Factors affecting stone-free rate and complications of percutaneous nephrolithotomy for treatment of staghorn stone.
ABSTRACT To determine factors affecting the stone-free rate and complications of percutaneous nephrolithotomy (PNL) for treatment of staghorn stones.
The computerized database of patients who underwent PNL for treatment of staghorn stones between January 2003 and January 2011 was reviewed. All perioperative complications were recorded and classified according to modified Clavien classification system. The stone-free rate was evaluated with low-dose noncontrast computed tomography (CT). Univariate and multivariate statistical analyses were performed to determine factors affecting stone-free and complication rates.
The study included 241 patients (125 male and 116 female) with a mean age of 48.7 ±14.3 years. All patients underwent 251 PNL (10 patients had bilateral stones). The stone-free rate of PNL monotherapy was 56% (142 procedures). At 3 months, the stone-free rate increased to 73% (183 kidneys) after shock wave lithotripsy. Independent risk factors for residual stones were complete staghorn stone and presence of secondary calyceal stones (relative risks were 2.2 and 3.1, respectively). The complication rate was 27% (68 PNL). Independent risk factors for development of complications were performance of the procedure by urologists other than experienced endourologist and positive preoperative urine culture (relative risks were 2.2 and 2.1, respectively).
Factors affecting the incidence of residual stones after PNL are complete staghorn stones and the presence of secondary calyceal stones. Complications are significantly high if PNL is not performed by an experienced endourologist or if preoperative urine culture is positive.
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ABSTRACT: Abstract Purpose: To report the clinical efficacy and intermediate-term functional outcome after laparoscopic anatrophic nephrolithotomy (LAN) as an alternative treatment modality for complete staghorn renal stone. Patients and Methods: The demographic and perioperative parameters as well as the intermediate outcome of 10 adults (9 men) who underwent transperitoneal LAN for complete staghorn renal stone were analyzed. Functional imaging studies consisted of intravenous urography (IVU) and technetium-99 dimercaptosuccinic acid scintigraphy (99Tc-DMSA) renal scan done before the operation and at the last follow-up visit. Results: Mean age of patients was 48.7 years (range 37-64 years). Mean stone size was 67.3 mm (50-90 mm). Mean operative time was 192 minutes (110-240 min), and mean warm ischemia time was 32.8 minutes (15-40 min). A few hours after laparoscopy, one patient underwent splenectomy because of significant hemorrhage from a splenic laceration (grade IIIb complication). During the follow-up period early after the operation, we detected an 8-mm lower caliceal stone and a 25-mm midcaliceal stone in one patient each (stone-free rate: 80%). After a mean follow-up of 11.9 months (6-19 mos), 85.5% of corresponding renal unit function was preserved; however, there was a significant mean decrease in 99Tc-DMSA uptake from 48.4%±8.83 before surgery to 41.4%±13.98 afterward (-7%±6.53; P=0.008). Nevertheless, renal units were completely functional at follow-up IVU with a significant improvement in obstruction in all patients. Conclusion: LAN is an alternative minimally invasive approach for one-session management of patients with complete staghorn renal stone. It offers an acceptable rate of stone clearance and operative complications but does incur a minimal loss of function in the affected kidney.Journal of endourology / Endourological Society 02/2013; · 1.75 Impact Factor
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ABSTRACT: The Seoul National University Renal Stone Complexity (S-ReSC) scoring system was developed to predict the stone-free rate (SFR) after single-tract percutaneous nephrolithotomy (PCNL). This study is an external validation of this scoring system. A retrospective review included 327 patients who underwent PCNL at 2 tertiary referral centers. The S-ReSC score was assigned from 1 to 9 based on the number of sites involved. The stone free status was defined as either complete clearance or clinically insignificant residual fragments <4 mm in size at 1 month follow-up imaging. Inter-observer and test-retest reliabilities were evaluated. The statistical performance of the prediction model was assessed by its predictive accuracy, predictive probability, and clinical usefulness. The overall SFR was 65.4%. SFRs were 83.9%, 47.6%, and 21.4% in low (1-2), intermediate (3-4), and high (5-9) score groups, respectively, with significant differences (P<0.001). Inter-observer and test-retest reliabilities revealed almost perfect agreements. External validation of the S-ReSC scoring system revealed an AUC of 0.731 (95% CI 0.675-0.788). The AUC of 3-titered S-ReSC score groups was 0.691 (95% CI, 0.629-0.753). The calibration plot showed that the predicted probability of SFR had a concordance comparable to that of the observed frequency. The Hosmer-Lemeshow goodness-of-fit statistic revealed an adequate performance of the predictive model (P = 0.10). Inter-observer and test-retest reliability showed a good level of agreement. The S-ReSC scoring system is useful in predicting the post-PCNL SFR and in describing the complexity of renal stones.PLoS ONE 01/2014; 9(1):e83628. · 3.53 Impact Factor
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ABSTRACT: Purpose: To determine the impact of staghorn calculi branch number on outcomes of percutaneous nephrolithotomy (PNL). Materials and Methods: Retrospectively, we evaluated 371 patients (386 renal units) who underwent PNL for staghorn calculi. All calculi were showed with CT 3-dimentional reconstruction (3-DR) imaging preoperatively. From 3-DR images, the number of stone branching into minor renal calices was recorded. According to the number, patients were divided into four groups. Group 1: the branch number 2-4; Group 2: the branch number 5-7; Group 3: the branch number 8-10; Group 4: the branch number＞10. The number of percutaneous tract, operative time, staged PNL, intra-operative blood loss，postoperative hospital stay, complications, main stone composition , and stone clearance rate were compared. Results: A significantly higher ratio of multi-tract (P＜0.001) and staged PNL(P＜0.001), longer operative time (P＜0.001) and postoperative hospital stay(P=0.043) and lower rate of stone clearance(P＜0.05) were found in PNL for calculi with stone branch number≥5. There was no statistical difference in intra-operative blood loss (P=0.101) and main stone composition (P=0.546). There was no statistically meaningful difference among the 4 groups based on Clavien complication system (P =0.46). Conclusion: With stone branch number more than 5, the possibility of multi-tract and staged PNL, lower rate of stone clearance and longer postoperative hospital stay increases for staghorn calculi.Journal of endourology / Endourological Society 10/2013; · 1.75 Impact Factor