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. 2022 Sep;40(9):2331-2338.
doi: 10.1007/s00345-022-04091-3. Epub 2022 Jul 13.

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

Letizia Maria Ippolita Jannello  1 , Matteo Turetti  1 , Carlo Silvani  1 , Gilda Galbiati  1 , Susanna Garbagnati  1 , Efrem Pozzi  1 , Matteo Malfatto  1 , Stefano Paolo Zanetti  1 , Fabrizio Longo  1 , Elisa De Lorenzis  1   2 , Giancarlo Albo  1   2 , Andrea Salonia  3 , Emanuele Montanari  1   2 , Luca Boeri  4
Affiliations

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

Letizia Maria Ippolita Jannello et al. World J Urol. 2022 Sep.

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.

Keywords: Intraoperative evaluation; Percutaneous nephrolithotomy; Stone-free rate; Vacuum-assisted percutaneous nephrolithotomy.

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Conflict of interest statement

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References

    1. Viljoen A, Chaudhry R, Bycroft J. Renal stones. Ann Clin Biochem. 2019;56:15–27. doi: 10.1177/0004563218781672. - DOI - PubMed
    1. Romero V, Akpinar H, Assimos DG. Kidney stones: a global picture of prevalence, incidence, and associated risk factors. Rev Urol. 2010;12:e86–96. - PMC - PubMed
    1. Türk C, Neisius A, Petřík A, Seitz C, Skolarikos A, Somani B, Thomas K, Gambaro G, Davis NF, Donaldson JF, Lombardo R, Tzelves L. EAU Guidelines on Urolithiasis. Available at: https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Urolithiasis-202.... Accessed Febrauary 18th, 2022. n.d.
    1. Han DS, Cher BAY, Lee D, Rajendran S, Riblet NBV, Pais VM. The durability of active surveillance in patients with asymptomatic kidney stones: a systematic review. J Endourol. 2019;33:598–605. doi: 10.1089/end.2018.0695. - DOI - PubMed
    1. Chung DY, Kang DH, Cho KS, Jeong WS, Jung HD, Kwon JK, et al. Comparison of stone-free rates following shock wave lithotripsy, percutaneous nephrolithotomy, and retrograde intrarenal surgery for treatment of renal stones: a systematic review and network meta-analysis. PLoS ONE. 2019;14:e0211316. doi: 10.1371/journal.pone.0211316. - DOI - PMC - PubMed