Abstract
PurposeRadiological parameters predicting a postoperative stone-free status (SFS) or a complicated perioperative course of mini-PNL, are scarce. Our aim was to identify such factors for prone 17.5F mini-PNL.MethodsA monocentric cohort of 103 cases was retrospectively analysed for factors predicting SFS and relevant complications, i.e. Clavien–Dindo (CD) ≥ 2. Parameters measured on preoperative supine CT included maximal stone diameter, skin-to-stone distance (SSD), ideal tract length (ITL), access angle, minimal T12—Lower Kidney Pole distance (T12LP) and minimal Iliac Crest—Lower Kidney Pole distance (ICLP). Infundibulopelvic angle (IPA) was measured on intraoperative pyelography.ResultsThe median maximal stone diameter was lower in cases with postoperative SFS [16 mm (Min. 10; Max. 35) vs. 20 mm (Min. 6; Max. 85), p = 0.0052]. CD ≥ 2 was more frequent in cases with a bigger stone burden [19 mm (Min. 13; Max. 85) vs. 16 mm (Min. 6; Max. 49), p = 0.0056] and with the ribs in the access angle [7/23 (30.43%) vs. 8/76 (10.53%); p = 0.0454]. T12LP significantly differed in cases with and without CD ≥ 2 [80.48 mm (± 21.31) vs. 90.43 mm (± 19.42), p = 0.0397]; however, it had no influence on SFS (p > 0.05). SSD, ITL, IPA and ICLP were significant regarding neither SFS nor CD ≥ 2 prevalence (p > 0.05). Using multivariate logistic regression, T12LP was confirmed as an independent predictor on CD ≥ 2 prevalence.ConclusionsPreoperative computed tomographic factors indicating elevated kidney position influence perioperative course of mini-PNL. T12LP and the presence of ribs in the access angle are, apart from stone diameter, the most useful indicators for cases at risk of CD ≥ 2.
Highlights
Percutaneous nephrolithotomy is the preferred option for the treatment of large kidney stones > 2 cm in diameter
A monocentric cohort of patients scheduled for prone 17.5F mini-PNL (103 cases) in our department between 2014 and 2019 was retrospectively analysed for factors predicting postoperative stone-free status (SFS) and relevant perioperative complications Clavien–Dindo (CD) ≥ 2
The CD ≥ 2 complication rate was 22.33% (23/103), and constituted mostly of postoperative febrile infections (18/23; 78.26%), that were defined as systemic inflammatory response syndrome (SIRS), requiring additional postoperative intravenous antibiotic therapy
Summary
Percutaneous nephrolithotomy is the preferred option for the treatment of large kidney stones > 2 cm in diameter. Despite the wide choice of devices for percutaneous stone treatment (4.8–24F), miniPNL is preferred in most clinical settings, as a compromise between good outcomes, safety and acceptable operation times [2]. World Journal of Urology (2021) 39:2147–2154 endourologic procedure is, with substantial perioperative complications [3], postoperative urinary tract infections or sepsis [4]. To identify high-risk cases and to increase patient’s safety, several risk factors, such as staghorn stones, positive preoperative urine culture, diabetes, patient’s age, prolonged operation time or upper pole access, have already been determined [4,5,6]. Apart from stone burden itself, other radiological parameters predicting a postoperative stone-free status (SFS) or complicated perioperative course of percutaneous procedures are scarce. Our aim was to identify such factors, based on preoperative computed tomography (CT) in supine position, and intraoperative pyelographic imaging, for prone 17.5F mini-PNL
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