1
|
Kingma RA, Mors R, Bus MTJ, Altobelli E, de Jong IJ, Roemeling S. Cone Beam Computed Tomography-Assisted Percutaneous Nephrolithotomy in a Hybrid Operating Room: Optimization of Patient Selection. J Endourol 2024; 38:432-437. [PMID: 38420888 DOI: 10.1089/end.2023.0437] [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] [Indexed: 03/02/2024] Open
Abstract
Background: Cone beam computed tomography (CBCT) enables intraoperative cross-sectional and three-dimensional imaging of the urinary tract. CBCT in a hybrid operating room can be used for intraoperative detection of residual stones and potential additional stone extraction at the end of percutaneous nephrolithotomy (PCNL). This study describes our initial experience with intraoperative CBCT during PCNL and analyzes its role in potentially improving its outcomes. Methods: We conducted a single-center retrospective cohort study at a tertiary referral hospital between 2018 and 2021. The study aimed to evaluate the outcome of patients who underwent intraoperative noncontrast CBCT scan during PCNL. The CBCT scan was performed when the urologist determined the kidney to be endoscopically stone-free. In case any residual fragments were imaged, an additional effort was made to extract them. Patients were divided into three groups based on treatment outcome: stone-free upon CBCT, not stone-free with additional stone extraction after CBCT, and not stone-free without additional stone extraction. Procedure and patient characteristics were recorded to identify factors associated with additional stone extraction during CBCT-assisted PCNL. Results: A total of 102 procedures were included in this study. Intraoperative CBCT scans showed residual calcifications in 58 (57%) cases. In 39 cases, which is 38% of the total population and 61% of the cases with residual calcifications, one or more residual fragments imaged on the intraoperative CBCT-scan were extracted additionally within the same procedure. A higher Guy's Stone Score was associated with a higher likelihood of additionally extracting stones as a result of the CBCT. Conclusions: CBCT-assisted PCNL in a hybrid operating room can lead to additional stone extraction in the same procedure in 37% of all cases and in over 60% of the cases in which residual fragments are imaged. The value of CBCT-assisted PCNL appears to increase in the case of more complex stone surgery cases.
Collapse
Affiliation(s)
- Riemer A Kingma
- Department of Urology, University Medical Center Groningen, University of Groningen, the Netherlands, Groningen, Netherlands
| | - Rianne Mors
- Department of Urology, University Medical Center Groningen, University of Groningen, the Netherlands, Groningen, Netherlands
| | - Mieke T J Bus
- Department of Urology, University Medical Center Groningen, University of Groningen, the Netherlands, Groningen, Netherlands
| | - Emanuela Altobelli
- Department of Urology, University Medical Center Groningen, University of Groningen, the Netherlands, Groningen, Netherlands
| | - Igle Jan de Jong
- Department of Urology, University Medical Center Groningen, University of Groningen, the Netherlands, Groningen, Netherlands
| | - Stijn Roemeling
- Department of Urology, University Medical Center Groningen, University of Groningen, the Netherlands, Groningen, 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
|
Lotan P, Goldberg H, Nevo A, Darawsha AE, Gefen S, Criederman G, Rubinstein R, Herzberg H, Holland R, Lifshitz D, Golomb D. Post-operative pain following percutaneous nephrolithotripsy- clinical correlates. Urologia 2023; 90:503-509. [PMID: 36326155 DOI: 10.1177/03915603221130899] [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] [Indexed: 07/20/2023]
Abstract
OBJECTIVES Management of postoperative pain following percutaneous nephrolithotripsy (PCNL) is a significant goal. We sought to identify risk factors and clinical correlates of postoperative pain in order to improve perioperative management and patient satisfaction. MATERIALS AND METHODS A single-center, retrospective analysis, from a prospectively maintained database, of all consecutive patients who underwent PCNL for renal calculi between January 2011 and August 2018. Postoperative pain was assessed using the visual analog scale (VAS) and analgesic use. We considered VAS score above 4 as meaningful. Pain management was standardized according to patirnt reported VAS scores. Multivariable logistic regression was performed to identify risk factors and clinical correlates. RESULTS A total of 496 patients were analyzed. Younger age was associated with VAS above 4 on the operative day and the first postoperative following PCNL (p = 0.003 and p < 0.001, respectively). Female gender was associated with VAS above 4 in the first 2 days following the operation (p < 0.001). CONCLUSIONS Younger age and female gender would most likely benefit from pre-emptive improved pain management protocols following PCNL.
