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

Harraz, Ahmed M.; Osman, Yasser; El-Nahas, Ahmed R.; Elsawy, Amr A.; Fakhreldin, Islam; Mahmoud, O. M.; El‐Assmy, Ahmed; Shokeir, Ahmed A.

doi:10.1007/s00345-016-1990-4

Cited by 22 publications

(18 citation statements)

References 29 publications

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“…Postoperative stone-free status was assessed by CT scan, and it was defined as the absence of residual stones larger than 4 mm. 8 Major surgical complications and the need for ancillary procedures to manage residual stones were also recorded. The preoperative, intraoperative, and postoperative variables used in this study are summarized in Supplementary Table S1.…”

Section: Patientsmentioning

confidence: 99%

Predicting the Postoperative Outcome of Percutaneous Nephrolithotomy with Machine Learning System: Software Validation and Comparative Analysis with Guy's Stone Score and the CROES Nomogram

Aminsharifi

Irani

Tayebi

et al. 2020

Journal of Endourology

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Purpose: To validate the output of a machine learning-based software as an intelligible interface for predicting multiple outcomes after percutaneous nephrolithotomy (PCNL). We compared the performance of this system with Guy's stone score (GSS) and the Clinical Research Office of Endourological Society (CROES) nomogram. Patients and Methods: Data from 146 adult patients (87 males, 59%) who underwent PCNL at our institute were used. To validate the system, accuracy of the software for predicting each postoperative outcome was compared with the actual outcome. Similarly, preoperative data were analyzed with GSS and CROES nomograms to determine stone-free status as predicted by these nomograms. A receiver operating characteristic (ROC) curve was generated for each scoring system, and the area under the ROC curve (AUC) was calculated and used to assess the predictive performance of all three models. Results: Overall stone-free rate was 72.6% (106/146). Forty of 146 patients (27.4%) were scheduled for 42 ancillary procedures (extracorporeal shockwave lithotripsy [SWL] [n = 31] or repeat PCNL [n = 11]) to manage residual renal stones. Overall, the machine learning system predicted the PCNL outcomes with an accuracy ranging between 80% and 95.1%. For predicting the stone-free status, the AUC for the software (0.915) was significantly larger than the AUC for GSS (0.615) or CROES nomograms (0.621) (p < 0.001). Conclusion: At the internal institutional level, the machine learning-based software was a promising tool for recording, processing, and predicting outcomes after PCNL. Validation of this system against an external dataset is highly recommended before its widespread application.

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Section: Patientsmentioning

confidence: 99%

Predicting the Postoperative Outcome of Percutaneous Nephrolithotomy with Machine Learning System: Software Validation and Comparative Analysis with Guy's Stone Score and the CROES Nomogram

Aminsharifi

Irani

Tayebi

et al. 2020

Journal of Endourology

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“…As a result of relentless evolution over the years, the safety profile of the tubeless PCNL has been repeatedly verified and its indications are progressively expanding, but extensive clinical trials are required to determine its absolute contraindication. Compared with postoperative non-contrast computed tomography, the sensitivity and the specificity of intraoperative detection rate of residual stone based on surgeons' experience were 50 and 97% respectively [16]. Thus, we can infer that it is not appropriate to estimate the stone clearance rate based on surgeons' intraoperative observation and evaluation, especially in case of complex stone.…”

Section: Resultsmentioning

confidence: 99%

Mini-Percutaneous Nephrolithotomy with Ureter Catheter: A Safe and Effective form of mPCNL Offers Better Quality of Life

