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Factors Affecting Residual Stone Rate, Operative Duration, and Complications in Patients Undergoing Minimally Invasive Percutaneous Nephrolithotomy

Background and objectives: Although minimally invasive percutaneous nephrolithotomy (MPCNL) has demonstrated its efficacy, complete stone clearance was not always achieved, necessitating a second procedure. The purpose of this study was to evaluate factors associated with residual stone rate, operat...

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Autores principales: Doykov, Mladen, Kostov, Gancho, Doykova, Katya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8952422/
https://www.ncbi.nlm.nih.gov/pubmed/35334598
http://dx.doi.org/10.3390/medicina58030422
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author Doykov, Mladen
Kostov, Gancho
Doykova, Katya
author_facet Doykov, Mladen
Kostov, Gancho
Doykova, Katya
author_sort Doykov, Mladen
collection PubMed
description Background and objectives: Although minimally invasive percutaneous nephrolithotomy (MPCNL) has demonstrated its efficacy, complete stone clearance was not always achieved, necessitating a second procedure. The purpose of this study was to evaluate factors associated with residual stone rate, operative duration, complications, and hospital stay, in order to develop algorithms for pre-operative prognosis and planning. Materials and Methods: This retrospective study involved 163 Bulgarian patients who underwent MPCNL with Holmium: YAG lithotripsy for the treatment of kidney stones. Patients were considered stone-free if no visible fragments (<3 mm) were found on nephroscopy at the end of the procedure, as well as on postoperative X-ray and abdominal ultrasound on the first postoperative day. Results: Immediate postoperative stone-free outcome was attained for 83.43% of the patients (136/163). Residuals were associated with staghorn stones (OR = 72.48, 95% CI: 5.76 to 91.81); stones in two locations (OR = 21.91, 95% CI: 4.15 to 137.56); larger stone size (OR = 1.12, 95% CI: 1.006 to 1.25); and higher density (OR = 1.03, 95% CI:1.005 to 1.06). The overall categorization accuracy for these factors was 93.80%, AUC = 0.971 (95% CI: 0.932 to 0.991), 89.71% sensitivity, and 96.30% specificity. Predictors of prolonged operative duration were staghorn stones and volume, R-square (adj.) = 39.00%, p < 0.001. Longer hospitalization was predicted for patients with hydronephrosis and staghorn stones, R-square (adj.) = 6.82%, p = 0.003. Post-operative complications were rare, predominantly of Clavien-Dindo Grade 1, and were more frequent in patients with hydronephrosis. We did not find a link between their occurrence and the outcome of MPCNL. Conclusions: Staghorn stones and stones in more than one location showed the strongest association with residual stone rate. Staghorn stones and larger volume were linked with a longer operative duration. Hydronephrosis increased the risk of complications and longer hospitalization.
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spelling pubmed-89524222022-03-26 Factors Affecting Residual Stone Rate, Operative Duration, and Complications in Patients Undergoing Minimally Invasive Percutaneous Nephrolithotomy Doykov, Mladen Kostov, Gancho Doykova, Katya Medicina (Kaunas) Article Background and objectives: Although minimally invasive percutaneous nephrolithotomy (MPCNL) has demonstrated its efficacy, complete stone clearance was not always achieved, necessitating a second procedure. The purpose of this study was to evaluate factors associated with residual stone rate, operative duration, complications, and hospital stay, in order to develop algorithms for pre-operative prognosis and planning. Materials and Methods: This retrospective study involved 163 Bulgarian patients who underwent MPCNL with Holmium: YAG lithotripsy for the treatment of kidney stones. Patients were considered stone-free if no visible fragments (<3 mm) were found on nephroscopy at the end of the procedure, as well as on postoperative X-ray and abdominal ultrasound on the first postoperative day. Results: Immediate postoperative stone-free outcome was attained for 83.43% of the patients (136/163). Residuals were associated with staghorn stones (OR = 72.48, 95% CI: 5.76 to 91.81); stones in two locations (OR = 21.91, 95% CI: 4.15 to 137.56); larger stone size (OR = 1.12, 95% CI: 1.006 to 1.25); and higher density (OR = 1.03, 95% CI:1.005 to 1.06). The overall categorization accuracy for these factors was 93.80%, AUC = 0.971 (95% CI: 0.932 to 0.991), 89.71% sensitivity, and 96.30% specificity. Predictors of prolonged operative duration were staghorn stones and volume, R-square (adj.) = 39.00%, p < 0.001. Longer hospitalization was predicted for patients with hydronephrosis and staghorn stones, R-square (adj.) = 6.82%, p = 0.003. Post-operative complications were rare, predominantly of Clavien-Dindo Grade 1, and were more frequent in patients with hydronephrosis. We did not find a link between their occurrence and the outcome of MPCNL. Conclusions: Staghorn stones and stones in more than one location showed the strongest association with residual stone rate. Staghorn stones and larger volume were linked with a longer operative duration. Hydronephrosis increased the risk of complications and longer hospitalization. MDPI 2022-03-13 /pmc/articles/PMC8952422/ /pubmed/35334598 http://dx.doi.org/10.3390/medicina58030422 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Doykov, Mladen
Kostov, Gancho
Doykova, Katya
Factors Affecting Residual Stone Rate, Operative Duration, and Complications in Patients Undergoing Minimally Invasive Percutaneous Nephrolithotomy
title Factors Affecting Residual Stone Rate, Operative Duration, and Complications in Patients Undergoing Minimally Invasive Percutaneous Nephrolithotomy
title_full Factors Affecting Residual Stone Rate, Operative Duration, and Complications in Patients Undergoing Minimally Invasive Percutaneous Nephrolithotomy
title_fullStr Factors Affecting Residual Stone Rate, Operative Duration, and Complications in Patients Undergoing Minimally Invasive Percutaneous Nephrolithotomy
title_full_unstemmed Factors Affecting Residual Stone Rate, Operative Duration, and Complications in Patients Undergoing Minimally Invasive Percutaneous Nephrolithotomy
title_short Factors Affecting Residual Stone Rate, Operative Duration, and Complications in Patients Undergoing Minimally Invasive Percutaneous Nephrolithotomy
title_sort factors affecting residual stone rate, operative duration, and complications in patients undergoing minimally invasive percutaneous nephrolithotomy
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8952422/
https://www.ncbi.nlm.nih.gov/pubmed/35334598
http://dx.doi.org/10.3390/medicina58030422
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