Collapse
Affiliation(s)
- Paz Lotan
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Hanan Goldberg
- Department of Urology, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Amihay Nevo
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | | | - Sheizaf Gefen
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | | | - Roy Rubinstein
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Haim Herzberg
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Ronen Holland
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - David Lifshitz
- Department of Urology, Rabin Medical Center, Petach Tikva, Israel
| | - Dor Golomb
- Department of Urology, Assuta Ashdod University Hospital, Ashdod, Israel
| |
Collapse
|
4
|
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
|
5
|
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
|
6
|
Patel PM, Kandabarow AM, Chuang E, McKenzie K, Druck A, Seffren C, Blanco-Martinez E, Capoccia E, Farooq AV, Branch J, Turk T, Baldea K. Using Intraoperative Portable CT Scan to Minimize Reintervention Rates in PCNL: A Prospective Trial. J Endourol 2022; 36:1382-1387. [PMID: 35620899 DOI: 10.1089/end.2022.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE More than 40% of patients undergoing PCNL are left with residual stone fragments and often require secondary procedures. Portable CT (PCT) technology allows surgeons to obtain intraoperative cross-sectional imaging, identify and extract residual stones immediately, and thereby reduce the need for subsequent procedures. This prospective trial evaluates how incorporation of PCT during PCNL affects perioperative outcomes. PATIENTS AND METHODS We prospectively enrolled eligible patients undergoing initial PCNL for this trial (n=60), which entailed a single intraoperative CT-abdomen and ipsilateral antegrade ureteroscopy when the surgeon felt stone treatment was visually complete. If residual fragments were identified, the surgeon continued nephroscopy to find and remove them; if not, the procedure was concluded. These patients were compared to a retrospective cohort (n=174) who underwent initial PCNL with post-operative imaging performed the following day. RESULTS The two cohorts had similar demographic properties and stone characteristics, and location of percutaneous access. In the prospective arm, 50% of intraoperative PCT scans identified residual fragments, prompting continuation of surgery to remove them. This cohort had significantly higher stone-free rate (82% vs. 36%, p<0.01), lower rate of planned reintervention (7% vs. 32%, p<0.01), lower rate of urgent presentation with ureteral obstruction (0% vs. 7%, p=0.04), lower total CT-based effective radiation dose (8.4 vs. 14.6 mSv, p<0.01), and shorter length of stay (2.3 vs. 3.5 days, p<0.01) when compared to the retrospective cohort that did not use intraoperative PCT. CONCLUSIONS Obtaining an intraoperative portable CT scan during PCNL can substantially improve perioperative outcomes. Further evaluation of this modality through a randomized-controlled trial is warranted.