et al. 2018

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Objective: To compare outcomes and postoperative quality of life (QoL) among patients with kidney stone who received mini-percutaneous nephrolithotomy (mPCNL), partial tubeless mPCNL or mPCNL with ureter catheter in a prospective randomized clinical trial. Methods: From May 2017 to December 2017, 60 patients with kidney stone who underwent mPCNL were randomized into 3 groups: Group I (mPCNL), Group II (partial tubeless mPCNL), Group III (mPCNL with ureter catheter). We evaluated perioperative characteristics, stone clearance, analgesic requirements and QoL by using the Wisconsin Stone QOL questionnaire. Results: The age, gender, stone diameter, body mass index, length of operation, drop in hemoglobin and stone-free rates for the 3 groups were similar among these groups. However, the postoperative visual analog scale and the analgesic requirement in Group II were significantly the lowest (p < 0.05). According to Wisconsin Stone QOL questionnaire, compared to Group I, statistical significant difference in the QoL was seen in Group II and III, indicating a meaningful and immediate improvement in the postoperative QoL following mPCNL. Conclusion: Compared with standard and partial tubeless mPCNL, mPCNL with ureter catheter is a safe and useful form of mPCNL, which can offer better QoL and is more cost effective.

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“…In a recent study by Harraz et al the authors evaluated stone free status with fluoroscopy guidance. In this study, surgeon's decision for stone free status has positive and negative predictive values of 92.8% and 72% (6). Portis et al evaluated the role of surgeon's decision for stone free status with the aid of flexible nephroscopy and reported positive and negative predictive values of 67% and 73% (7).…”

Section: Introductionmentioning

confidence: 82%

“…Portis et al evaluated the role of surgeon's decision for stone free status with the aid of flexible nephroscopy and reported positive and negative predictive values of 67% and 73% (7). These previous studies proved that fluoroscopic evaluation of the stone free status following PNL is not highly sensitive and specific (6) and additional use of antegrade flexible nephroscopy does not make the evaluation perfect as well (7).…”

Section: Introductionmentioning

confidence: 99%

Retrograde vs. antegrade flexible nephroscopy for detection of residual fragments following PNL: a prospective study with computerized tomography control

et al. 2019

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Introduction:The main aim of stone surgery is to establish stone free status. Performing flexible nephroscopy is an effective tool in this manner. The aim of this study was to evaluate the role of retrograde flexible nephroscopy for detection of residual fragments following percutaneous nephrolithotomy (PNL) in comparison with antegrade approach.Materials and Methods:Data of 137 patients underwent ECIRS was collected prospectively. In all cases following stone clearance, collecting system was checked for residual fragments. First antegrade than retrograde flexible nephroscopy was performed and success rates to reach all calices and detection of residual fragments were noted. All patients underwent CT and success rate of antegrade and retrograde approaches were compared. PPV and NPV of retrograde approach to detect residual fragments were calculated.Results:Antegrade and retrograde nephroscopy successfully accessed all of the calices in 101 (73.7%) and 130 (94.9%) patients respectively (p<0.0001). Residual fragments were observed in 18 (13.1%) patients following antegrade flexible nephroscopy. Retrograde approach identified residual stones in 17 more cases. These cases were treated with flexible nephroscopy or secondary percutaneous tract. Postoperative CT revealed residual stones in 10 (7.3%) patients. PPV and NPV of retrograde flexible nephroscopy were 83.3% and 96.2%.Conclusions:Flexible nephroscopy effectively detects residual fragments following PNL. Retrograde approach was more successful than antegrade approach to reach all calices. We recommend performing retrograde flexible nephroscopy following PNL especially in complex cases as it has the potential to increase SFR, decrease the need for second look surgery and unnecessary postoperative imaging.

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

Cited by 22 publications

References 29 publications

Predicting the Postoperative Outcome of Percutaneous Nephrolithotomy with Machine Learning System: Software Validation and Comparative Analysis with Guy's Stone Score and the CROES Nomogram

Predicting the Postoperative Outcome of Percutaneous Nephrolithotomy with Machine Learning System: Software Validation and Comparative Analysis with Guy's Stone Score and the CROES Nomogram

Mini-Percutaneous Nephrolithotomy with Ureter Catheter: A Safe and Effective form of mPCNL Offers Better Quality of Life

Retrograde vs. antegrade flexible nephroscopy for detection of residual fragments following PNL: a prospective study with computerized tomography control

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