-free rate and cross-sectional imaging evaluation after vacuum-assisted mini-percutaneous nephrolithotomy. World J Urol 2022; 40:2331-2338. [PMID: 35831471 PMCID: PMC9427905 DOI: 10.1007/s00345-022-04091-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/30/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To assess how accurate are urologists in predicting stone-free status (SFS) after vacuum-assisted mini-PCNL (vamPCNL) compared to computed tomography (CT) and clinical predictors of discordant SFS. Methods Data from 235 patients who underwent vamPCNL were analysed. Patient’s demographics, stones’ characteristics and operative data were recorded. SFS was evaluated intraoperatively by the treating urologist (iSFS) and with non-contrast CT 3 months after vamPCNL (ctSFS). SFS was defined as no residual stones. Stone complexity was scored with the Guy’s score. Descriptive statistics and logistic regression models were used to identify clinical factors associated with discordant SFS (namely iSFS not confirmed at CT). Results iSFS and ctSFS were 88.5% and 65.5%, respectively, with 54 (23%) cases resulting in discordant evaluation of SFS between the surgeon and CT imaging. Patients with discordant SFS had larger stone volume (p < 0.001), higher rate of multiple stones (p = 0.03) and higher rate of multiple calyceal groups affected by stones (p < 0.001) than those with concordant SFS. The use of flexible ureteroscopes to look for residual stones after lithotripsy was more frequently reported in cases with concordant SFS (p = 0.001). Multivariable logistic regression analysis revealed that stones in > 2 calyceal groups (OR 10.2, p < 0.001), Guy’s score II (OR 5.8, p < 0.01) and not using flexible ureteroscopes after lithotripsy (OR 2.9, p = 0.02) were independent predictors of discordant SFS. Conclusion One out of five patients is erroneously considered SF after vamPCNL. Urologist should carefully evaluate patients with multiple calyceal stones and consider using flexible ureteroscopes to complete lapaxy of migrated fragments in order to improve their prediction of SFS.
Collapse
Affiliation(s)
- Letizia Maria Ippolita Jannello
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Matteo Turetti
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Carlo Silvani
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Gilda Galbiati
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Susanna Garbagnati
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Efrem Pozzi
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Matteo Malfatto
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Stefano Paolo Zanetti
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Fabrizio Longo
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy
| | - Elisa De Lorenzis
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giancarlo Albo
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URIIRCCS Ospedale San RaffaeleUniversity Vita-Salute San Raffaele, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via della Commenda 15, 20122, Milan, Italy.
| |
Collapse
|
5
|
Zhao H, Li W, Li J, Li L, Wang H, Guo J. Predicting the Stone-Free Status of Percutaneous Nephrolithotomy With the Machine Learning System: Comparative Analysis With Guy’s Stone Score and the S.T.O.N.E Score System. Front Mol Biosci 2022; 9:880291. [PMID: 35601833 PMCID: PMC9114350 DOI: 10.3389/fmolb.2022.880291] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/07/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose: The aim of the study was to use machine learning methods (MLMs) to predict the stone-free status after percutaneous nephrolithotomy (PCNL). We compared the performance of this system with Guy’s stone score and the S.T.O.N.E score system. Materials and Methods: Data from 222 patients (90 females, 41%) who underwent PCNL at our center were used. Twenty-six parameters, including individual variables, renal and stone factors, and surgical factors were used as input data for MLMs. We evaluated the efficacy of four different techniques: Lasso-logistic (LL), random forest (RF), support vector machine (SVM), and Naive Bayes. The model performance was evaluated using the area under the curve (AUC) and compared with that of Guy’s stone score and the S.T.O.N.E score system. Results: The overall stone-free rate was 50% (111/222). To predict the stone-free status, all receiver operating characteristic curves of the four MLMs were above the curve for Guy’s stone score. The AUCs of LL, RF, SVM, and Naive Bayes were 0.879, 0.803, 0.818, and 0.803, respectively. These values were higher than the AUC of Guy’s score system, 0.800. The accuracies of the MLMs (0.803% to 0.818%) were also superior to the S.T.O.N.E score system (0.788%). Among the MLMs, Lasso-logistic showed the most favorable AUC. Conclusion: Machine learning methods can predict the stone-free rate with AUCs not inferior to those of Guy’s stone score and the S.T.O.N.E score system.
