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. 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.

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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

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