Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb 14;42(1):78.
doi: 10.1007/s00345-024-04774-z.

The significance of clinically insignificant residual fragments after percutaneous nephrolithotomy: an analysis into the relevance of complete stone clearance

Riemer A Kingma  1 , Carleen Doppen  2 , Mieke T J Bus  2 , Emanuela Altobelli  2 , Igle Jan de Jong  2 , Stijn Roemeling  2
Affiliations

The significance of clinically insignificant residual fragments after percutaneous nephrolithotomy: an analysis into the relevance of complete stone clearance

Riemer A Kingma et al. World J Urol. .

Abstract

Purpose: After treatment for kidney stones, residual fragments with a diameter of ≤ 4 mm are traditionally referred to as 'clinically insignificant residual fragments'. We hypothesize that patients with these fragments are at an increased risk for stone-related morbidity, such as complaints, hydronephrosis, and stone regrowth, when compared to stone-free patients. This study aimed to investigate the relevance of complete stone clearance in surgical treatment of urolithiasis.

Methods: We conducted a single-center retrospective cohort study. Patients who underwent percutaneous nephrolithotomy between 2015 and 2020 were included if a CT-scan was available within 6 months after the procedure, and the follow-up duration was at least 1 year. The stone-free status at the end of the first stone episode during the study period was categorized as fully stone-free, not stone-free with small residual fragments (≤ 4 mm) and not stone-free with large residual fragments (> 4 mm). Follow-up data were collected, including stone-related events and re-intervention rates.

Results: A total of 103 subjects were included with a median follow-up of 21.4 months. Stone-related events occurred in 10 (29.4%) of the fully stone-free subjects, 20 (58.8%) of the subjects with small residual fragments and 25 (71.4%) of the subjects with large residual fragments. The stone-related event-free survival per subgroup resulted in a significantly different survival distribution in a log rank test (p = 0.008).

Conclusion: A complete stone-free status seems to be of fundamental importance for decreasing stone-related morbidity. Further developments and research should focus on optimizing the full clearance of stone material during PCNL.

Keywords: Event free survival; Kidney stones; Percutaneous nephrolithotomy; Residual fragments; Urolithiasis.

PubMed Disclaimer

Conflict of interest statement

SR: EMS Urology consultant.

Figures

Fig. 1
Fig. 1
Stone-related event-free survival per subgroup
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Assimos D, Krambeck A, Miller NL et al (2016) Surgical management of stones: American Urological Association/Endourological Society Guideline Part I. J Urol 196(4):1153–1160. 10.1016/j.juro.2016.05.090 - PubMed
    1. Osman MM, Alfano Y, Kamp S et al (2005) 5-year-follow-up of patients with clinically insignificant residual fragments after extracorporeal shockwave lithotripsy. Eur Urol 47(6):860–864. 10.1016/j.eururo.2005.01.005 - PubMed
    1. Suarez-Ibarrola R, Hein S, Miernik A (2019) Residual stone fragments: clinical implications and technological innovations. Curr Opin Urol 29(2):129–134. 10.1097/MOU.0000000000000571 - PubMed
    1. Hein S, Miernik A, Wilhelm K et al (2016) Clinical significance of residual fragments in 2015: impact, detection, and how to avoid them. World J Urol 34(6):771–778. 10.1007/s00345-015-1713-2 - PubMed
    1. Tan YH, Wong M (2005) How significant are clinically insignificant residual fragments following lithotripsy? Curr Opin Urol 15(2):127–131. 10.1097/01.mou.0000160628.43860.f9 - PubMed

LinkOut - more resources