Collapse
Affiliation(s)
- Parth M Patel
- UCLA, 8783, 1260 15th St., Suite 1200, Los Angeles, California, United States, 90404;
| | - Alexander M Kandabarow
- Loyola University Medical Center, 25815, Urology, 2160 S 1st Ave, Building 54, Room 237A, Maywood, Illinois, United States, 60153;
| | - Eric Chuang
- Loyola University Chicago Stritch School of Medicine, 12248, Maywood, Illinois, United States;
| | - Kevin McKenzie
- Loyola University Chicago Stritch School of Medicine, 12248, Maywood, Illinois, United States;
| | | | - Christopher Seffren
- Loyola University Chicago Stritch School of Medicine, 12248, Maywood, Illinois, United States;
| | - Enrique Blanco-Martinez
- Loyola University Chicago Stritch School of Medicine, 12248, Maywood, Illinois, United States;
| | - Edward Capoccia
- Loyola University Medical Center, 25815, Urology, Maywood, Illinois, United States;
| | - Ahmer V Farooq
- Loyola University Medical Center, 25815, Urology, Maywood, Illinois, United States;
| | - Jeffrey Branch
- Loyola University Medical Center, 25815, Urology, Maywood, Illinois, United States;
| | - Thomas Turk
- Loyola University Medical Center, 25815, Urology, Maywood, Illinois, United States;
| | - Kristen Baldea
- Loyola University Medical Center, 25815, Urology, Maywood, Illinois, United States;
| |
Collapse
|
7
|
Kingma RA, de Jong IJ, Greuter MJW, Roemeling S. Cone beam computed tomography for detecting residual stones in percutaneous nephrolithotomy, a randomized controlled trial (CAPTURE) protocol. Trials 2021; 22:805. [PMID: 34781993 PMCID: PMC8591918 DOI: 10.1186/s13063-021-05794-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Percutaneous nephrolithotomy (PCNL) is the standard surgical treatment method for large kidney stones. Its aim is to achieve a stone-free status, since any residual fragments (RFs) after PCNL are likely to cause additional morbidity or stone growth. Enhancing intraoperative detectability of RFs could lead to increased stone-free rates and decreased re-intervention rates. Cone beam computed tomography (CBCT) has recently been introduced in urology as a feasible method for intraoperatively imaging RFs. The aim of this trial is to determine the added value of CBCT in percutaneous nephrolithotomy, by measuring differences in stone-related morbidity for patients with procedures in which a CBCT is used versus patients with procedures without the use of CBCT. Methods The CAPTURE trial is an investigator-initiated single-center, randomized controlled trial (RCT) in adult patients who have an indication for percutaneous nephrolithotomy. A contemporary percutaneous nephrolithotomy is performed. Once the surgeon is convinced of a stone-free status by means of fluoroscopy and nephroscopy, randomization allocates patients to either the study group in whom an intraoperative CBCT scan is performed or to the control group in whom no intraoperative CBCT scan is performed. The main endpoint is the stone-free status as assessed four weeks postoperatively by low-dose non-contrast abdominal CT, as a standard follow-up procedure. Secondary endpoints include the number of PCNL procedures required and the number of stone-related events (SREs) registered. The total study population will consist of 320 patients that undergo PCNL and are eligible for randomization for an intraoperative CBCT scan. Discussion We deem a randomized controlled trial to be the most effective and reliable method to assess the efficacy of CBCT in PCNL. Though some bias may occur due to the impossibility of blinding the urologist at randomization, we estimate that the pragmatic nature of the study, standardized circumstances, and follow-up methods with pre-defined outcome measures will result in a high level of evidence. Trial registration Netherlands Trial Register (NTR) NL8168, ABR NL70728.042.19. Registered on 15 October 2019. Prospectively registered.
