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Taghavi K, Kusel A, Webb N, McCahy P, Badawy M, Ditchfield M. The burden of radiation exposure in children requiring percutaneous nephrolithotomy. J Pediatr Urol 2023; 19:559.e1-559.e7. [PMID: 37302924 DOI: 10.1016/j.jpurol.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Children undergoing investigation and management for complex upper tract urolithiasis often require multimodal imaging. The significance of related radiation exposure in stone care pathways has received little attention in the published literature. STUDY DESIGN Medical records of paediatric patients undergoing percutaneous nephrolithotomy were retrospectively analysed to ascertain the modalities used and determine extent of radiation exposure occurring during each care pathway. Radiation dose simulation and calculation was performed a priori. The cumulative effective dose (mSv) and cumulative organ dose (mGy) for radiosensitive organs was calculated. RESULTS A total of 140 imaging studies were included from the care pathways of 15 children with complex upper tract urolithiasis. Median follow-up was 9.6 years (range: 6.7-16.8 years). The average number of imaging studies with ionising radiation per patient was nine, with a cumulative effective dose of 18.3 mSv across all modalities. The most common modalities were: mobile fluoroscopy (43%), x-ray (24%), and computed tomography (18%). The cumulative effective dose per study type was greatest for CT (4.09 mSv), followed by fixed and mobile fluoroscopy (2.79 mSv and 1.82 mSv, respectively). CONCLUSION There is high general awareness of radiation exposure involved in CT scanning with resultant caution in employing this modality in paediatric patients. However, the significant radiation exposure relating to fluoroscopy (whether fixed or mobile) is less well documented in children. We recommend implementing steps to minimise radiation exposure by optimisation and avoidance of certain modalities where possible. Paediatrics urologists must employ strategies to minimise radiation exposure in children with urolithiasis, given the significant exposures encountered.
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Affiliation(s)
- Kiarash Taghavi
- Department of Paediatric Urology, Monash Children's Hospital, Monash Health, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia.
| | - Amanda Kusel
- Department of Paediatric Urology, Monash Children's Hospital, Monash Health, Melbourne, Australia
| | - Nathalie Webb
- Department of Paediatric Urology, Monash Children's Hospital, Monash Health, Melbourne, Australia; School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Philip McCahy
- Department of Urology, Monash Health, Melbourne, Australia; School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Mohamed Badawy
- Monash Health Imaging, Monash Health, Clayton, Victoria, Australia; Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Michael Ditchfield
- Department of Paediatrics, Monash University, Melbourne, Australia; Monash Health Imaging, Monash Health, Clayton, Victoria, Australia
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Zhan CS, Zhang C, Wang JZ, Fan S, Zhao L, Shu HM, Hao ZY. Stone attenuation on computer tomography helps surgeons make decisions between miniaturized percutaneous nephrolithotomy or retrograde intrarenal surgery for lower pole stones: a retrospective study. Urolithiasis 2023; 51:77. [PMID: 37093335 DOI: 10.1007/s00240-023-01442-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 03/30/2023] [Indexed: 04/25/2023]
Abstract
A retrospective study was performed on 200 patients who underwent miniaturized percutaneous nephrolithotomy (mini-PCNL) or retrograde intrarenal surgery (RIRS) for 10-20 mm sized lower pole renal calculi to investigate the relationship between computed tomography (CT) attenuation of calculi and surgical outcomes. CT was used to examine the location, size, and CT attenuation values of the calculi. Additionally, the operation time, hospital stay, hemoglobin (Hb) reduction, stone-free rate (SFR), and complication rate were also meticulously documented and subjected to comparative analysis. Complications were assessed using the Clavien-Dindo grading system. We observed no significant differences in hospitalization data and follow-up outcomes, except for a longer hospital stay and higher Hb drops in patients receiving mini-PCNL. Statistical analysis revealed an association between CT attenuation and operation time. Compared with mini-PCNL, RIRS could reduce bleeding, hospital stay, surgery time, and complications for 10-20 mm sized lower pole kidney stones with CT values < 1000 HU. RIRS resulted in longer operation time and lower stone-free rates despite shorter hospital stays and less bleeding than mini-PCNL for stones with CT values > 1000 HU. Therefore, selecting an appropriate surgical method based on CT attenuation might improve outcomes. For patients with stone attenuation values < 1000 HU, RIRS is the recommended option. When stone attenuation values > 1000 HU, the surgical method should be chosen based on the patient's individual situation.
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Affiliation(s)
- Chang-Sheng Zhan
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Cheng Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Jian-Zhong Wang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Song Fan
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Lei Zhao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Institute of Urology, Anhui Medical University, Hefei, China
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China
| | - Hong-Min Shu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zong-Yao Hao
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
- Institute of Urology, Anhui Medical University, Hefei, China.
- Anhui Province Key Laboratory of Genitourinary Diseases, Anhui Medical University, Hefei, China.
