Abstract
ABSTRACTPurpose:To identify the factors increased fluoroscopy time during percutaneous nephrolithotomy and investigate the relationship between the 3D segmentation volume ratio of stone to renal collecting system and fluoroscopy time.Materials and Methods:Data from 102 patients who underwent percutaneous nephrolithotomy were analyzed retrospectively. Volume segmentation of both the renal collecting system and stones were obtained from 3D segmentation software with the images on CT data. Analyzed stone volume (ASV), renal collecting system volume (RCSV) measured and the ASV-to-RCSV ratio was calculated. Several parameters were evaluated for their predictive ability with regard to fluoroscopy time.Results:The stone-free rate was 55.9% after the percutaneous nephrolithotomy. Complications occurred in 31(30.4%) patients. The mean fluoroscopy time was 199.4±151.1 seconds. The fluoroscopy time was significantly associated with the ASV-to-RCSV ratio (p<0.001, r=0.614). The single tract was used in 77 (75.5%) cases while multiple tracts were used in 25 (24.5%) cases. Fluoroscopy time was significantly associated with multiple access (p<0.001, r=0.689). On univariate linear regression analysis, longer fluoroscopy time was related with increased stone size, increased stone volume, increased number of access, increased calyx number with stone, increased ASV-to-RCSV, increased operative time and decreased stone essence. On multivariate linear regression analysis, the number of access and the ASV-to-RCSV were independent predictors of fluoroscopy time during percutaneous nephrolithotomy.Conclusions:The distribution of the stone burden volume in the pelvicalyceal system is a significant predictor for prolonged fluoroscopy time during percutaneous nephrolithotomy. Measures to decrease FT could be beneficial in patients with a high ASV-to-RCSV ratio for precise preoperative planning.
Highlights
Percutaneous nephrolithotomy (PCNL) has become standard treatment for complex renal stones from when it was first portrayed by Fernström and Johansson in 1976 [1]
As it is shown in Figure-2, fluoroscopy time (FT) was significantly associated with the Analyzed stone volume (ASV) / renal collecting system volume (RCSV) ratio (p
Our study showed that the ASV-to-RCSV ratio and the number of tracts were the independent predictors for increased FT during PCNL
Summary
Percutaneous nephrolithotomy (PCNL) has become standard treatment for complex renal stones from when it was first portrayed by Fernström and Johansson in 1976 [1]. Alltough it has some advantages such as high success, low morbidity and early convalescence, PCNL is still related to higher radiation exposure compared to other urological procedures [2,3,4]. The surgeons evaluate the pelvicalyceal system and choose the optimal calyx for puncturing with the help of fluoroscopy. It is significant to identify the related factors that affect fluoroscopy time (FT) during PCNL. FT is an important factor used for the evaluation of radiation exposure during urological operations [4]
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