Collapse
Affiliation(s)
- Hong Zhao
- Shanghai Xuhui Central Hospital, Shanghai, China
| | - Wanling Li
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junsheng Li
- Shanghai Xuhui Central Hospital, Shanghai, China
| | - Li Li
- Shanghai Xuhui Central Hospital, Shanghai, China
| | - Hang Wang
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jianming Guo
- Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Jianming Guo,
| |
Collapse
|
6
|
Aminsharifi A, Irani D, Tayebi S, Jafari Kafash T, Shabanian T, Parsaei H. Predicting the Postoperative Outcome of Percutaneous Nephrolithotomy with Machine Learning System: Software Validation and Comparative Analysis with Guy's Stone Score and the CROES Nomogram. J Endourol 2020; 34:692-699. [PMID: 31886708 DOI: 10.1089/end.2019.0475] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To validate the output of a machine learning-based software as an intelligible interface for predicting multiple outcomes after percutaneous nephrolithotomy (PCNL). We compared the performance of this system with Guy's stone score (GSS) and the Clinical Research Office of Endourological Society (CROES) nomogram. Patients and Methods: Data from 146 adult patients (87 males, 59%) who underwent PCNL at our institute were used. To validate the system, accuracy of the software for predicting each postoperative outcome was compared with the actual outcome. Similarly, preoperative data were analyzed with GSS and CROES nomograms to determine stone-free status as predicted by these nomograms. A receiver operating characteristic (ROC) curve was generated for each scoring system, and the area under the ROC curve (AUC) was calculated and used to assess the predictive performance of all three models. Results: Overall stone-free rate was 72.6% (106/146). Forty of 146 patients (27.4%) were scheduled for 42 ancillary procedures (extracorporeal shockwave lithotripsy [SWL] [n = 31] or repeat PCNL [n = 11]) to manage residual renal stones. Overall, the machine learning system predicted the PCNL outcomes with an accuracy ranging between 80% and 95.1%. For predicting the stone-free status, the AUC for the software (0.915) was significantly larger than the AUC for GSS (0.615) or CROES nomograms (0.621) (p < 0.001). Conclusion: At the internal institutional level, the machine learning-based software was a promising tool for recording, processing, and predicting outcomes after PCNL. Validation of this system against an external dataset is highly recommended before its widespread application.
Collapse
Affiliation(s)
- Alireza Aminsharifi
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran.,Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Dariush Irani
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sona Tayebi
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Tayebeh Shabanian
- Department of Medical Physics and Engineering, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Parsaei
- Department of Medical Physics and Engineering, Shiraz University of Medical Sciences, Shiraz, Iran.,Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
7
|
Schulster M, Small AC, Silva MV, Abbott JE, Davalos JG. Endoscopic Combined Intrarenal Surgery Can Accurately Predict High Stone Clearance Rates on Postoperative CT. Urology 2019; 133:46-49. [DOI: 10.1016/j.urology.2019.08.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/29/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022]
|
8
|
Gökce Mİ, Gülpinar O, Ibiş A, Karaburun M, Kubilay E, Süer E. Retrograde vs. antegrade fl exible nephroscopy for detection of residual fragments following PNL: A prospective study with computerized tomography control. Int Braz J Urol 2019; 45:581-587. [PMID: 30901169 PMCID: PMC6786124 DOI: 10.1590/s1677-5538.ibju.2018.0695] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/04/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The main aim of stone surgery is to establish stone free status. Performing fl exible nephroscopy is an effective tool in this manner. The aim of this study was to evaluate the role of retrograde fl exible nephroscopy for detection of residual fragments following percutaneous nephrolithotomy (PNL) in comparison with antegrade approach. MATERIALS AND METHODS Data of 137 patients underwent ECIRS was collected prospectively. In all cases following stone clearance, collecting system was checked for residual fragments. First antegrade than retrograde fl exible nephroscopy was performed and success rates to reach all calices and detection of residual fragments were noted. All patients underwent CT and success rate of antegrade and retrograde approaches were compared. PPV and NPV of retrograde approach to detect residual fragments were calculated. RESULTS Antegrade and retrograde nephroscopy successfully accessed all of the calices in 101 (73.7%) and 130 (94.9%) patients respectively (p<0.0001). Residual fragments were observed in 18 (13.1%) patients following antegrade fl exible nephroscopy. Retrograde approach identifi ed residual stones in 17 more cases. These cases were treated with fl exible nephroscopy or secondary percutaneous tract. Postoperative CT revealed residual stones in 10 (7.3%) patients. PPV and NPV of retrograde fl exible nephroscopy were 83.3% and 96.2%. CONCLUSIONS Flexible nephroscopy effectively detects residual fragments following PNL. Retrograde approach was more successful than antegrade approach to reach all calices. We recommend performing retrograde fl exible nephroscopy following PNL especially in complex cases as it has the potential to increase SFR, decrease the need for second look surgery and unnecessary postoperative imaging.