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Yildirim Ü, Sarica K, Ezer M, Uslu M, Erihan İB, Kara C. Analysis of stone-free rates and residual fragment sizes following standard percutaneous nephrolithotomy: mistakes in the treatment of non-opaque kidney stones. Urolithiasis 2023; 51:69. [PMID: 37043027 DOI: 10.1007/s00240-023-01448-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/06/2023] [Indexed: 04/13/2023]
Abstract
Our presented study aimed to evaluate the possible effects of stone opacity, on both the success of percutaneous nephrolithotomy and the sizes of residual fragments following the procedure. Medical records of patients undergoing PCNL treatment for kidney stones at our clinic between July 2014 and May 2022 were evaluated in a retrospective manner. A total sample size of 304 patients with the required criteria was included. Patients were divided into two groups based on the radiopacity status of the stones assessed in the kidney-ureter-bladder graphy (KUB) [Group O (n = 211): opaque, Group N (n = 93): non-opaque)]. Demographic data, laboratory results, and surgical follow-up information were comparatively evaluated between groups. The mean age and percentage of female patients were higher in Group N (45.2 vs. 25,1%; p < 0.001). Also, patients in this group were associated with more comorbidities. No significant difference was present regarding stones' laterality, size, surface area, and localization. Cases in the Group N group demonstrated higher median hemoglobin reduction [1.7 (IQR = 1.2-2.5) vs. 2 (IQR = 1.6-2.6); p = 0.047]. The stone-free rates in Group O patients were higher (67.8% vs. 53.8%; p = 0.014). The size of the residual fragments was meaningfully larger in Group N cases [8 (IQR = 7-13) vs. 10 (IQR = 8-16); p = 0.032]. Finally, no significant difference was observed between the groups regarding both minor (as grade 3a and below) and major (grade 3b and above) assessed by the Modified Clavien-Dindo Classification. Our data show that treatment of patients with so-called non-opaque kidney stones by PCNL results in low SFR and larger residual fragments, which is due to a variety of errors that should be avoided by appropriate measures.
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4
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Moon HW, Taeyb M, Park YH, Bae WJ, Ha US, Hong SH, Lee JY, Kim SW, Cho HJ. The impact of Hounsfield unit-related variables on percutaneous nephrolithotomy outcomes. Sci Rep 2022; 12:18451. [PMID: 36323761 PMCID: PMC9630435 DOI: 10.1038/s41598-022-23383-7] [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: 09/05/2021] [Accepted: 10/31/2022] [Indexed: 11/05/2022] Open
Abstract
We aimed to identify the association between Hounsfield Unit(HU)-related variables and percutaneous nephrolithotomy (PCNL) outcomes. We enrolled patients with single renal stones (1-3 cm) who underwent single-tract PCNL between January 2014 and October 2019. Demographics and stone characteristics were retrospectively reviewed. Preoperative computerized tomography (CT) and follow-up CT within at least 3 months after PCNL were included in this analysis. Stone-free status was defined as residual stone measuring ≤ 2 mm within 3 months postoperatively. HU and cross-sectional area (CSA) were measured using the free-draw technique. We analyzed HU-related variables using logistic regression model for outcomes. Altogether, 188 out of 683 patients met the inclusion criteria. The stone-free rate (SFR) was 79.2%. There were no significant differences in age, sex, BMI, ASA class, laterality, pre-op shockwave lithotripsy, stone size, stone burden, skin-to-stone distance, and HU between the stone-free and remnant groups. CSA and HU/CSA in the stone-free and remnant groups were 94.5 ± 46.1 and 128.3 ± 98.5 (p = 0.043) and 10.1 ± 5.6 and 7.3 ± 3.4 (p = 0.001), respectively. Multivariate logistic regression analysis revealed that pelvis, ureteropelvic junction stones, and HU/CSA were independent predictors of SFR. HU did not affect PCNL outcomes. We believe that HU/CSA could be used for determining stone treatment plans and predicting outcomes.
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Affiliation(s)
- Hyong Woo Moon
- grid.411947.e0000 0004 0470 4224Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591 Republic of Korea
| | - Mustafa Taeyb
- grid.411947.e0000 0004 0470 4224Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591 Republic of Korea ,grid.415310.20000 0001 2191 4301Department of Urology, King Faisal Hospital, Mecca, Saudi Arabia
| | - Yong Hyun Park
- grid.411947.e0000 0004 0470 4224Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591 Republic of Korea
| | - Woong Jin Bae
- grid.411947.e0000 0004 0470 4224Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591 Republic of Korea
| | - U.-Syn Ha
- grid.411947.e0000 0004 0470 4224Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591 Republic of Korea
| | - Sung-Hoo Hong
- grid.411947.e0000 0004 0470 4224Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591 Republic of Korea
| | - Ji Youl Lee
- grid.411947.e0000 0004 0470 4224Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591 Republic of Korea
| | - Sae Woong Kim
- grid.411947.e0000 0004 0470 4224Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591 Republic of Korea
| | - Hyuk Jin Cho
- grid.411947.e0000 0004 0470 4224Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591 Republic of Korea
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5
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Elbaset MA, Taha DE, Anas M, Abouelkheir RT, Edwan M, Abdullateef M, Ashour R, Osman Y, Sheir KZ. Optimization of shockwave lithotripsy use for single medium sized hard renal stone with stone density ≥ 1000 HU. A prospective study. World J Urol 2021; 40:243-250. [PMID: 34392391 DOI: 10.1007/s00345-021-03807-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To identify shock wave lithotripsy (SWL) success predictors in hard renal stones (average stone density ≥ 1000 HU). MATERIALS We prospectively evaluated patients who underwent SWL for hard renal stones between April 2018 and December 2020. Radiological parameters were identified, e.g., stone site, size, the average density in addition to stone core and shell mean density, and renal cortical thickness (RKT). SWL sessions were performed using Doli-S lithotripter till a maximum of 3-4 sessions with 2-4 weeks interval. Initial response to SWL included stone fragmentation and decreased stone size after the first SWL. Treatment success was considered if complete clearance of renal stones occurred or in case of clinically insignificant residual fragments ≤ 4 mm after 12 weeks follow up by NCCT. RESULTS Out of 1878 patients who underwent SWL, the study included 157 patients with hard renal stones. Treatment overall success was found in 92 patients (58.6%) where 69 patients (43.9%) had complete stone clearance. On multivariate analysis, stone shell density < 901 HU, maximum stone size < 1 cm, RKT > 1.95 cm and initial treatment response were associated with increased the success rate after SWL for hard renal stones (P = 0.0001, 0.009, < 0.0001 and < 0.0001, respectively). CONCLUSION In hard renal stones, treatment overall success was found in 58.6% where complete stone clearance was found in 43.9%. Stone outer shell fragility, lower stone size, increased RKT and initial response to SWL were associated with a higher success rate at 12-week follow-up.
