WISQOL is internally consistent and discriminates among patients with different stone statuses and symptoms. WISQOL is externally valid across the North American population. It may be used for multicenter health related quality of life studies in kidney stone disease.
Background
The purpose of this prospective trial was to compare the performance of ultra-low-dose computed tomography (CT) reconstruction algorithms with routine low-dose CT for the detection of urolithiasis.
Methods
48 consenting adults prospectively underwent routine low-dose non-contrast CT immediately followed by ultra-low-dose series targeted at 70-90% reduction from routine low-dose technique (sub-mSv range). Ultra-low-dose series were reconstructed with FBP, ASIR, and MBIR techniques. Transverse (axial) and coronal images were sequentially reviewed by three relatively inexperienced trainees (radiology resident, urology fellow, and abdominal imaging fellow). Three experienced abdominal radiologists independently reviewed the routine low-dose FBP images, which served as the reference standard.
Results
Mean effective dose for the ultra-low-dose scans was 0.91 mSv (median, 0.82 mSV), a 78 ± 5% reduction compared with routine low-dose. The overall per-stone sensitivity/PPV for ultra-low-dose CT at a 4 mm threshold was 0.91/0.98, respectively, with per-patient sensitivity/specificity/PPV/NPV/accuracy of 0.87/1.00/1.00/0.94/0.96. At a 4-mm threshold, per-stone sensitivity/PPV of the ultra-low-dose series for FBP, ASIR, and MBIR was 0.89/0.96, 0.91/0.98, and 0.93/1.00, respectively. Per-patient sensitivity/specificity/PPV/NPV/accuracy at the 4 mm threshold was 0.82/1.00/1.00/0.91/0.94 for FBP; 0.85/1.00/1.00/0.93/0.95 for ASIR; and 0.94/1.00/1.00/0.97/0.98 for MBIR. Sequential review of coronal images changed the final stone read in 13% of cases and improved diagnostic confidence in 49% of cases.
Conclusions
At a renal calculus size threshold of 4-mm, ultra-low-dose CT is accurate for detection when referenced against routine low-dose series with dose reduction to below the level of a typical 2-view KUB. Small differences were seen between reconstruction algorithms, with mild improvement with MBIR over FBP and ASIR. Coronal images improved both detection and diagnostic confidence over axial alone.
The majority of Endourological Society members performing PCNLs who responded obtain their own access, and there is a higher proportion of self-obtained access in fellowship-trained endourologists. Prone positioning is predominant, and more than 75% of respondents leave a nephrostomy tube postoperatively, underscoring that the tubeless approach is rare.
Renal angiomyolipomas (AMLs) are benign renal masses that are often asymptomatic and detected incidentally. However, treatment might be necessary in symptomatic presentations or when the mass exceeds 4 cm in size. While the goal of management for renal AMLs is to relieve symptoms and prevent hemorrhage, a priority is renal function preservation, especially given the propensity of these lesions to recur. The traditional treatment for renal AMLs is renal angioembolization or surgical excision of the lesion. With advancements in minimally invasive surgery, several other modalities have now emerged for nephron sparing approaches. These include angioembolization, laparoscopic and percutaneous ablative therapies such as radiofrequency ablation, cryoablation and microwave ablation, and pure or robot-assisted laparoscopic partial nephrectomy. Given the relatively low frequency of renal AMLs requiring treatment, much of the available literature on these minimally invasive approaches is largely extrapolative, based on series on small renal masses, i.e. renal cell carcinoma (RCC). This report is based on a thorough review of the published literature to date on the minimally invasive treatment and outcomes of renal AMLs.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.