Collapse
Affiliation(s)
- Mehmet İlker Gökce
- Department of Urology, Ankara University School of Medicine, Adnan Saygun Caddesi, Altindağ, Ankara, Turkey
| | - Omer Gülpinar
- Department of Urology, Ankara University School of Medicine, Adnan Saygun Caddesi, Altindağ, Ankara, Turkey
| | - Arif Ibiş
- Department of Urology, Ankara University School of Medicine, Adnan Saygun Caddesi, Altindağ, Ankara, Turkey
| | - Muratcan Karaburun
- Department of Urology, Ankara University School of Medicine, Adnan Saygun Caddesi, Altindağ, Ankara, Turkey
| | - Eralp Kubilay
- Department of Urology, Ankara University School of Medicine, Adnan Saygun Caddesi, Altindağ, Ankara, Turkey
| | - Evren Süer
- Department of Urology, Ankara University School of Medicine, Adnan Saygun Caddesi, Altindağ, Ankara, Turkey
| |
Collapse
|
9
|
Aminsharifi A, Irani D, Amirzargar H. Shock Wave Lithotripsy is More Effective for Residual Fragments after Percutaneous Nephrolithotomy than for Primary Stones of the Same Size: A Matched Pair Cohort Study. Curr Urol 2018; 12:27-32. [PMID: 30374277 DOI: 10.1159/000447227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/24/2017] [Indexed: 11/19/2022] Open
Abstract
Aims To compare the outcome of shock wave lithotripsy (SWL) on post-percutaneous nephrolithotomy (PCNL) residual fragments (RFs) versus primary stones of the same size through a matched pair study. Methods Patients with a single 5-15 mm fragment 3 months after PCNL were enrolled (study group n = 59). The control group (n = 67) consisted of all adult patients with a single 5-15 mm renal stone. Results The success rate of SWL was significantly higher in the study group (81.4 vs. 59.7%; p = 0.008; OR: 2.95). With a cutoff point of Hounsfield units (HU) 750: the success rate was significantly lower in patients with a stone HU ≥ 750 (OR: 3.488). This HU cutoff value had no effect on the outcome of SWL in patients with post-PCNL RF (p = 0.14). On the other hand, the outcome of SWL was significantly more favorable in control group when HU < 750 (p = 0.02). Conclusion The success rate of SWL was 2.95-fold higher for post-PCNL RFs than in a stone burden-matched control group. The likelihood of stone clearance after SWL was 3.488-fold greater when HU was less than 750. This effect of HU was more prominent in patients receiving SWL for their primary stones while SWL was evenly effective on post PCNL RFs with different HUs.
Collapse
Affiliation(s)
- Alireza Aminsharifi
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Duke University Medical Center, Department of Surgery, Division of Urologic Surgery, Durham, NC, USA
| | - Dariush Irani
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Amirzargar
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
10
|
Nevo A, Holland R, Schreter E, Gilad R, Baniel J, Cohen A, Lifshitz DA. How Reliable Is the Intraoperative Assessment of Residual Fragments During Percutaneous Nephrolithotomy? A Prospective Study. J Endourol 2018; 32:471-475. [DOI: 10.1089/end.2018.0005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Amihay Nevo
- Unit of Endourology, Rabin Medical Center, Petah Tikva, Israel
| | - Ronen Holland
- Unit of Endourology, Rabin Medical Center, Petah Tikva, Israel
| | - Eran Schreter
- Unit of Endourology, Rabin Medical Center, Petah Tikva, Israel
| | - Ron Gilad
- Unit of Endourology, Rabin Medical Center, Petah Tikva, Israel
| | - Jack Baniel
- Unit of Endourology, Rabin Medical Center, Petah Tikva, Israel
| | - Aenov Cohen
- Radiology Department, Rabin Medical Center, Petah Tikva, Israel
| | | |
Collapse
|
11
|
Wei C, Zhang Y, Pokhrel G, Liu X, Gan J, Yu X, Ye Z, Wang S. Research progress of percutaneous nephrolithotomy. Int Urol Nephrol 2018; 50:807-817. [PMID: 29556901 DOI: 10.1007/s11255-018-1847-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/12/2018] [Indexed: 12/29/2022]
Abstract
Percutaneous nephrolithotomy (PCNL) is generally accepted as the gold standard treatment for the treatment of large kidney stones (> 2 cm). For nearly 40 years, with the continuous progress of technology and the constant updating of ideas, PCNL has made great progress. In this review, we discuss the current research progress, recent advancement and hot spot of the whole process of PCNL including anesthesia, position, puncture, dilation, lithotripsy approaches, perfusate, tube placement, hospitalization time, drug, treatment of residual stones, prognosis judgment and operation evaluation by summarizing the related research in this article.
Collapse
Affiliation(s)
- Chao Wei
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Yucong Zhang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Gaurab Pokhrel
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Xiaming Liu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Jiahua Gan
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Xiao Yu
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiafang Avenue, Qiaokou, Wuhan, 430030, Hubei, China.
| |
Collapse
|