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Affiliation(s)
- M A Elbaset
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
| | - Diaa-Eldin Taha
- Urology Department, KafrELshiekh University, Kafr Al Sheikh, Egypt
| | - Marwan Anas
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Rasha T Abouelkheir
- Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed Edwan
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Muhamad Abdullateef
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Rawdy Ashour
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Yasser Osman
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - K Z Sheir
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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KARSLI O, ÜSTÜNER M, HALAT AÖ, ÖZCAN L, GOKALP F, KORAŞ Ö, VOYVODA B, MEMİK Ö. Do Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio Predict the Hardness of Kidney Stone. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2021. [DOI: 10.17944/mkutfd.873615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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7
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Basatac C, Özman O, Akgül HM, Ozyaman O, Cinar O, Can G, Sancak EB, Yazici CM, Akpinar H. The Impact of Stone Density on Operative Complications of Retrograde Intrarenal Surgery: A Multicenter Study with Propensity Score Matching Analysis. J Laparoendosc Adv Surg Tech A 2021; 32:142-148. [PMID: 33471596 DOI: 10.1089/lap.2020.0936] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The aim of the study was to evaluate the impact of stone density on operative complication rates in retrograde intrarenal surgery (RIRS). Materials and Methods: A total of 473 consecutive patients undergoing RIRS for the treatment of upper tract urinary stones were included. To adjust for baseline confounders, one-to-one propensity score matching was performed. After matching, the patients were divided into two groups according to stone density (low density [LD] group, ≤970 Hounsfield unit [HU]; high density [HD] group, >970 HU). The patients' demographics, stone-related features, stone-free rates, and intraoperative and postoperative complication rates were compared between the groups. The primary objective was to evaluate whether the intraoperative and postoperative complication rates were higher in patients whose stone density was greater than 970 HU. Results: After propensity score matching, 170 of 210 LD and 170 of 263 HD patients undergoing RIRS were included. The baseline characteristics did not differ significantly between the groups. There were no significant differences between LD and HD patients with respect to intraoperative (5.9% and 8.8%, respectively; P = .29), postoperative (10.6% and 15.3%, respectively; P = .14), and overall complication rates (15.2% and 21.1%, respectively; P = .16). Stone-free status was achieved in 143 patients (84.1%) in the LD group and 148 patients (87%) in the HD group; the difference was not statistically significant (P = .27). Conclusion: Our results show that RIRS is a safe and effective minimally invasive procedure for the treatment of upper urinary tract stones, even in HD stones.
