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Comparison of endoscopic versus CT assessment of stone-free status after percutaneous nephrolithotomy (PCNL)

This study is aimed to determine whether postoperative low dose computed tomography (LDCT) imaging is necessary after percutaneous nephrolithotomy (PCNL), or the surgeon's intraoperative assessment of residual fragments (RF) is sufficient and avoidance of postoperative imaging with reduction of...

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Autores principales: Hartung, F. O., Müller, K. J., Herrmann, J., Grüne, B., Michel, M. S., Rassweiler-Seyfried, M. C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10558392/
https://www.ncbi.nlm.nih.gov/pubmed/37801124
http://dx.doi.org/10.1007/s00240-023-01495-7
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author Hartung, F. O.
Müller, K. J.
Herrmann, J.
Grüne, B.
Michel, M. S.
Rassweiler-Seyfried, M. C.
author_facet Hartung, F. O.
Müller, K. J.
Herrmann, J.
Grüne, B.
Michel, M. S.
Rassweiler-Seyfried, M. C.
author_sort Hartung, F. O.
collection PubMed
description This study is aimed to determine whether postoperative low dose computed tomography (LDCT) imaging is necessary after percutaneous nephrolithotomy (PCNL), or the surgeon's intraoperative assessment of residual fragments (RF) is sufficient and avoidance of postoperative imaging with reduction of radiation exposure can be achieved. Data of all 610 patients who underwent PCNL in prone position in our institution from February 2009 to September 2020 was collected. Parameters such as age, gender, BMI, ASA-Classification, stone related parameters and the surgeon’s assessment of stone-free status were analyzed. The LDCT performed postoperatively was compared to the intraoperative assessment of the surgeon regarding RF. The mean age of patients was 52.82 years; the mean BMI was 28.18 kg/m(2). In 418 cases, the surgeon made a clear statement about the presence of RF and postoperative LDCT was carried out. The discrepancy between the two methods (surgeon´s assessment vs. LDCT) was significant at p < 0.0001. The sensitivity, specificity, positive and negative predictive value of the surgeon when assessing RF were 24.05%, 99.45%, 98.28% and 50%. Stone free rate (SFR) after primary PCNL was 45.57%. The overall SFR at discharge was 96.23%. Although the surgeon´s assessment of RF was reliable, postoperative LDCT imaging should still be performed if endoscopic stone clearance is suspected due to the high false negative rate and the low negative predictive value. The optimal timing of postoperative imaging following PCNL remains unclear.
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spelling pubmed-105583922023-10-08 Comparison of endoscopic versus CT assessment of stone-free status after percutaneous nephrolithotomy (PCNL) Hartung, F. O. Müller, K. J. Herrmann, J. Grüne, B. Michel, M. S. Rassweiler-Seyfried, M. C. Urolithiasis Research This study is aimed to determine whether postoperative low dose computed tomography (LDCT) imaging is necessary after percutaneous nephrolithotomy (PCNL), or the surgeon's intraoperative assessment of residual fragments (RF) is sufficient and avoidance of postoperative imaging with reduction of radiation exposure can be achieved. Data of all 610 patients who underwent PCNL in prone position in our institution from February 2009 to September 2020 was collected. Parameters such as age, gender, BMI, ASA-Classification, stone related parameters and the surgeon’s assessment of stone-free status were analyzed. The LDCT performed postoperatively was compared to the intraoperative assessment of the surgeon regarding RF. The mean age of patients was 52.82 years; the mean BMI was 28.18 kg/m(2). In 418 cases, the surgeon made a clear statement about the presence of RF and postoperative LDCT was carried out. The discrepancy between the two methods (surgeon´s assessment vs. LDCT) was significant at p < 0.0001. The sensitivity, specificity, positive and negative predictive value of the surgeon when assessing RF were 24.05%, 99.45%, 98.28% and 50%. Stone free rate (SFR) after primary PCNL was 45.57%. The overall SFR at discharge was 96.23%. Although the surgeon´s assessment of RF was reliable, postoperative LDCT imaging should still be performed if endoscopic stone clearance is suspected due to the high false negative rate and the low negative predictive value. The optimal timing of postoperative imaging following PCNL remains unclear. Springer Berlin Heidelberg 2023-10-06 2023 /pmc/articles/PMC10558392/ /pubmed/37801124 http://dx.doi.org/10.1007/s00240-023-01495-7 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research
Hartung, F. O.
Müller, K. J.
Herrmann, J.
Grüne, B.
Michel, M. S.
Rassweiler-Seyfried, M. C.
Comparison of endoscopic versus CT assessment of stone-free status after percutaneous nephrolithotomy (PCNL)
title Comparison of endoscopic versus CT assessment of stone-free status after percutaneous nephrolithotomy (PCNL)
title_full Comparison of endoscopic versus CT assessment of stone-free status after percutaneous nephrolithotomy (PCNL)
title_fullStr Comparison of endoscopic versus CT assessment of stone-free status after percutaneous nephrolithotomy (PCNL)
title_full_unstemmed Comparison of endoscopic versus CT assessment of stone-free status after percutaneous nephrolithotomy (PCNL)
title_short Comparison of endoscopic versus CT assessment of stone-free status after percutaneous nephrolithotomy (PCNL)
title_sort comparison of endoscopic versus ct assessment of stone-free status after percutaneous nephrolithotomy (pcnl)
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10558392/
https://www.ncbi.nlm.nih.gov/pubmed/37801124
http://dx.doi.org/10.1007/s00240-023-01495-7
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