MP68-18 IS THE STONE-FREE STATUS THE DESIRED OUTCOME FOR PATIENTS UNDERGOING PERCUTANEOUS NEPHROLITHOTOMY?

Abstract

You have accessJournal of UrologyStone Disease: Surgical Therapy IV1 Apr 2018MP68-18 IS THE STONE-FREE STATUS THE DESIRED OUTCOME FOR PATIENTS UNDERGOING PERCUTANEOUS NEPHROLITHOTOMY? Jorge Moreno Palacios, Virgilio Augusto López Sámano, Rodrigo Leon Mar, Oswaldo José Avilés Ibarra, León Octavio Torres Mercado, and Efraín Maldonado Alcaraz Jorge Moreno PalaciosJorge Moreno Palacios More articles by this author , Virgilio Augusto López SámanoVirgilio Augusto López Sámano More articles by this author , Rodrigo Leon MarRodrigo Leon Mar More articles by this author , Oswaldo José Avilés IbarraOswaldo José Avilés Ibarra More articles by this author , León Octavio Torres MercadoLeón Octavio Torres Mercado More articles by this author , and Efraín Maldonado AlcarazEfraín Maldonado Alcaraz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2222AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Currently stone-free status has been considered the most relevant outcome in patients undergoing percutaneous nephrolithotomy (PCNL), and complications associated with this surgery have been reported as secondary clinical outcome. We propose a stone-free status plus non-major complications as a novel and more relevant outcome. Clinical risk factors associated with this outcome were also identified. METHODS A cohort of 581 patients undergoing PCNL was analyzed. We stratified patients in three different groups: Patients with stone-free status and non-major complications (good prognosis); patients with residual stones and non-major complications (intermediate prognosis); and patients with major complications regardless of stone-free status (poor prognosis). Clinical characteristics including age, gender, Body Mass Index (BMI), American Society of Anesthesiologist (ASA) score, Charlson Comorbidity Index (CCI), urinary tract infection, affected kidney and complexity of stone, were collected. Univariate analysis and multiple logistic regression (MLR) were performed calculating risks (with 95% confidence interval) to determine the relationship of preoperative factors and the successful treatment. RESULTS A total of 581 PCNL procedures were included. Of these, 59% women with a median age of 49 years, 39% positive urine cultures, 30% complex stone and 6% CCI =5; 378 (65%) good, 126 (22%) intermediate and 77 (13%) poor prognosis. Female gender, positive urine culture, CCI =5 and complex stone were associated with poor prognosis (Table 1). In the MLR, complex stone remain as the only independent factor for intermediate prognosis (OR 2.2, CI 1.4-3.3, p 0.00) while female gender (OR 2.3, CI 1.3-4.3, p 0.00), positive urine culture (OR 1.7 CI 1.02-3.0, p 0.04), CCI =5 (OR 3.6 CI 1.4-8.9, p 0.00) and complex stone (OR 2.9, CI 1.7-5.0, p 0.00) resulted as independent risk factors for poor prognosis. CONCLUSIONS Treatment success in PCNL is mandatory to be considered as a composite outcome that includes the stone-free status and the presence of major complications. Complex stone, CCI, positive urine culture and female gender are the main predictors for poor prognosis in patients undergoing PCNL. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e924 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jorge Moreno Palacios More articles by this author Virgilio Augusto López Sámano More articles by this author Rodrigo Leon Mar More articles by this author Oswaldo José Avilés Ibarra More articles by this author León Octavio Torres Mercado More articles by this author Efraín Maldonado Alcaraz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...