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Affiliation(s)
- Cem Basatac
- Department of Urology, Group Florence Nightingale Hospitals, Istanbul, Turkey
| | - Oktay Özman
- Department of Urology, Istanbul Gaziosmanpaşa Teaching Hospital, Istanbul, Turkey
| | - Hacı Murat Akgül
- Department of Urology, School of Medicine, Tekirdag Namık Kemal University, Tekirdag, Turkey
| | - Onur Ozyaman
- Department of Urology, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Onder Cinar
- Department of Urology, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Günay Can
- Department of Public Health, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Eyüp Burak Sancak
- Department of Urology, School of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Cenk Murat Yazici
- Department of Urology, School of Medicine, Tekirdag Namık Kemal University, Tekirdag, Turkey
| | - Haluk Akpinar
- Department of Urology, Group Florence Nightingale Hospitals, Istanbul, Turkey
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Quirke K, Aydın A, Bultitude M, Sarıca K, Glass J, Khan A, Marsh H, Al‐Hayek S, Wiseman O, Patterson J, Makanjuola J, Skolarikos A, Somani B, Khan MS, Dasgupta P, Ahmed K. Development and content validation of the percutaneous nephrolithotomy assessment score. Int J Urol 2020; 27:960-964. [DOI: 10.1111/iju.14332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 06/29/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Kate Quirke
- MRC Center for Transplantation King’s College London London UK
| | | | - Matthew Bultitude
- Department of Urology Guy’s and St Thomas’ NHS Foundation Trust London UK
| | - Kemal Sarıca
- Department of Urology Biruni University Hospital Istanbul Turkey
| | - Jonathan Glass
- Department of Urology Guy’s and St Thomas’ NHS Foundation Trust London UK
| | - Azhar Khan
- Department of Urology Guy’s and St Thomas’ NHS Foundation Trust London UK
- Department of Urology King’s College Hospital NHS Foundation Trust London UK
| | - Howard Marsh
- Department of Urology Medway NHS Foundation Trust Kent UK
| | - Samih Al‐Hayek
- Department of Urology Cambridge University Hospitals NHS Foundation Trust Cambridge UK
| | - Oliver Wiseman
- Department of Urology Cambridge University Hospitals NHS Foundation Trust Cambridge UK
| | - Jake Patterson
- Department of Urology Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK
| | - Jonathan Makanjuola
- Department of Urology King’s College Hospital NHS Foundation Trust London UK
| | - Andreas Skolarikos
- 2nd Department of Urology Sismanoglio Hospital, National and Kapodistrian University of Athens Athens Greece
| | - Bhaskar Somani
- Department of Urology University Hospital Southampton NHS Foundation Trust Southampton UK
| | - Muhammad Shamim Khan
- MRC Center for Transplantation King’s College London London UK
- Department of Urology Guy’s and St Thomas’ NHS Foundation Trust London UK
| | - Prokar Dasgupta
- MRC Center for Transplantation King’s College London London UK
- Department of Urology Guy’s and St Thomas’ NHS Foundation Trust London UK
| | - Kamran Ahmed
- MRC Center for Transplantation King’s College London London UK
- Department of Urology King’s College Hospital NHS Foundation Trust London UK
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9
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Gadzhiev N, Malkhasyan V, Akopyan G, Petrov S, Jefferson F, Okhunov Z. Percutaneous nephrolithotomy for staghorn calculi: Troubleshooting and managing complications. Asian J Urol 2020; 7:139-148. [PMID: 32257807 PMCID: PMC7096695 DOI: 10.1016/j.ajur.2019.10.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/06/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023] Open
Abstract
Staghorn calculi comprise a unique subset of complex kidney stone disease. Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for staghorn stones. Despite continuous refinements to the technique and instrumentation of PCNL, these stones remain a troublesome challenge for endourologists and are associated with a higher rate of perioperative complications than that for non-staghorn stones. Common and notable intraoperative complications include bleeding, renal collecting system injury, injury of visceral organs, pulmonary complications, thromboembolic complications, extrarenal stone migration, and misplacement of the nephrostomy tube. Postoperative complications include infection and urosepsis, bleeding, persistent nephrocutaneous urine leakage, infundibular stenosis, and death. In this review, we report recommendations regarding troubleshooting measures that can be used to identify and characterize these complications. Additionally, we include information regarding management strategies for complications associated with PCNL for staghorn calculi.
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Affiliation(s)
- Nariman Gadzhiev
- Department of Urology, Pavlov First Saint Petersburg State Medical University, Russia
- Corresponding author.
| | - Vigen Malkhasyan
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Gagik Akopyan
- Department of Urology, Sechenov First Moscow State Medical University, Russia
| | - Sergei Petrov
- Department of Urology, Pavlov First Saint Petersburg State Medical University, Russia
| | | | - Zhamshid Okhunov
- Department of Urology, University of California, Oakland, CA, USA
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10
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Gadelmoula M, Elderwy AA, Abdelkawi IF, Moeen AM, Althamthami G, Abdel-Moneim AM. Percutaneous nephrolithotomy versus shock wave lithotripsy for high-density moderate-sized renal stones: A prospective randomized study. Urol Ann 2019; 11:426-431. [PMID: 31649466 PMCID: PMC6798294 DOI: 10.4103/ua.ua_63_19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Context: The management of renal stones of high density (>1000 Hounsfield units) on non-contrast computed tomography (NCCT), and moderate sized (15-25 mm) is still debatable. Aims: The aim of this study was to compare the outcomes of percutaneous nephrolithotomy (PCNL) and shock wave lithotripsy (SWL) for the high-density and moderate-sized renal stones regarding the stone-free rate (SFR), morbidity, and patients' quality of life. Settings and Design: This is a prospective randomized study. Patients and Methods: Eighty consecutive patients with renal stones, excluding those with lower calyceal stones, were randomized to receive either PCNL or SWL (40 in each arm). Patients were followed up by abdominal ultrasound and plain X-ray (NCCT if indicated) till clearance of stone. Outcomes, complications, costs, and SF-8 Health Survey scoring were recorded for each group. Statistical Analysis: We used Stata software, version 9.2 (Intercooled STATA®; StataCorp LP College Station, Texas, USA). Comparison of the two groups was made with regard to patient and stone criteria and the procedure details. Continuous variables were compared using the Mann–Whitney U-test with values shown as the median and interquartile range. Categorical variables were compared using the Pearson's Chi-square/Fisher's exact test. Multivariate logistic regression analysis was used to identify variables independently associated with the stone clearance after two sessions of SWL. P < 0.05 was considered statistically significant. Results: The basic characteristics of both groups were comparable. After a single treatment session, the SFR was 80% and 27.5% for PCNL and SWL, respectively (P < 0.001). The overall 3-month SFR was 87.5% versus 90%, respectively (P = 0.723). The median number of the required maneuvers was 1 (range: 1–3) for PCNL versus 2 (range: 1–4) for SWL (P < 0.001). The complication rate was 10% and 7.5%, respectively (P = 0.692). The cost of SWL was significantly lower (P < 0.001). On multivariate analysis, a single stone was an independent predictor for stone clearance after two sessions of SWL (odds ratio: 7.26, 95% confidence interval: 1.13–46.62, P = 0.037). Conclusions: PCNL for the dense, and moderate-sized renal stone provides higher initial success and lower re-treatment rates compared with SWL with comparable outcome after 3 months of therapy. However, SWL is an alternative, especially for a single stone.
