Size is Not Everything That Matters: Preoperative CT Predictors of Stone Free After RIRS - 30/09/19
, Bruno Aragão Rocha 2, Fabio Cesar Miranda Torricelli 1, Giovanni Scala Marchini 1, Carlos Batagello 1, Fabio Carvalho Vicentini 1, Olivier Traxer 3, Publio Cesar Cavalcante Viana 2, Miguel Srougi 4, William C. Nahas 4, Eduardo Mazzucchi 1ABSTRACT |
Objective |
To define computed tomography (CT) predictors of residual fragments after retrograde intrarenal surgery (RIRS) for kidney stones up to 20 mm in patients never submitted to surgical procedures for stone removal.
Methods |
From August 2016 to August 2017, symptomatic adult patients with kidney stones less than 20 mm treated by RIRS had their pre- and postoperative CT prospectively evaluated in search for predictors of residual stone fragments. Stone size, stone volume, number of stones, stone density, and location were evaluated in preoperative CT and analyzed as predictors for residual stone fragments on 90 POD CT. Stone location was represented by the infundibulopelvic angle (IPA) measured for each stone on preoperative noncontrast CT using multiplanar reconstruction.
Results |
Ninety-two patients were successfully submitted to RIRS. Bilateral procedures were performed in 23 patients (25%) resulting in 115 renal units operated. Operative time was 54.5 ± 26.7 minutes (mean ± SD) and 96.7% (89/92) of the patients were discharged up to 12 hours after the procedure. Postoperative CT demonstrated stone-free in 86 of 115 (74.8%), 0-2 mm in 10 of 115 (8.7%), and > 2 mm residual fragments in 19 of 115 (16.5%) procedures. Logistic regression analysis revealed steep IPA was a predictor for any residual stone fragment after RIRS for kidney stones < 20 mm (P= .012). ROC curve showed that IPA < 41° was associated with a higher chance of residual fragments after RIRS.
Conclusion |
IPA < 41° is associated with a higher chance of residual fragments after RIRS for kidney stones up to 20 mm.
Le texte complet de cet article est disponible en PDF.Plan
| Conflict of Interest: Alexandre Danilovic - speaker Coloplast, BD; Bruno Aragão Rocha - no conflict; Fabio Cesar Miranda Torricelli - no conflict; Giovanni Scala Marchini - no conflict; Carlos Batagello - no conflict; Fabio Carvalho Vicentini - speaker Boston Scientific; Olivier Traxer - consultant for Coloplast, EMS, Boston Sci Olympus, IPG Medical, Rocamed; Publio Cesar Cavalcante Viana - no conflict; Miguel Srougi - no conflict; William Carlos Nahas - no conflict; Eduardo Mazzucchi - speaker Boston Scientific, Promedon, Apsen. |
|
| Financial Disclosures: FAPESP 2014/05130-2. |
Vol 132
P. 63-68 - octobre 2019 Retour au numéro
Article précédent
- Performance of a Natural Language Processing Method to Extract Stone Composition From the Electronic Health Record
- Cosmin A. Bejan, Daniel J. Lee, Yaomin Xu, Ryan S. Hsi
- Upper Tract Urothelial Carcinoma Grade Prediction Based on the Ureteroscopic Appearance: Caution Should be Taken
- Jan Erik Freund, Jaap D. Legemate, Joyce Baard, Kasra Saeb-Parsy, Oliver Wiseman, Steeve Doizi, Esteban Emiliani, Alberto Breda, Bart J. Boodt, Ernst P. van Haarst, Mariska M.G. Leeflang, Guido M. Kamphuis
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?