Top

Published in:

Open Access 01-06-2021 | Computed Tomography | Original Article

New computed tomographic predictors of complicated perioperative course of 17.5F mini-percutaneous nephrolithotomy (mini-PNL)

Authors: Tomasz Ozimek, Jan M. Laturnus, Carolin Gohlke, Judith R. Wiessmeyer, Julian P. Struck, Marie C. Hupe, Axel S. Merseburger, Mario W. Kramer

Published in: World Journal of Urology | Issue 6/2021

Abstract

Purpose

Radiological parameters predicting a postoperative stone-free status (SFS) or a complicated perioperative course of mini-PNL, are scarce. Our aim was to identify such factors for prone 17.5F mini-PNL.

Methods

A monocentric cohort of 103 cases was retrospectively analysed for factors predicting SFS and relevant complications, i.e. Clavien–Dindo (CD) ≥ 2. Parameters measured on preoperative supine CT included maximal stone diameter, skin-to-stone distance (SSD), ideal tract length (ITL), access angle, minimal T12—Lower Kidney Pole distance (T12LP) and minimal Iliac Crest—Lower Kidney Pole distance (ICLP). Infundibulopelvic angle (IPA) was measured on intraoperative pyelography.

Results

The median maximal stone diameter was lower in cases with postoperative SFS [16 mm (Min. 10; Max. 35) vs. 20 mm (Min. 6; Max. 85), p = 0.0052]. CD ≥ 2 was more frequent in cases with a bigger stone burden [19 mm (Min. 13; Max. 85) vs. 16 mm (Min. 6; Max. 49), p = 0.0056] and with the ribs in the access angle [7/23 (30.43%) vs. 8/76 (10.53%); p = 0.0454]. T12LP significantly differed in cases with and without CD ≥ 2 [80.48 mm (± 21.31) vs. 90.43 mm (± 19.42), p = 0.0397]; however, it had no influence on SFS (p > 0.05). SSD, ITL, IPA and ICLP were significant regarding neither SFS nor CD ≥ 2 prevalence (p > 0.05). Using multivariate logistic regression, T12LP was confirmed as an independent predictor on CD ≥ 2 prevalence.

Conclusions

Preoperative computed tomographic factors indicating elevated kidney position influence perioperative course of mini-PNL. T12LP and the presence of ribs in the access angle are, apart from stone diameter, the most useful indicators for cases at risk of CD ≥ 2.

Turk C, Petrik A, Sarica K et al (2016) EAU guidelines on interventional treatment for Urolithiasis. Eur Urol 69:475–482CrossRef

Zanetti SP, Talso M, Palmisano F et al (2018) Comparison among the available stone treatment techniques from the first European Association of Urology Section of Urolithiasis (EULIS) Survey: Do we have a queen? PLoS ONE 13(11):e0205159CrossRef

de la Rossette JJ, Opondo J, Daels FP et al (2012) Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy. Eur Urol 62(2):246–255CrossRef

Gutierrez J, Smith A, Gleavlete P et al (2013) Urinary tract infections and post-operative fever in percutaneous nephrolithotomy. World J Urol 31(5):1135–1140CrossRef

Singh P, Yadav S, Singh A et al (2016) Systemic inflammatory response syndrome following percutaneous nephrolithotomy: assessment of risk factors and their impact on patient outcomes. Urol Int 96(2):207–211CrossRef

Olvera-Posada D, Tailly T, Alenezi H et al (2015) Risk factors for postoperative complications of percutaneous nephrolithotomy at a Tertiary Referral Center. J Urol 194(6):1646–1651CrossRef

Hammad FT, Balakrishnan A (2010) The effect of fat and nonfat components of the skin-to-stone distance on shockwave lithotripsy outcome. J Endourol 24(11):1825–1829CrossRef

Marchini GS, Berto FC, Vincentini FC et al (2015) Preoperative planning with noncontrast computed tomography in the prone and supine position for percutaneous nephrolithotomy: a practical overview. J Endourol 29(1):6–12CrossRef

Elbahnasy AM, Shalhav AL, Hoenig DM et al (1998) Lower caliceal stone clearance after shock wave lithotripsy or ureteroscopy: the impact of lower pole radiographic anatomy. J Urol 159:676–682CrossRef

10.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRef

11.

