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Does unenhanced computerized tomography as imaging standard post-retrograde intrarenal surgery paradoxically reduce stone-free rate and increase additional treatment for residual fragments? Outcomes from 5395 patients in the FLEXOR study by the TOWER group
BACKGROUND: Assessment of residual fragments (RFs) is a key step after treatment of kidney stones. OBJECTIVE: To evaluate differences in RFs estimation based on unenhanced computerized tomography (CT) versus X-rays/ultrasound after retrograde intrarenal surgery (RIRS) for kidney stones. DESIGN: A re...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10493056/ https://www.ncbi.nlm.nih.gov/pubmed/37701535 http://dx.doi.org/10.1177/17562872231198629 |
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author | Gauhar, Vineet Castellani, Daniele Chew, Ben Hall Smith, Daron Chai, Chu Ann Fong, Khi Yung Teoh, Jeremy Yuen-Chun Traxer, Olivier Somani, Bhaskar Kumar Tailly, Thomas |
author_facet | Gauhar, Vineet Castellani, Daniele Chew, Ben Hall Smith, Daron Chai, Chu Ann Fong, Khi Yung Teoh, Jeremy Yuen-Chun Traxer, Olivier Somani, Bhaskar Kumar Tailly, Thomas |
author_sort | Gauhar, Vineet |
collection | PubMed |
description | BACKGROUND: Assessment of residual fragments (RFs) is a key step after treatment of kidney stones. OBJECTIVE: To evaluate differences in RFs estimation based on unenhanced computerized tomography (CT) versus X-rays/ultrasound after retrograde intrarenal surgery (RIRS) for kidney stones. DESIGN: A retrospective analysis of data from 20 centers of adult patients who had RIRS was done (January 2018–August 2021). METHODS: Exclusion criteria: ureteric stones, anomalous kidneys, bilateral renal stones. Patients were divided into two groups (group 1: CT; group 2: plain X-rays or combination of X-rays/ultrasound within 3 months after RIRS). Clinically significant RFs (CSRFs) were considered RFs ⩾ 4 mm. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Multivariable logistic regression analysis was performed to evaluate independent predictors of CSRFs. RESULTS: A total of 5395 patients were included (1748 in group 1; 3647 in group 2). After matching, 608 patients from each group with comparable baseline and stone characteristics were included. CSRFs were diagnosed in 1132 patients in the overall cohort (21.0%). Post-operative CT reported a significantly higher number of patients with RFs ⩾ 4 mm, before (35.7% versus 13.9%, p < 0.001) and after matching (43.1% versus 23.9%, p < 0.001). Only 21.8% of patients in the matched cohort had an ancillary procedure post-RIRS which was significantly higher in group 1 (74.8% versus 47.6%, p < 0.001). Age [OR 1.015 95% confidence interval (CI) 1.009–1.020, p < 0.001], stone size (OR 1.028 95% CI 1.017–1.040, p < 0.001), multiple stones (OR 1.171 95% CI 1.025–1.339, p = 0.021), lower pole stone (OR 1.853 95% CI 1.557–2.204, p < 0.001) and the use of post-operative CT scan (OR 5.9883 95% CI 5.094–7.037, p < 0.001) had significantly higher odds of having CSRFs. CONCLUSIONS: CT is the only reliable imaging to assess the burden of RFs following RIRS and urologist should consider at least one CT scan to determine the same and definitely plan reintervention only based on CT rather than ultrasound and X-ray combination. |
format | Online Article Text |
id | pubmed-10493056 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-104930562023-09-11 Does unenhanced computerized tomography as imaging standard post-retrograde intrarenal surgery paradoxically reduce stone-free rate and increase additional treatment for residual fragments? Outcomes from 5395 patients in the FLEXOR study by the TOWER group Gauhar, Vineet Castellani, Daniele Chew, Ben Hall Smith, Daron Chai, Chu Ann Fong, Khi Yung Teoh, Jeremy Yuen-Chun Traxer, Olivier Somani, Bhaskar Kumar Tailly, Thomas Ther Adv Urol Original Research BACKGROUND: Assessment of residual fragments (RFs) is a key step after treatment of kidney stones. OBJECTIVE: To evaluate differences in RFs estimation based on unenhanced computerized tomography (CT) versus X-rays/ultrasound after retrograde intrarenal surgery (RIRS) for kidney stones. DESIGN: A retrospective analysis of data from 20 centers of adult patients who had RIRS was done (January 2018–August 2021). METHODS: Exclusion criteria: ureteric stones, anomalous kidneys, bilateral renal stones. Patients were divided into two groups (group 1: CT; group 2: plain X-rays or combination of X-rays/ultrasound within 3 months after RIRS). Clinically significant RFs (CSRFs) were considered RFs ⩾ 4 mm. