1889 CALCIUM PHOSPHATE CONTENT DOES NOT EFFECT STONE FREE RATES FOLLOWING PERCUTANEOUS NEPROLITHOTOMY (PCNL)

Abstract

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopic or Percutaneous Stone Removal IV1 Apr 20101889 CALCIUM PHOSPHATE CONTENT DOES NOT EFFECT STONE FREE RATES FOLLOWING PERCUTANEOUS NEPROLITHOTOMY (PCNL) Chad Tracy, Amit Gupta, Richard Ho, Margaret Pearle, and Yair Lotan Chad TracyChad Tracy Iowa City, IA More articles by this author , Amit GuptaAmit Gupta Dallas, TX More articles by this author , Richard HoRichard Ho Dallas, TX More articles by this author , Margaret PearleMargaret Pearle Dallas, TX More articles by this author , and Yair LotanYair Lotan Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1843AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Work by others has suggested that stone free rates with percutaneous nephrostolithotomy (PCNL) are lower in patients with calcium phosphate stones compared with stones of other composition. Although stone composition may be important in non-extirpative stone surgery, it is unclear why stone composition should influence stone clearance in procedures that rely on stone fragmentation and retrieval under endoscopic visualization. We reviewed our PCNL experience in patients with calcium phosphate stones. METHODS 200 consecutive patients underwent PCNL between September 2005 and May 2007. A total of 212 procedures were performed in these 200 patients and, after excluding patients with simultaneous bilateral PCNL, the study group consisted of 188 patients who underwent unilateral PCNL. Initial stone size prior to PCNL was determined, and patients were assigned into 4 groups based on stone burden: < 2cm, > 2cm, partial staghorn calculus, and complete staghorn calculus. Stone analysis was available for all patients and stones were classified by calcium phosphate content (0 %, 1-10%, 11-60%, and >60%). Unenhanced computerized tomography (CT) was obtained on post-operative day 1, and, in order to stay consistent with the previous paper, cases were considered to be failures if stone fragments were > 2 mm. RESULTS The study group comprised 101 women (54%), and 132 patients (71%) were recurrent stone formers. Partial or complete staghorn calculi occurred in 47% of patients and an additional 13% had a maximal stone diameter > 2 cm. Among the group, 87% of patients had no anatomic abnormalities. Overall, 57% (n = 107) of patients had calcium phosphate as a component of their stone and of these patients, 20% (n = 37) had a stone composition consisting of >60% calcium phosphate. After PCNL, 38% of the patients were found on CT to have >2 mm residual fragments (treatment failures). Increasing stone size was associated with reduced stone free rates and the failure rates were 23%, 36%, 38% and 59% for patients with stone size < 2cm, > 2 cm, partial and complete staghorn respectively (p=0.001). There was no association between calcium phosphate content and failure. The failure rates were 37%, 46.4%, 38.1% and 32.4% for patients with 0%, 1-10%, 11-60%, and >60% calcium phosphate stone content (p=0.68). On multivariable logistic regression analyses, after controlling for stone size there was no association between calcium phosphate content and >2 mm residual stones (p = 0.67). CONCLUSIONS Calcium phosphate stone composition does not predict poor stone free rates after PCNL. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e734 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chad Tracy Iowa City, IA More articles by this author Amit Gupta Dallas, TX More articles by this author Richard Ho Dallas, TX More articles by this author Margaret Pearle Dallas, TX More articles by this author Yair Lotan Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...