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Affiliation(s)
- Mohamed Gadelmoula
- Department of Urology, Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Ahmad A Elderwy
- Department of Urology, Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Islam F Abdelkawi
- Department of Urology, Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Ahmed M Moeen
- Department of Urology, Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Ghaleb Althamthami
- Department of Urology, Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
| | - Ahmed M Abdel-Moneim
- Department of Urology, Urology and Nephrology Hospital, Assiut University, Assiut, Egypt
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11
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Jiang H, Yao S. Letter to the Editor regarding the article "A contemporary lower pole approach for complete staghorn calculi: outcomes and efficacy". World J Urol 2018; 36:2089-2090. [PMID: 30003377 DOI: 10.1007/s00345-018-2401-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- Huiming Jiang
- Department of Urology, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, No. 63, Huang Tang Road, Meizhou, 514031, Guangdong, People's Republic of China.
| | - Shiwu Yao
- Department of Urology, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated to Sun Yat-sen University, No. 63, Huang Tang Road, Meizhou, 514031, Guangdong, People's Republic of China
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Renal stone composition does not affect the outcome of percutaneous nephrolithotomy in children. World J Urol 2018; 36:1863-1869. [PMID: 29761226 DOI: 10.1007/s00345-018-2325-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/04/2018] [Indexed: 10/16/2022] Open
Abstract
PURPOSE We sought to investigate the association between renal stone composition and percutaneous nephrolithotomy outcomes in pediatric patients and define the characterization of the stone composition. METHODS The data of 1157 children who underwent percutaneous nephrolithotomy between 1991 and 2012 were retrieved from the multicenter database of the Turkish Pediatric Urology Society. The study population comprised 359 children (160 girls, 199 boys) with stone analyses. Patients were divided into five groups according to the stone composition [group 1: calcium oxalate; group 2: calcium phosphate; group 3: infection stones (magnesium ammonium phosphate, ammonium urate); group 4: cystine; group 5: uric acid, xanthine stones]. RESULTS Patient characteristics, perioperative, postoperative, and stone characteristics were compared considering the stone composition. There were no significant differences between the groups concerning age, sex, side involved, preoperative hematocrit levels, and solitary renal unit. Patients with cystine stones were more likely to have a history of stone treatment. Groups 2 and 5 had mostly solitary stones. However, group 3 had staghorn stone more often, and group 4 frequently had multiple stones. Overall stone-free rate (79.4%) was similar among the groups. Although stone composition was related to blood transfusion and prolonged operative and fluoroscopy screening times on univariate analysis, it was not a significant predictor of them on multivariate analysis. CONCLUSIONS Stone composition was not a predictor of outcomes of pediatric percutaneous nephrolithotomy. However, cystine and infection stones, which are larger and filled multiple calyxes due to the nature of stone forming, were more challenging cases that need multiple tracts.
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Falahatkar S, Mokhtari G, Amin A, Kazemnezhad E, Esmaeili S, Herfeh NR, Falahatkar R. Comparison of the outcomes of complete supine percutaneous nephrolithotomy in patients with radiopaque and radiolucent kidney stones. Turk J Urol 2017; 43:490-496. [PMID: 29201513 DOI: 10.5152/tud.2017.14477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 05/24/2017] [Indexed: 11/22/2022]
Abstract
Objective This study compared the stone opacity effect in patients who had radiopaque and radiolucent stones in percutaneous nephrolithotomy (PCNL) results. Material and methods The medical records of 171 complete supine PCNL procedures were gathered. Patients were categorized into two groups: those with radiopaque (n=141) and those with radiolucent (n=30) stones. Kidney, ureter and bladder x-ray was done a day after PCNL and Ultrasound imaging was done two weeks later to evaluate the stone free rate. A stone free result was defined as having less than 4 mm residual stone size. Outcome parameters were compared by univariate analysis and those which were significantly different between the two groups were assessed by multivariate binary logistic regression analysis. Results There were no significant differences in age, sex, body mass index, hypertension, diabetes mellitus, pre-surgery hemoglobin, pre-surgery serum creatinine, stone and also surgery-related parameters between the two groups. Stone free rate, surgery time, complication-related parameters, hemoglobin drop, serum creatinine and glomerular filtration rate (GFR) changes were similar in both groups based on univariate analysis. The radiopaque group had higher post-surgery GFR (p=0.04) and longer hospital stay (p=0.009). However, opacity had no effect on these outcomes after multivariate analysis. Higher post-surgery GFR was seen in patient with higher GFR before surgery (p<0.0001). Also, higher hemoglobin before surgery was correlated with less hospital stay (p=0.001). Conclusion The complete supine percutaneous nephrolithotomy outcomes are similar in patients with radiopaque and radiolucent stones.
