1966: Sensitivity and Specificity of High Magnification Flouroscopy and Endoscopy for Intraoperative Detection of Residual Fragments During Percutaneous Nephrolithotomy

AbstractCone beam computed tomography (CBCT) provides multiplanar cross-sectional imaging and three-dimensional reconstructions and can be used intraoperatively in a hybrid operating room. In this study, we investigated the feasibility of using a CBCT-scanner for detecting residual stones during percutaneous nephrolithotomy (PCNL). Intraoperative CBCT-scans were made during PCNL procedures from November 2018 until March 2019 in a university hospital. At the point where the urologist would have otherwise ended the procedure, a CBCT-scan was made to image any residual fragments that could not be detected by either nephroscopy or conventional C-arm fluoroscopy. Residual fragments that were visualized on the CBCT-scan were attempted to be extracted additionally. To evaluate the effect of this additional extraction, each CBCT-scan was compared with a regular follow-up CT-scan that was made 4 weeks postoperatively. A total of 19 procedures were analyzed in this study. The mean duration of performing the CBCT-scan, including preparation and interpretation, was 8 min. Additional stone extraction, if applicable, had a mean duration of 11 min. The mean effective dose per CBCT-scan was 7.25 mSv. Additional extraction of residual fragments as imaged on the CBCT-scan occurred in nine procedures (47%). Of the follow-up CT-scans, 63% showed a stone-free status as compared to 47% of the intraoperative CBCT-scans. We conclude that the use of CBCT for the detection of residual stones in PCNL is meaningful, safe, and feasible.

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Re: Clinically Insignificant Residual Fragments After Percutaneous Nephrolithotomy: Medium-Term Follow-Up(From: Altunrende F, Tefekli A, Stein RJ, et al. J Endourol 2011;25:941–945)

Journal of Endourology ◽

10.1089/end.2012.0318 ◽

2016 ◽

Vol 30 (7) ◽

pp. 831-831

Author(s):

Swarnendu Mandal ◽

Apul Goel ◽

Rohit Kathpalia

Keyword(s):

Percutaneous Nephrolithotomy ◽

Medium Term ◽

Residual Fragments

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Stone Clearance by Computed Tomography after Percutaneous Nephrolithotomy: A Descriptive Cross-sectional Study

Journal of Nepal Medical Association ◽

10.31729/jnma.5219 ◽

2020 ◽

Vol 58 (228) ◽

Author(s):

Chitaranjan Shah ◽

Robin Bahadur Basnet ◽

Arvind Shah ◽

Prakash Chhettri ◽

Anup Chapagain ◽

...

Keyword(s):

Computed Tomography ◽

Percutaneous Nephrolithotomy ◽

Low Dose ◽

Cross Sectional Study ◽

Sectional Study ◽

Residual Stone ◽

Cross Sectional ◽

Stone Clearance ◽

Low Dose Computed Tomography ◽

Residual Fragments

Introduction: Percutaneous nephrolithotomy has the highest stone free rate among other procedures with relatively higher complication rate. Post-operative imaging after stone surgeries has not been uniform. This study was done to study about the stone clearance by computed tomography after percutaneous nephrolithotomy. Methods: The descriptive cross-sectional study was conducted in the Department of Urology, Bir Hospital for six months duration. The patients undergoing percutaneous nephrolithotomy and those with intra-operative fluoroscopic clearance were evaluated with a low dose computed tomography after 48 hours to assess residual fragments its size and location. Patient’s demographics, stone characteristics and complications were compared between the stone free and with residual stone patients. Results: Out of 72 percutaneous nephrolithotomy performed, 40 patients were included in the study. Low dose computed tomography kidney, ureter and bladder after 48 hours of surgery detected residual fragments in 11 (27.5%) patients. The RFs size of <4mm were found in 7 (63.63%) of cases whereas RFs of >4mm were found in 4 (36.36%). The stone size was 352.47 ± 97.47 mm2 and 254.79 ± 172.68mm2 in group with residual fragments and stone free group respectively. Conclusions: Low dose computed tomography kidney, ureter and bladder done for assessment of stone clearance after 48 hours of percutaneous nephrolithomy detected residual in around one fourth of patients, however majority of them had residual fragments <4mm. Intra-operative fluoroscopic clearance may over estimate stone clearance after percutaneous nephrolithomy as about one third of patients still may have residual fragments of >4mm size.

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MP30-12 POST PERCUTANEOUS NEPHROLITHOTOMY, WHAT DEFINES CLINICAL INSIGINIFICANT RESIDUAL FRAGMENTS

The Journal of Urology ◽

10.1016/j.juro.2015.02.594 ◽

2015 ◽

Vol 193 (4S) ◽

Author(s):

Tze Ying, Benjamin Lim ◽

Wai Loon Yam ◽

Sey Kiat Lim ◽

Foo Cheong Ng ◽

Kok Kit Ng

Keyword(s):

Percutaneous Nephrolithotomy ◽

Residual Fragments

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697 VALUE OF CLINICALLY INSIGNIFICANT RESIDUAL FRAGMENTS AS DEFINED BY COMPUTED TOMOGRAPHY AFTER PERCUTANEOUS NEPHROLITHOTOMY

European Urology Supplements ◽

10.1016/s1569-9056(11)60685-4 ◽

2011 ◽

Vol 10 (2) ◽

pp. 223

Author(s):

Y.M. Osman ◽

A.R. El-Nahas ◽

B. Awad ◽

H. El-Refaie ◽

A. El-Asmy ◽

...

Keyword(s):

Computed Tomography ◽

Percutaneous Nephrolithotomy ◽

Residual Fragments

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PERCUTANEOUS NEPHROLITOTOMY ON THE MANAGEMENT OF CALYX INFERIOR STONES

Indonesian Journal of Urology ◽

10.32421/juri.v21i2.37 ◽

2014 ◽

Vol 21 (2) ◽

Author(s):

Pande Made Wisnu Tirtayasa ◽

Ponco Birowo ◽

Nur Rasyid

Keyword(s):

Percutaneous Nephrolithotomy ◽

Medical Records ◽

Renal Ultrasonography ◽

Abdominal Radiography ◽

Stone Burden ◽

Stone Free Rate ◽

Plain Abdominal Radiography ◽

Free Rate ◽

Free Status ◽

Residual Fragments

Objectives: To compare the stone free rates of inferior calyceal stones with stone burden < 20 mm, 21-30 mm, and > 30 mm on post-percutaneous nephrolithotomy (PCNL) patients in Cipto Mangunkusumo Hospital. Material & method: The data was collected retrospectively from PCNL medical records in Cipto Mangunkusumo Hospital between January 2000 until May 2012. Patients were followed-up with plain abdominal radiography (BNO) or renal ultrasonography (USG). Stone free status was defined as no residual fragments on radiography or USG. Results: As many as 88 patients with inferior calyceal stones who underwent PCNL were included. Forty-three cases had stone burden < 20 mm, 34 cases with stone burden 21-30 mm, and 11 cases with stone burden > 30 mm. Overall, 81 (92%) cases were defined as stone free. On group < 20 mm, 21-30 mm, and > 30 mm; 41 (95%), 32 (94%), and 8 (73%) cases defined as stone free respectively (p = 0.485). Conclusion: PCNL is the primary modalityon the management of calyx inferior stones with high stone free rate. The stone free rate of these three groups showed no statistically significant difference.Keywords: Percutaneous nephrolithotomy, inferior calyx stone, stone free rate.

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