Collapse
Affiliation(s)
- R A Kingma
- Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - I J de Jong
- Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M J W Greuter
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - S Roemeling
- Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
8
|
Kingma RA, Voskamp MJH, Doornweerd BHJ, de Jong IJ, Roemeling S. Intraoperative cone beam computed tomography for detecting residual stones in percutaneous nephrolithotomy: a feasibility study. Urolithiasis 2021; 49:551-557. [PMID: 33683420 PMCID: PMC8560674 DOI: 10.1007/s00240-021-01259-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/23/2021] [Indexed: 11/27/2022]
Abstract
Cone beam computed tomography (CBCT) provides multiplanar cross-sectional imaging and three-dimensional reconstructions and can be used intraoperatively in a hybrid operating room. In this study, we investigated the feasibility of using a CBCT-scanner for detecting residual stones during percutaneous nephrolithotomy (PCNL). Intraoperative CBCT-scans were made during PCNL procedures from November 2018 until March 2019 in a university hospital. At the point where the urologist would have otherwise ended the procedure, a CBCT-scan was made to image any residual fragments that could not be detected by either nephroscopy or conventional C-arm fluoroscopy. Residual fragments that were visualized on the CBCT-scan were attempted to be extracted additionally. To evaluate the effect of this additional extraction, each CBCT-scan was compared with a regular follow-up CT-scan that was made 4 weeks postoperatively. A total of 19 procedures were analyzed in this study. The mean duration of performing the CBCT-scan, including preparation and interpretation, was 8 min. Additional stone extraction, if applicable, had a mean duration of 11 min. The mean effective dose per CBCT-scan was 7.25 mSv. Additional extraction of residual fragments as imaged on the CBCT-scan occurred in nine procedures (47%). Of the follow-up CT-scans, 63% showed a stone-free status as compared to 47% of the intraoperative CBCT-scans. We conclude that the use of CBCT for the detection of residual stones in PCNL is meaningful, safe, and feasible.
Collapse
Affiliation(s)
- R A Kingma
- Department of Urology, University of Groningen, University Medical Center Groningen, House Zip Code CB 62, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - M J H Voskamp
- Department of Urology, University of Groningen, University Medical Center Groningen, House Zip Code CB 62, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - B H J Doornweerd
- Department of Urology, University of Groningen, University Medical Center Groningen, House Zip Code CB 62, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - I J de Jong
- Department of Urology, University of Groningen, University Medical Center Groningen, House Zip Code CB 62, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - S Roemeling
- Department of Urology, University of Groningen, University Medical Center Groningen, House Zip Code CB 62, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| |
Collapse
|
9
|
Van den Broeck T, Zhu X, Kusters A, Futterer J, Langenhuijsen J, d'Ancona F. Percutaneous Nephrolithotomy with Intraoperative Computed Tomography Scanning Improves Stone-Free Rates. J Endourol 2020; 35:267-273. [PMID: 32689828 DOI: 10.1089/end.2020.0365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Introduction: The use of fluoroscopy during percutaneous nephrolithotomy (PCNL) may lead to an overestimation of stone-free rates. The objective of this study is to demonstrate the feasibility of intraoperative CT-guided PCNL compared with standard of care (SoC) PCNL. Patients and Methods: A prospective feasibility study (20 patients undergoing PCNL with an intraoperative CT scan between June 2017 and February 2020) and a retrospective study of a historical cohort (20 consecutive patients undergoing SoC PCNL between September 2015 and September 2016) were conducted. All procedures were performed by an expert endourologist in a tertiary referral hospital. Follow-up was performed at 6 weeks postoperatively. The primary goal is to investigate the practicality and potential benefits and harms of intraoperative CT scanning during PCNL. Secondary outcomes are a stone-free rate after the 6-week follow-up, perioperative radiation exposure, the need for postoperative imaging, and peri- and postoperative complications. Statistical significance was considered at p < 0.05. Results: The initial stone-free rate in the CT scan group was 65% (n = 13). In 25% (n = 5) of patients, residual stone fragments were removed after the perioperative CT scan. In the SoC group, 85% (n = 17) of patients were thought to be stone free perioperatively. At the 6-week follow-up, 80% (n = 16) in the CT scan group vs 50% in the SoC group (n = 10) were found to be stone free. Radiation exposure, perioperatively, was higher in the CT scan group. Complications were comparable between groups. Limitations of the study are the nonrandomized design of the study and nonstandardized follow-up imaging. Conclusions: Intraoperative CT scanning during PCNL is feasible and gives a better estimate of any remaining stone fragments compared with fluoroscopy only.