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Affiliation(s)
- Siavash Falahatkar
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Gholamreza Mokhtari
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Atiyeh Amin
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnezhad
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Samaneh Esmaeili
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Nadia Rastjou Herfeh
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Reza Falahatkar
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Wu WJ, Okeke Z. Current clinical scoring systems of percutaneous nephrolithotomy outcomes. Nat Rev Urol 2017; 14:459-469. [PMID: 28534536 DOI: 10.1038/nrurol.2017.71] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Percutaneous nephrolithotomy has become the preferred treatment modality for patients with large renal calculi. The technique provides excellent stone clearance, but complication rates are higher than those of minimally invasive techniques, such as ureteroscopy and shockwave lithotripsy. Guy's stone score, S.T.O.N.E. nephrolithometry, the CROES nomogram, and S-ReSC are contemporary scoring systems introduced to provide standardized grading of stone complexity and outcomes of percutaneous stone surgery. Guy's stone score is easy to apply and has been validated in multiple studies. The S.T.O.N.E. score is based on factors determined through CT imaging, which is the currently preferred imaging modality for patients with nephrolithiasis. The CROES nomogram was developed from data in a large multicentre database and has high statistical power. Determination of the S-ReSC score relies on stone location only, providing a simple approach to grading disease complexity. Each system has advantages and disadvantages, but several studies suggest that their ability to predict stone-free rate is comparable. The optimal system should have a high predictive ability, should be simple to use and should be widely applicable. Additional studies are required to evaluate patient clinical factors that influence stone complexity and are predictive of outcomes. A future unified scoring system might incorporate the strengths of each currently available system and optimize care of patients with nephrolithiasis.
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Affiliation(s)
- Wayland J Wu
- Smith Institute for Urology, Hofstra Northwell School of Medicine, 450 Lakeville Road, Suite M41, Lake Success, New York 11042, USA
| | - Zeph Okeke
- Smith Institute for Urology, Hofstra Northwell School of Medicine, 450 Lakeville Road, Suite M41, Lake Success, New York 11042, USA
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Kwon O, Park J, Cho MC, Son H, Jeong H, Cho SY. Feasibility of single-session endoscopic combined intrarenal surgery for ipsilateral large renal stones and retrograde intrarenal surgery for contralateral renal stones: Initial experience. Int J Urol 2017; 24:377-382. [DOI: 10.1111/iju.13313] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/16/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Ohseong Kwon
- Department of Urology; Hallym University Kangnam Sacred Heart Hospital; Seoul Korea
| | - Juhyun Park
- Department of Urology; SMG-SNU Boramae Medical Center; Seoul Korea
| | - Min Chul Cho
- Department of Urology; SMG-SNU Boramae Medical Center; Seoul Korea
| | - Hwancheol Son
- Department of Urology; SMG-SNU Boramae Medical Center; Seoul Korea
| | - Hyeon Jeong
- Department of Urology; SMG-SNU Boramae Medical Center; Seoul Korea
| | - Sung Yong Cho
- Department of Urology; SMG-SNU Boramae Medical Center; Seoul Korea
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Singla A, Khattar N, Nayyar R, Mehra S, Goel H, Sood R. How practical is the application of percutaneous nephrolithotomy scoring systems? Prospective study comparing Guy's Stone Score, S.T.O.N.E. score and the Clinical Research Office of the Endourological Society (CROES) nomogram. Arab J Urol 2017; 15:7-16. [PMID: 28275512 PMCID: PMC5329720 DOI: 10.1016/j.aju.2016.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/13/2016] [Accepted: 11/27/2016] [Indexed: 12/03/2022] Open
Abstract
Objective To prospectively compare the Guy’s Stone Score (GSS), S.T.O.N.E. [stone size (S), tract length (T), obstruction (O), number of involved calices (N), and essence or stone density (E)] score and the Clinical Research Office of the Endourological Society (CROES) nephrolithometric nomogram to predict percutaneous nephrolithotomy (PCNL) success rate and assess the correlation with perioperative complications. Patients and methods We prospectively evaluated all consecutive PCNL patients at our institute between 1 November 2013 and 31 May 2015. The above scoring systems were applied to preoperative non-contrast computed tomography and the practical difficulties in such applications were noted. Perioperative complications and the stone-free rate (SFR) were also recorded. Receiver operating characteristic curves were drawn and the areas under curves were compared and appropriate statistical analysis done. Results In all, 48 renal units were included in the study. The overall SFR was 62.2%. The presence of staghorn stones (β = 27.285, 95% confidence interval 1.19–625.35; P = 0.039) was the only significant variable associated with the residual stones on multivariate analysis. Stone-free patients had significantly lower median GSS (2 vs 4) and S.T.O.N.E. scores (6 vs 10) and higher median CROES scores (83% vs 63%) (all P < 0.001) compared to residual-stone patients. All scoring systems were significantly associated with SFR (all P < 0.001). There was no significant difference in the areas under curves of the scoring systems (0.858, 0.923, and 0.931, respectively). Furthermore, all scoring systems had weak correlations with Clavien–Dindo classified complications (r = 0.29, P = 0.045; r = 0.40, P = 0.005 and r = −0.295, P = 0.04, respectively). We found no standardisation for the measurement of stone dimensions, tract length, Hounsfield units, and staghorn definition. Conclusions All scoring systems equally predicted SFR and had a weak correlation with Clavien–Dindo complications. Standardisation is needed for the variables in which they have been found deficient.
