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Upper urinary tract stone disease in patients with poor performance status: active stone removal or conservative management?

BACKGROUND: It remains controversial as to whether active stone removal should be performed in patients with poor performance status because of their short life expectancy and perioperative risks. Our objectives were to evaluate treatment outcomes of active stone removal in patients with poor perfor...

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Autores principales: Yamashita, Shimpei, Kohjimoto, Yasuo, Hirabayashi, Yasuo, Iguchi, Takashi, Iba, Akinori, Higuchi, Masatoshi, Koike, Hiroyuki, Wakamiya, Takahito, Nishizawa, Satoshi, Hara, Isao
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5691806/
https://www.ncbi.nlm.nih.gov/pubmed/29145832
http://dx.doi.org/10.1186/s12894-017-0293-4
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author Yamashita, Shimpei
Kohjimoto, Yasuo
Hirabayashi, Yasuo
Iguchi, Takashi
Iba, Akinori
Higuchi, Masatoshi
Koike, Hiroyuki
Wakamiya, Takahito
Nishizawa, Satoshi
Hara, Isao
author_facet Yamashita, Shimpei
Kohjimoto, Yasuo
Hirabayashi, Yasuo
Iguchi, Takashi
Iba, Akinori
Higuchi, Masatoshi
Koike, Hiroyuki
Wakamiya, Takahito
Nishizawa, Satoshi
Hara, Isao
author_sort Yamashita, Shimpei
collection PubMed
description BACKGROUND: It remains controversial as to whether active stone removal should be performed in patients with poor performance status because of their short life expectancy and perioperative risks. Our objectives were to evaluate treatment outcomes of active stone removal in patients with poor performance status and to compare life prognosis with those managed conservatively. METHODS: We retrospectively reviewed 74 patients with Eastern Cooperative Oncology Group performance status 3 or 4 treated for upper urinary tract calculi at our four hospitals between January 2009 and March 2016. Patients were classified into either surgical treatment group or conservative management group based on the presence of active stone removal. Stone-free rate and perioperative complications in surgical treatment group were reviewed. In addition, we compared overall survival and stone-specific survival between the two groups. Cox proportional hazards analysis was performed to investigate predictors of overall survival and stone-specific survival. RESULTS: Fifty-two patients (70.3%) underwent active stone removal (surgical treatment group) by extracorporeal shock wave lithotripsy (n = 6), ureteroscopy (n = 39), percutaneous nephrolithotomy (n = 6) or nephrectomy (n = 1). The overall stone-free rate was 78.8% and perioperative complication was observed in nine patients (17.3%). Conservative treatment was undergone by 22 patients (29.7%) (conservative management group). Two-year overall survival rates in surgical treatment and conservative management groups were 88.0% and 38.4%, respectively (p < 0.01) and two-year stone-specific survival rates in the two groups were 100.0% and 61.3%, respectively (p < 0.01). On multivariate analysis, stone removal was not significant, but was considered a possible favorable predictor for overall survival (p = 0.07). Moreover, stone removal was the only independent predictor of stone-specific survival (p < 0.01). CONCLUSIONS: Active stone removal for patients with poor performance status could be performed safely and effectively. Compared to conservative management, surgical stone treatment achieved longer overall survival and stone-specific survival. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12894-017-0293-4) contains supplementary material, which is available to authorized users.
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spelling pubmed-56918062017-11-24 Upper urinary tract stone disease in patients with poor performance status: active stone removal or conservative management? Yamashita, Shimpei Kohjimoto, Yasuo Hirabayashi, Yasuo Iguchi, Takashi Iba, Akinori Higuchi, Masatoshi Koike, Hiroyuki Wakamiya, Takahito Nishizawa, Satoshi Hara, Isao BMC Urol Research Article BACKGROUND: It remains controversial as to whether active stone removal should be performed in patients with poor performance status because of their short life expectancy and perioperative risks. Our objectives were to evaluate treatment outcomes of active stone removal in patients with poor performance status and to compare life prognosis with those managed conservatively. METHODS: We retrospectively reviewed 74 patients with Eastern Cooperative Oncology Group performance status 3 or 4 treated for upper urinary tract calculi at our four hospitals between January 2009 and March 2016. Patients were classified into either surgical treatment group or conservative management group based on the presence of active stone removal. Stone-free rate and perioperative complications in surgical treatment group were reviewed. In addition, we compared overall survival and stone-specific survival between the two groups. Cox proportional hazards analysis was performed to investigate predictors of overall survival and stone-specific survival. RESULTS: Fifty-two patients (70.3%) underwent active stone removal (surgical treatment group) by extracorporeal shock wave lithotripsy (n = 6), ureteroscopy (n = 39), percutaneous nephrolithotomy (n = 6) or nephrectomy (n = 1). The overall stone-free rate was 78.8% and perioperative complication was observed in nine patients (17.3%). Conservative treatment was undergone by 22 patients (29.7%) (conservative management group). Two-year overall survival rates in surgical treatment and conservative management groups were 88.0% and 38.4%, respectively (p < 0.01) and two-year stone-specific survival rates in the two groups were 100.0% and 61.3%, respectively (p < 0.01). On multivariate analysis, stone removal was not significant, but was considered a possible favorable predictor for overall survival (p = 0.07). Moreover, stone removal was the only independent predictor of stone-specific survival (p < 0.01). CONCLUSIONS: Active stone removal for patients with poor performance status could be performed safely and effectively. Compared to conservative management, surgical stone treatment achieved longer overall survival and stone-specific survival. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12894-017-0293-4) contains supplementary material, which is available to authorized users. BioMed Central 2017-11-16 /pmc/articles/PMC5691806/ /pubmed/29145832 http://dx.doi.org/10.1186/s12894-017-0293-4 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Yamashita, Shimpei
Kohjimoto, Yasuo
Hirabayashi, Yasuo
Iguchi, Takashi
Iba, Akinori
Higuchi, Masatoshi
Koike, Hiroyuki
Wakamiya, Takahito
Nishizawa, Satoshi
Hara, Isao
Upper urinary tract stone disease in patients with poor performance status: active stone removal or conservative management?
title Upper urinary tract stone disease in patients with poor performance status: active stone removal or conservative management?
title_full Upper urinary tract stone disease in patients with poor performance status: active stone removal or conservative management?
title_fullStr Upper urinary tract stone disease in patients with poor performance status: active stone removal or conservative management?
title_full_unstemmed Upper urinary tract stone disease in patients with poor performance status: active stone removal or conservative management?
title_short Upper urinary tract stone disease in patients with poor performance status: active stone removal or conservative management?
title_sort upper urinary tract stone disease in patients with poor performance status: active stone removal or conservative management?
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5691806/
https://www.ncbi.nlm.nih.gov/pubmed/29145832
http://dx.doi.org/10.1186/s12894-017-0293-4
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