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: 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 evaluate the efficacy of endoscopic combined intrarenal surgery using retrograde flexible ureteroscopy and miniature percutaneous nephrolithotomy for the treatment of patients with staghorn calculi in the prone split-leg position. Patients and Methods: We retrospectively reviewed the records of 42 patients with staghorn calculi (45.8 ± 3.2 mm) who underwent endoscopic combined intrarenal surgery using retrograde flexible ureteroscopy and miniature percutaneous nephrolithotomy in the prone split-leg position for the treatment of staghorn calculi in our center between December 2010 and August 2013. A flexible ureteroscope with a laser fiber was inserted through a ureteral access sheath, and lithoclast lithotripsy was performed through a mini-percutaneous tract. Both procedures were performed simultaneously by two urologists. Surgical parameters including surgical time, stone free rates, modified Clavien complication grades, and risk factors for residual stones were analyzed. Results: Fifteen patients (35.7%) had complete staghorn calculi. Among the 42 staghorn calculi treated, 23 had 0-5 stone branches, 14 had 6-10 stone branches, and 5 had ≥11 stone branches. All procedures were performed successfully using a single lithotripsy tract with the patient in the prone split-leg position. The mean surgical time was 143.2 ± 9.2 min. The initial stone-free rate was 71.4%, and the final stone-free rate was 83.3% after further treatment. One patient required a blood transfusion (2.4%), but no patient experienced a ≥3 Clavien grade complication. Risk factors for residual stones were stone size, stone surface area, complete staghorn calculi, and the number of stone branches. Conclusions: Endoscopic combined intrarenal surgery for staghorn calculi in the prone split-leg position is a safe, efficient, and versatile method for the effective management of staghorn calculi without the creation of multiple percutaneous tracts.Journal of endourology / Endourological Society 06/2014; · 1.75 Impact Factor
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ABSTRACT: The purpose of this study was to compare the treatment outcomes of staghorn stones using minimally invasive percutaneous nephrolithotomy (MPCNL) in patients who had positive preoperative urine culture to patients with negative urine culture. The records of 284 patients with staghorn calculi, who underwent MPCNL in our center from January 2012 to January 2013, were retrospectively analyzed. Patients were divided into positive and negative group, according to the result of preoperative urine culture. Staghorn stones with negative culture received a single dose of broad spectrum antibiotic prophylaxis, whereas stones with positive culture were treated for at least 72 h according to antibiogram. The perioperative findings and postoperative outcomes were compared between the two groups. There were 70 (24.6 %) patients with positive and 214 (75.4 %) patients with negative preoperative urine culture who underwent MPCNL. There were no statistical differences in the duration of hospital stay, operative time, estimated blood loss, final stone free rate (SFR) as well as the incidence of the following infectious complications such as fever, systemic inflammatory response syndrome and septic shock, between both groups. Our retrospective study showed that MPCNL was a safe and effective modality in the treatment of staghorn stones. The morbidity, complication, and SFR were similar between patients with positive and negative preoperative urine cultures, once the culture positive infections were adequately controlled.Urolithiasis. 02/2014;