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Key Words
- 3D, three-dimensional
- ACS, acute angle, complicated calyx and stone size
- AUC, area under curve
- BMI, body mass index
- CCI, Charlson Comorbidity Index
- CROES, Clinical Research Office of the Endourological Society
- Clinical Research Office of the Endourological Society (CROES)
- GSS, Guy’s Stone Score
- Guy’s Stone Score
- HU, Hounsfield unit
- IQR, interquartile range
- KUB, plain abdominal radiograph of the kidneys, ureters and bladder
- NCCT, non-contrast CT
- PCNL, percutaneous nephrolithotomy
- Percutaneous nephrolithotomy (PCNL)
- ROC, receiver operating characteristic
- Renal stone
- S.O.N., stone size, obstruction and number of involved calyces
- S.T.O.N.E. score
- S.T.O.N.E., stone size (S), tract length (T), obstruction (O), number of involved calices (N), and essence or stone density (E)
- SFR, stone-free rate
- SFS, stone-free status
- SPSS, Statistical Package for the Social Sciences
- SSD, skin-to-stone distance
- SWL, shockwave lithotripsy
- US, ultrasonography
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Affiliation(s)
- Anurag Singla
- Department of Urology, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, Delhi, India
| | - Nikhil Khattar
- Department of Urology, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, Delhi, India
| | - Rishi Nayyar
- Department of Urology, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, Delhi, India
| | - Shibani Mehra
- Department of Radio-diagnosis, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, Delhi, India
| | - Hemant Goel
- Department of Urology, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, Delhi, India
| | - Rajeev Sood
- Department of Urology, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, Delhi, India
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Karalar M, Tuzel E, Keles I, Okur N, Sarici H, Ates M. Effects of Parenchymal Thickness and Stone Density Values on Percutaneous Nephrolithotomy Outcomes. Med Sci Monit 2016; 22:4363-4368. [PMID: 27842051 PMCID: PMC5111639 DOI: 10.12659/msm.898212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/05/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND It is unclear whether parenchymal thickness (PT), in combination with stone density measured by Hounsfield Units (HU), affects stone-free rates after PCNL. The aim of the present study was to investigate the relationship between PT in combination with stone density values and the outcomes of PCNL. MATERIAL AND METHODS From 2009 to 2014, data from 216 PCNL patients were prospectively analyzed. In total, 120 patients were included in the study. Using NCCT images, stone burden, stone localization, stone density as HU values, PT, and operative-postoperative parameters were recorded. RESULTS Stone localization, stone type, stone burden, and presence of hydronephrosis were statistically significant factors affecting stone-free status (p<0.001, p<0.001, p<0.01, and p<0.01, respectively). The stone-free rate in patients with thicker renal parenchyma was higher than in patients with lower parenchymal thickness (p<0.01). No correlation was detected between stone density and success rate (p>0.05). Drop in Hb (%) was only correlated with parenchymal thickness (p<0.01). In univariate analyses, factors that affected blood transfusion requirement were PT, BMI, and operative times (p<0.01, p<0.05, and p<0.05, respectively). CONCLUSIONS Stone location, stone burden, and presence of hydronephrosis detected with NCCT were factors affecting PCNL outcome. Stone density values did not correlate with the rate of bleeding or success of PCNL. PT measured by NCCT may predict bleeding and may guide surgeons in determining preoperative blood requirements. The outcome of PCNL appeared to be better in patients with thicker renal parenchyma and should be taken into consideration in the clinical evaluation of patients undergoing PCNL.
