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01-08-2017 | Original Article

Residual stones after percutaneous nephrolithotomy: comparison of intraoperative assessment and postoperative non-contrast computerized tomography

Authors: Ahmed M. Harraz, Yasser Osman, Ahmed R. EL-Nahas, Amr A. Elsawy, Islam Fakhreldin, Osama Mahmoud, Ahmed El-Assmy, Ahmed A. Shokeir

Published in: World Journal of Urology | Issue 8/2017

Abstract

Objectives

To compare the intraoperative surgeon perspective for detection of residual fragments (RFs) after percutaneous nephrolithotomy (PNL) with postoperative NCCT.

Methods

A prospective study of adult patients who underwent PNL between March and September 2014 was conducted. Stone complexity was evaluated using the Guy’s stone score (GSS). All patients were evaluated by pre- and postoperative NCCT. After the procedure, the surgeon had been asked whether there were residual stones or not. The sensitivity, specificity and predictive values were tested against postoperative NCCT. Predictors of accurate intraoperative assessment were determined using univariate and multivariate statistical analyses.

Results

The study included 306 consecutive patients. The surgeons reported no residual stones in 236 procedures; of whom 170 (72%) were reported stone-free by NCCT. On the other hand, 65 out of 70 procedures (93%) reported with residual stones by the surgeons were true by NCCT. The sensitivity was 50% and the NPV was 72%, while the specificity was 97% and the PPV was 93%. On multivariate analysis, only lower GSS (p < 0.001) was independently associated with true negative surgeon opinion.

Conclusions

Although there was a high surgeon ability to detect post-PNL residual stones, postoperative imaging is mandatory because of the high false negative rates and low NPV. The surgeon opinions can be judged only in stones with lower GSS. The NPV could be enhanced if a consistent definition of clinically significant RFs is introduced.

Osman Y, Harraz AM, El-Nahas AR, Awad B, El-Tabey N, Shebel H, Shoma AM, Eraky I, El-Kenawy M (2013) Clinically insignificant residual fragments: an acceptable term in the computed tomography era? Urology 81(4):723–726. doi:10.1016/j.urology.2013.01.011 CrossRefPubMed

Ozgor F, Simsek A, Binbay M, Akman T, Kucuktopcu O, Sarilar O, Muslumanoglu AY, Berberoglu Y (2014) Clinically insignificant residual fragments after flexible ureterorenoscopy: medium-term follow-up results. Urolithiasis 42(6):533–538. doi:10.1007/s00240-014-0691-y CrossRefPubMed

El-Assmy A, El-Nahas AR, Harraz AM, El Demerdash Y, Elsaadany MM, El-Halwagy S, Sheir KZ (2015) Clinically insignificant residual fragments: Is it an appropriate term in children? Urology 86(3):593–598. doi:10.1016/j.urology.2015.06.017 CrossRefPubMed

Shahrour K, Tomaszewski J, Ortiz T, Scott E, Sternberg KM, Jackman SV, Averch TD (2012) Predictors of immediate postoperative outcome of single-tract percutaneous nephrolithotomy. Urology 80(1):19–25. doi:10.1016/j.urology.2011.12.065 CrossRefPubMed

Tirapegui FI, Gonzalez MS, Gonzalez IP, Daels FP (2015) Pyelocaliceal distribution of kidney stones used as an outcome predictor in percutaneous nephrolithotomy after being evaluated with preoperative and postoperative CT scan. J Endourol/Endourol Soc 29(6):666–670. doi:10.1089/end.2014.0410 CrossRef

Thomas K, Smith NC, Hegarty N, Glass JM (2011) The Guy’s stone score—grading the complexity of percutaneous nephrolithotomy procedures. Urology 78(2):277–281. doi:10.1016/j.urology.2010.12.026 CrossRefPubMed

Smith A, Averch TD, Shahrour K, Opondo D, Daels FPJ, Labate G, Turna B, de la Rosette JJMCH (2013) A nephrolithometric nomogram to predict treatment success of percutaneous nephrolithotomy. J Urol 190(1):149–156. doi:10.1016/j.juro.2013.01.047 CrossRefPubMed

Parente A, Tardaguila AR, Romero R, Burgos L, Rivas S, Angulo JM (2013) Is intraoperative surgeon’s opinion an accurate tool to assess the outcome of endoscopic treatment for vesicoureteral reflux? J Pediatr Urol 9(6 Pt B):1145–1149. doi:10.1016/j.jpurol.2013.04.017 CrossRefPubMed

Herr HW (2001) Does cystoscopy correlate with the histology of recurrent papillary tumours of the bladder? BJU Int 88(7):683–685CrossRefPubMed

10.

Portis AJ, Laliberte MA, Holtz C, Ma W, Rosenberg MS, Bretzke CA (2008) Confident intraoperative decision making during percutaneous nephrolithotomy: Does this patient need a second look? Urology 71(2):218–222. doi:10.1016/j.urology.2007.08.063 CrossRefPubMed

11.

de la Rosette JJ, Laguna MP, Rassweiler JJ, Conort P (2008) Training in percutaneous nephrolithotomy—a critical review. Eur Urol 54(5):994–1001. doi:10.1016/j.eururo.2008.03.052 CrossRefPubMed

12.

Ng CF (2014) Training in percutaneous nephrolithotomy: the learning curve and options. Arab J Urol 12(1):54–57. doi:10.1016/j.aju.2013.08.002 CrossRefPubMed

13.

Perez-Fentes DA, Gude F, Blanco M, Novoa R, Freire CG (2013) Predictive analysis of factors associated with percutaneous stone surgery outcomes. Can J Urol 20(6):7050–7059PubMed

14.