Valdivia JG, Scarpa RM, Duvdevani M et al (2011) Supine versus prone position during percutaneous nephrolithotomy: a report from the clinical research office of the endourological society percutaneous nephrolithotomy global study. J Endourol 25(10):1619–1625CrossRef

12.

Tuttle DN, Yeh BM, Meng MV et al (2005) Risk of injury to adjacent organs with lower-pole fluoroscopically guided percutaneous nephrostomy: evaluation with prone, supine, and multiplanar reformatted CT. J Vasc Interv Radiol 16(11):1489–1492CrossRef

13.

Noureldin YA, Elkoushy MA, Andonian S et al (2015) Which is better? Guy's vs. S.T.O.N.E. nephrolithometry scoring systems in predicting stone-free status post-percutaneous nephrolithotomy. World J Urol 33(11):1821–1825CrossRef

14.

Vincentini FC, Serzedello FR, Thomas K et al (2017) What is the quickest scoring system to predict percutaneous nephrolithotomy outcomes? A comparative study among S.T.O.N.E score, Guy's Stone Score and CROES nomogram. Int Braz J Urol 43(6):1102–1109CrossRef

15.

Lightner DJ, Wymer K, Sanchez J et al (2020) Best practice statement on urologic procedures and antimicrobial prophylaxis. J Urol 203(2):351–356CrossRef

16.

Liu J, Zhou C, Gao W et al (2020) Does preoperative urine culture still play a role in predicting post-PCNL SIRS? A retrospective cohort study. Urolithiasis 48(3):251–256CrossRef

17.

Aminsharifi A, Haghpanah R, Haghpanah S (2014) Predictors of excessive renal displacement during access in percutaneous nephrolithotomy: a randomized prospective trial. Urolithiasis 42(1):61–65CrossRef

18.

Ozimek T, Cordes J, Wiessmeyer JR et al (2018) Steep infundibulopelvic angle (IPA) as a new risk factor for flexible ureteroscope damage and complicated postoperative course. J Endourol 32(7):597–602CrossRef

19.

Oezsoy M, Acar O, Sarica K et al (2014) Impact of gender on success and complication rates after ureteroscopy. World J Urol 33:1297–1302CrossRef

Title: New computed tomographic predictors of complicated perioperative course of 17.5F mini-percutaneous nephrolithotomy (mini-PNL)
Authors: Tomasz Ozimek
Jan M. Laturnus
Carolin Gohlke
Judith R. Wiessmeyer
Julian P. Struck
Marie C. Hupe
Axel S. Merseburger
Mario W. Kramer
Publication date: 01-06-2021
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Computed Tomography
Published in: World Journal of Urology / Issue 6/2021
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-020-03388-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

New computed tomographic predictors of complicated perioperative course of 17.5F mini-percutaneous nephrolithotomy (mini-PNL)

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 6/2021

Is multiple tract percutaneous nephrolithotomy a safe approach for staghorn calculi?

Polyethylene glycol-based hydrogel rectal spacers for prostate brachytherapy: a systematic review with a focus on technique

Endoscopic enucleation for prostate larger than 60 mL: comparison between holmium laser enucleation and plasmakinetic enucleation

Non-technical skills for urological surgeons (NoTSUS): development and evaluation of curriculum and assessment scale

Development of a nomogram predicting metastatic disease and the assessment of NCCN, AUA and EAU guideline recommendations for bone imaging in prostate cancer patients

A right colon pouch with a novel efferent channel concept: long-term results of the Turin pouch