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Affiliation(s)
- Mustafa Karalar
- Department of Urology, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Emre Tuzel
- Department of Urology, Baskent University, Izmir, Turkey
| | - Ibrahim Keles
- Department of Urology, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Nazan Okur
- Department of Radiology, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Hasmet Sarici
- Department of Urology, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Mutlu Ates
- Department of Urology, Afyon Kocatepe University, Afyonkarahisar, Turkey
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Ghani KR, Andonian S, Bultitude M, Desai M, Giusti G, Okhunov Z, Preminger GM, de la Rosette J. Percutaneous Nephrolithotomy: Update, Trends, and Future Directions. Eur Urol 2016; 70:382-96. [DOI: 10.1016/j.eururo.2016.01.047] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/28/2016] [Indexed: 12/24/2022]
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Xiao B, Chen S, Zhang X, Hu WG, Liu YB, Tang YZ, Li JX. A Novel Semi-rigid Nephroscope Percutaneous Nephrolithotomy: The Best Therapy for Renal Staghorn Calculi. Chin Med J (Engl) 2015; 128:3109-11. [PMID: 26608995 PMCID: PMC4795261 DOI: 10.4103/0366-6999.169109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | | | - Wei-Guo Hu
- Department of Urology, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing 102218, China
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Ganpule A, Chhabra JS, Kore V, Mishra S, Sabnis R, Desai M. Factors predicting outcomes of micropercutaneous nephrolithotomy: results from a large single-centre experience. BJU Int 2015; 117:478-83. [DOI: 10.1111/bju.13263] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Arvind Ganpule
- Muljibhai Patel Urological Hospital; Nadiad Gujarat India
| | | | - Vinayak Kore
- Muljibhai Patel Urological Hospital; Nadiad Gujarat India
| | | | | | - Mahesh Desai
- Muljibhai Patel Urological Hospital; Nadiad Gujarat India
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Mahalingam H, Lal A, Mandal AK, Singh SK, Bhattacharyya S, Khandelwal N. Evaluation of low-dose dual energy computed tomography for in vivo assessment of renal/ureteric calculus composition. Korean J Urol 2015; 56:587-93. [PMID: 26279828 PMCID: PMC4534433 DOI: 10.4111/kju.2015.56.8.587] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/16/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study aimed to assess the accuracy of low-dose dual-energy computed tomography (DECT) in predicting the composition of urinary calculi. MATERIALS AND METHODS A total of 52 patients with urinary calculi were scanned with a 128-slice dual-source DECT scanner by use of a low-dose protocol. Dual-energy (DE) ratio, weighted average Hounsfield unit (HU) of calculi, radiation dose, and image noise levels were recorded. Two radiologists independently rated study quality. Stone composition was assessed after extraction by Fourier transform infrared spectroscopy (FTIRS). Analysis of variance was used to determine if the differences in HU values and DE ratios between the various calculus groups were significant. Threshold cutoff values to classify the calculi into separate groups were identified by receiver operating characteristic curve analysis. RESULTS A total of 137 calculi were detected. FTIRS analysis differentiated the calculi into five groups: uric acid (n=17), struvite (n=3), calcium oxalate monohydrate and dihydrate (COM-COD, n=84), calcium oxalate monohydrate (COM, n=28), and carbonate apatite (n=5). The HU value could differentiate only uric acid calculi from calcified calculi (p<0.001). The DE ratio could confidently differentiate uric acid, struvite, calcium oxalate, and carbonate apatite calculi (p<0.001) with cutoff values of 1.12, 1.34, and 1.66, respectively, giving >80% sensitivity and specificity to differentiate them. The DE ratio could not differentiate COM from COM-COD calculi. No study was rated poor in quality by either of the observers. The mean radiation dose was 1.8 mSv. CONCLUSIONS Low-dose DECT accurately predicts urinary calculus composition in vivo while simultaneously reducing radiation exposure without compromising study quality.
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Affiliation(s)
- Harshavardhan Mahalingam
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anupam Lal
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arup K Mandal
- Department of Urology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shrawan Kumar Singh
- Department of Urology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shalmoli Bhattacharyya
- Department of Biophysics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Lessons learned from the CROES percutaneous nephrolithotomy global study. World J Urol 2014; 33:223-33. [PMID: 25100624 DOI: 10.1007/s00345-014-1367-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 07/18/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE The purpose of the study was to give an overview of the data derived from the CROES PCNL Global Study published previously in 25 articles. METHODS A comprehensive overview of the outcome of the CROES PCNL Global Study was made, analysed and compared with the current literature and guidelines. RESULTS Percutaneous nephrolithotomy (PCNL) was predominately performed in prone position. Although the supine position claims to be favourable over the prone approach, the present study showed a longer operation time and lower stone-free rate (SFR). This might be explained by differences in definition in operation time and methods in the evaluation of residual stones. Ultrasound (US)-guided access proves beneficial in lowering puncture time and radiation exposure. Renal anomalies can safely be treated by PCNL and have similar outcomes to a normal situation. In patients with a solitary kidney, however, there is a lower SFR and more bleeding. Also, severe chronic kidney disease (CKD) patients have less favourable outcome. Morbidity and complications following PCNL are dominated by fever (10.5%) and bleeding (7.8%). A matched control analysis confirmed that antibiotic prophylaxis gives a threefold lower post-operative fever rate. In a multivariate analysis, it was elegantly demonstrated that bleeding was directly related to the size of the dilatation: the larger the bore, the higher the chance for bleeding. Elderly patients are at higher risk of complications and longer hospital stay. Overall, obese patients have similar outcome as the general population; however, super-obese (BMI > 40) patients have a higher chance of more severe complications. For the first time, this database illustrated a significant relationship between results and complications of PCNL, and caseload volume. The optimal case volume per centre appears to be 120 PCNL's/year. Finally, a nomogram has been developed that enables better patient counselling and decision-making. CONCLUSION The CROES PCNL Global Study is the largest real-life study providing new insights into general and special conditions. Because of the vast number of patients included, rare conditions including renal anomalies, solitary kidneys and patient characteristics like severe CKD, super obesity and old age could be analysed. Besides this information, a nomogram was developed. And for the first time, the influence of caseload volume was established.
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