Noureldin YA, Elkoushy MA, Andonian S (2015) Which is better? Guy’s versus S.T.O.N.E. nephrolithometry scoring systems in predicting stone-free status post-percutaneous nephrolithotomy. World J Urol. doi:10.1007/s00345-015-1508-5

15.

Portis AJ, Laliberte MA, Tatman P, Lendway L, Rosenberg MS, Bretzke CA (2014) Retreatment after percutaneous nephrolithotomy in the computed tomographic era: long-term follow-up. Urology 84(2):279–284. doi:10.1016/j.urology.2014.02.041 CrossRefPubMed

16.

Ali S, Kumar N, Baloch U (2014) Outcome of percutaneous nephrolithotomy. J Coll Phys Surg-Pak JCPSP 24(4):261–264

17.

Tyson MD 2nd, Humphreys MR (2014) Postoperative complications after percutaneous nephrolithotomy: a contemporary analysis by insurance status in the United States. J Endourol/Endourol Soc 28(3):291–297. doi:10.1089/end.2013.0624 CrossRef

18.

Armitage JN, Withington J, van der Meulen J, Cromwell DA, Glass J, Finch WG, Irving SO, Burgess NA (2014) Percutaneous nephrolithotomy in England: practice and outcomes described in the Hospital Episode Statistics database. BJU Int 113(5):777–782. doi:10.1111/bju.12373 CrossRefPubMed

19.

Sountoulides P, Metaxa L, Cindolo L (2013) Is computed tomography mandatory for the detection of residual stone fragments after percutaneous nephrolithotomy? J Endourol/Endourol Soc 27(11):1341–1348. doi:10.1089/end.2012.0253 CrossRef

20.

Harraz AM, Osman Y, El-Nahas AR (2013) Reply by the authors. Urology 82(2):497. doi:10.1016/j.urology.2013.04.019 CrossRefPubMed

21.

el-Nahas AR, Eraky I, Shokeir AA, Shoma AM, el-Assmy AM, el-Tabey NA, Soliman S, Elshal AM, el-Kappany HA, el-Kenawy MR (2012) Factors affecting stone-free rate and complications of percutaneous nephrolithotomy for treatment of staghorn stone. Urology 79(6):1236–1241. doi:10.1016/j.urology.2012.01.026 CrossRefPubMed

22.

Guner B, Gurbuz C, Canat L, Caskurlu T (2012) Place of non contrast thin-slice spiral computed tomography in evaluation of stone-free ratio after percutaneous nephrolithotomy. Curr Urol 6(2):71–75. doi:10.1159/000343512 CrossRefPubMedPubMedCentral

23.

Sofer M, Druckman I, Blachar A, Ben-Chaim J, Matzkin H, Aviram G (2012) Non-contrast computed tomography after percutaneous nephrolithotomy: findings and clinical significance. Urology 79(5):1004–1010. doi:10.1016/j.urology.2011.11.022 CrossRefPubMed

24.

Gnessin E, Mandeville JA, Handa SE, Lingeman JE (2012) The utility of noncontrast computed tomography in the prompt diagnosis of postoperative complications after percutaneous nephrolithotomy. J Endourol/Endourol Soc 26(4):347–350. doi:10.1089/end.2011.0504 CrossRef

25.

Skolarikos A, Papatsoris AG (2009) Diagnosis and management of postpercutaneous nephrolithotomy residual stone fragments. J Endourol/Endourol Soc 23(10):1751–1755. doi:10.1089/end.2009.1546 CrossRef

26.

Williams SK, Leveillee RJ (2008) Management of staghorn calculus: single puncture with judicious use of the flexible nephroscope. Curr Opin Urol 18(2):224–228. doi:10.1097/MOU.0b013e3282f517c0 CrossRefPubMed

27.

Ganpule AP, Desai M (2008) Management of the staghorn calculus: multiple-tract versus single-tract percutaneous nephrolithotomy. Curr Opin Urol 18(2):220–223. doi:10.1097/MOU.0b013e3282f3e6e4 CrossRefPubMed

28.

Portis AJ, Laliberte MA, Drake S, Holtz C, Rosenberg MS, Bretzke CA (2006) Intraoperative fragment detection during percutaneous nephrolithotomy: evaluation of high magnification rotational fluoroscopy combined with aggressive nephroscopy. J Urol 175(1):162–165. doi:10.1016/s0022-5347(05)00052-2 (discussion 165–166) CrossRefPubMed

29.

Vicentini FC, Marchini GS, Mazzucchi E, Claro JF, Srougi M (2014) Utility of the Guy’s stone score based on computed tomographic scan findings for predicting percutaneous nephrolithotomy outcomes. Urology 83(6):1248–1253. doi:10.1016/j.urology.2013.12.041 CrossRefPubMed

30.

Osman Y, El-Tabey N, Refai H, Elnahas A, Shoma A, Eraky I, Kenawy M, El-Kapany H (2008) Detection of residual stones after percutaneous nephrolithotomy: role of nonenhanced spiral computerized tomography. J Urol 179(1):198–200. doi:10.1016/j.juro.2007.08.175 (discussion 200) CrossRefPubMed

Title: Residual stones after percutaneous nephrolithotomy: comparison of intraoperative assessment and postoperative non-contrast computerized tomography
Authors: Ahmed M. Harraz
Yasser Osman
Ahmed R. EL-Nahas
Amr A. Elsawy
Islam Fakhreldin
Osama Mahmoud
Ahmed El-Assmy
Ahmed A. Shokeir
Publication date: 01-08-2017
Publisher: Springer Berlin Heidelberg
Published in: World Journal of Urology / Issue 8/2017
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-016-1990-4

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Residual stones after percutaneous nephrolithotomy: comparison of intraoperative assessment and postoperative non-contrast computerized tomography

Abstract

Objectives

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

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