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Multivariable logistic regression analysis was performed to evaluate independent predictors of CSRFs. RESULTS: A total of 5395 patients were included (1748 in group 1; 3647 in group 2). After matching, 608 patients from each group with comparable baseline and stone characteristics were included. CSRFs were diagnosed in 1132 patients in the overall cohort (21.0%). Post-operative CT reported a significantly higher number of patients with RFs ⩾ 4 mm, before (35.7% versus 13.9%, p < 0.001) and after matching (43.1% versus 23.9%, p < 0.001). Only 21.8% of patients in the matched cohort had an ancillary procedure post-RIRS which was significantly higher in group 1 (74.8% versus 47.6%, p < 0.001). Age [OR 1.015 95% confidence interval (CI) 1.009–1.020, p < 0.001], stone size (OR 1.028 95% CI 1.017–1.040, p < 0.001), multiple stones (OR 1.171 95% CI 1.025–1.339, p = 0.021), lower pole stone (OR 1.853 95% CI 1.557–2.204, p < 0.001) and the use of post-operative CT scan (OR 5.9883 95% CI 5.094–7.037, p < 0.001) had significantly higher odds of having CSRFs. CONCLUSIONS: CT is the only reliable imaging to assess the burden of RFs following RIRS and urologist should consider at least one CT scan to determine the same and definitely plan reintervention only based on CT rather than ultrasound and X-ray combination. SAGE Publications 2023-09-08 /pmc/articles/PMC10493056/ /pubmed/37701535 http://dx.doi.org/10.1177/17562872231198629 Text en © The Author(s), 2023 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Research Gauhar, Vineet Castellani, Daniele Chew, Ben Hall Smith, Daron Chai, Chu Ann Fong, Khi Yung Teoh, Jeremy Yuen-Chun Traxer, Olivier Somani, Bhaskar Kumar Tailly, Thomas Does unenhanced computerized tomography as imaging standard post-retrograde intrarenal surgery paradoxically reduce stone-free rate and increase additional treatment for residual fragments? Outcomes from 5395 patients in the FLEXOR study by the TOWER group |
title | Does unenhanced computerized tomography as imaging standard post-retrograde intrarenal surgery paradoxically reduce stone-free rate and increase additional treatment for residual fragments? Outcomes from 5395 patients in the FLEXOR study by the TOWER group |
title_full | Does unenhanced computerized tomography as imaging standard post-retrograde intrarenal surgery paradoxically reduce stone-free rate and increase additional treatment for residual fragments? Outcomes from 5395 patients in the FLEXOR study by the TOWER group |
title_fullStr | Does unenhanced computerized tomography as imaging standard post-retrograde intrarenal surgery paradoxically reduce stone-free rate and increase additional treatment for residual fragments? Outcomes from 5395 patients in the FLEXOR study by the TOWER group |
title_full_unstemmed | Does unenhanced computerized tomography as imaging standard post-retrograde intrarenal surgery paradoxically reduce stone-free rate and increase additional treatment for residual fragments? Outcomes from 5395 patients in the FLEXOR study by the TOWER group |
title_short | Does unenhanced computerized tomography as imaging standard post-retrograde intrarenal surgery paradoxically reduce stone-free rate and increase additional treatment for residual fragments? Outcomes from 5395 patients in the FLEXOR study by the TOWER group |
title_sort | does unenhanced computerized tomography as imaging standard post-retrograde intrarenal surgery paradoxically reduce stone-free rate and increase additional treatment for residual fragments? outcomes from 5395 patients in the flexor study by the tower group |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10493056/ https://www.ncbi.nlm.nih.gov/pubmed/37701535 http://dx.doi.org/10.1177/17562872231198629 |
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