Collapse
Affiliation(s)
- Thomas Van den Broeck
- Radboud University Medical Center, Nijmegen, The Netherlands.,University Hospitals Leuven, Leuven, Belgium
| | - Xiaoye Zhu
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anneke Kusters
- Radboud University Medical Center, Nijmegen, The Netherlands.,Regional Hospital Queen Beatrix, Winterswijk, The Netherlands
| | - Jurgen Futterer
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Frank d'Ancona
- Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
10
|
Goldberg H, Nevo A, Shtabholtz Y, Lubin M, Baniel J, Margel D, Ehrlich Y, Lifshitz D. Tubeless supra-costal percutaneous nephrolithotomy is associated with significantly less hydrothorax: a prospective randomized clinical study. BJU Int 2019; 125:276-283. [PMID: 31721407 DOI: 10.1111/bju.14950] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate prospectively whether a tubeless (JJ stent-only) percutaneous nephrolithotomy (PCNL) might reduce the risk of hydrothorax, compared to an approach where a nephrostomy tube is left. MATERIALS AND METHODS We conducted a two-arm open-label prospective randomized study (NCT02036398) comparing tubeless supra-costal PCNL (with a JJ stent only) to standard PCNL (with nephrostomy tube and JJ stent) using intention-to-treat (ITT) and per-protocol (PP) analyses. All patients underwent a standard single-stage prone supra-costal procedure with single-tract access. Complication data were collected according to the Clavien-Dindo grading system. The primary endpoint was the rate of hydrothorax, and secondary endpoints included stone-free rate (SFR) and complication rate. Multivariable logistic regression analysis identified factors associated with hydrothorax formation. RESULTS Out of 101 patients approached, 75 were finally analysed. No differences were observed between the two arms with regard to baseline demographic and stone characteristics. The mean largest stone size ranged between 23 and 24.2 mm. No significant difference was seen in the mean operating time and length of hospital stay. The incidence of hydrothorax was significantly higher in the nephrostomy group in comparison to the tubeless group (37.8% vs 15.8%, P = 0.031, and 38.4% vs 13.8%, P = 0.016, in the ITT and PP analyses, respectively). The SFR and complication rate were similar in both groups using the ITT and PP analyses. Multivariable logistic regression analysis showed that nephrostomy tube placement was the only covariate associated in a statistically significant manner to hydrothorax (odds ratio 3.628, 95% confidence interval 1.073-12.265; P = 0.038). CONCLUSION The rate of hydrothorax in supra-costal PCNL is associated with the type of postoperative drainage left. When possible, a tubeless approach should be applied as it may confer a lower risk of hydrothorax.
Collapse
Affiliation(s)
- Hanan Goldberg
- Minimally Invasive Unit, Department of Urology, Golda Hospital, Rabin Medical Centre, Petach Tikva, Israel.,Department of Urology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Amihay Nevo
- Minimally Invasive Unit, Department of Urology, Golda Hospital, Rabin Medical Centre, Petach Tikva, Israel
| | - Yariv Shtabholtz
- Minimally Invasive Unit, Department of Urology, Golda Hospital, Rabin Medical Centre, Petach Tikva, Israel
| | - Marc Lubin
- Minimally Invasive Unit, Department of Urology, Golda Hospital, Rabin Medical Centre, Petach Tikva, Israel
| | - Jack Baniel
- Minimally Invasive Unit, Department of Urology, Golda Hospital, Rabin Medical Centre, Petach Tikva, Israel
| | - David Margel
- Minimally Invasive Unit, Department of Urology, Golda Hospital, Rabin Medical Centre, Petach Tikva, Israel
| | - Yaron Ehrlich
- Minimally Invasive Unit, Department of Urology, Golda Hospital, Rabin Medical Centre, Petach Tikva, Israel
| | - David Lifshitz
- Minimally Invasive Unit, Department of Urology, Golda Hospital, Rabin Medical Centre, Petach Tikva, Israel
| |
Collapse
|
11
|
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]
|