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Urologists are optimistic surgeons: prevalence and predictors of discordance between intraoperative stone-free rate and cross-sectional imaging evaluation after vacuum-assisted mini-percutaneous nephrolithotomy

PURPOSE: To assess how accurate are urologists in predicting stone-free status (SFS) after vacuum-assisted mini-PCNL (vamPCNL) compared to computed tomography (CT) and clinical predictors of discordant SFS. METHODS: Data from 235 patients who underwent vamPCNL were analysed. Patient’s demographics,...

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Autores principales: Jannello, Letizia Maria Ippolita, Turetti, Matteo, Silvani, Carlo, Galbiati, Gilda, Garbagnati, Susanna, Pozzi, Efrem, Malfatto, Matteo, Zanetti, Stefano Paolo, Longo, Fabrizio, De Lorenzis, Elisa, Albo, Giancarlo, Salonia, Andrea, Montanari, Emanuele, Boeri, Luca
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9427905/
https://www.ncbi.nlm.nih.gov/pubmed/35831471
http://dx.doi.org/10.1007/s00345-022-04091-3
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author Jannello, Letizia Maria Ippolita
Turetti, Matteo
Silvani, Carlo
Galbiati, Gilda
Garbagnati, Susanna
Pozzi, Efrem
Malfatto, Matteo
Zanetti, Stefano Paolo
Longo, Fabrizio
De Lorenzis, Elisa
Albo, Giancarlo
Salonia, Andrea
Montanari, Emanuele
Boeri, Luca
author_facet Jannello, Letizia Maria Ippolita
Turetti, Matteo
Silvani, Carlo
Galbiati, Gilda
Garbagnati, Susanna
Pozzi, Efrem
Malfatto, Matteo
Zanetti, Stefano Paolo
Longo, Fabrizio
De Lorenzis, Elisa
Albo, Giancarlo
Salonia, Andrea
Montanari, Emanuele
Boeri, Luca
author_sort Jannello, Letizia Maria Ippolita
collection PubMed
description PURPOSE: To assess how accurate are urologists in predicting stone-free status (SFS) after vacuum-assisted mini-PCNL (vamPCNL) compared to computed tomography (CT) and clinical predictors of discordant SFS. METHODS: Data from 235 patients who underwent vamPCNL were analysed. Patient’s demographics, stones’ characteristics and operative data were recorded. SFS was evaluated intraoperatively by the treating urologist (iSFS) and with non-contrast CT 3 months after vamPCNL (ctSFS). SFS was defined as no residual stones. Stone complexity was scored with the Guy’s score. Descriptive statistics and logistic regression models were used to identify clinical factors associated with discordant SFS (namely iSFS not confirmed at CT). RESULTS: iSFS and ctSFS were 88.5% and 65.5%, respectively, with 54 (23%) cases resulting in discordant evaluation of SFS between the surgeon and CT imaging. Patients with discordant SFS had larger stone volume (p < 0.001), higher rate of multiple stones (p = 0.03) and higher rate of multiple calyceal groups affected by stones (p < 0.001) than those with concordant SFS. The use of flexible ureteroscopes to look for residual stones after lithotripsy was more frequently reported in cases with concordant SFS (p = 0.001). Multivariable logistic regression analysis revealed that stones in > 2 calyceal groups (OR 10.2, p < 0.001), Guy’s score II (OR 5.8, p < 0.01) and not using flexible ureteroscopes after lithotripsy (OR 2.9, p = 0.02) were independent predictors of discordant SFS. CONCLUSION: One out of five patients is erroneously considered SF after vamPCNL. Urologist should carefully evaluate patients with multiple calyceal stones and consider using flexible ureteroscopes to complete lapaxy of migrated fragments in order to improve their prediction of SFS.
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spelling pubmed-94279052022-09-01 Urologists are optimistic surgeons: prevalence and predictors of discordance between intraoperative stone-free rate and cross-sectional imaging evaluation after vacuum-assisted mini-percutaneous nephrolithotomy Jannello, Letizia Maria Ippolita Turetti, Matteo Silvani, Carlo Galbiati, Gilda Garbagnati, Susanna Pozzi, Efrem Malfatto, Matteo Zanetti, Stefano Paolo Longo, Fabrizio De Lorenzis, Elisa Albo, Giancarlo Salonia, Andrea Montanari, Emanuele Boeri, Luca World J Urol Original Article PURPOSE: To assess how accurate are urologists in predicting stone-free status (SFS) after vacuum-assisted mini-PCNL (vamPCNL) compared to computed tomography (CT) and clinical predictors of discordant SFS. METHODS: Data from 235 patients who underwent vamPCNL were analysed. Patient’s demographics, stones’ characteristics and operative data were recorded. SFS was evaluated intraoperatively by the treating urologist (iSFS) and with non-contrast CT 3 months after vamPCNL (ctSFS). SFS was defined as no residual stones. Stone complexity was scored with the Guy’s score. Descriptive statistics and logistic regression models were used to identify clinical factors associated with discordant SFS (namely iSFS not confirmed at CT). RESULTS: iSFS and ctSFS were 88.5% and 65.5%, respectively, with 54 (23%) cases resulting in discordant evaluation of SFS between the surgeon and CT imaging. Patients with discordant SFS had larger stone volume (p < 0.001), higher rate of multiple stones (p = 0.03) and higher rate of multiple calyceal groups affected by stones (p < 0.001) than those with concordant SFS. The use of flexible ureteroscopes to look for residual stones after lithotripsy was more frequently reported in cases with concordant SFS (p = 0.001). Multivariable logistic regression analysis revealed that stones in > 2 calyceal groups (OR 10.2, p < 0.001), Guy’s score II (OR 5.8, p < 0.01) and not using flexible ureteroscopes after lithotripsy (OR 2.9, p = 0.02) were independent predictors of discordant SFS. CONCLUSION: One out of five patients is erroneously considered SF after vamPCNL. Urologist should carefully evaluate patients with multiple calyceal stones and consider using flexible ureteroscopes to complete lapaxy of migrated fragments in order to improve their prediction of SFS. Springer Berlin Heidelberg 2022-07-13 2022 /pmc/articles/PMC9427905/ /pubmed/35831471 http://dx.doi.org/10.1007/s00345-022-04091-3 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis 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 Original Article
Jannello, Letizia Maria Ippolita
Turetti, Matteo
Silvani, Carlo
Galbiati, Gilda
Garbagnati, Susanna
Pozzi, Efrem
Malfatto, Matteo
Zanetti, Stefano Paolo
Longo, Fabrizio
De Lorenzis, Elisa
Albo, Giancarlo
Salonia, Andrea
Montanari, Emanuele
Boeri, Luca
Urologists are optimistic surgeons: prevalence and predictors of discordance between intraoperative stone-free rate and cross-sectional imaging evaluation after vacuum-assisted mini-percutaneous nephrolithotomy
title Urologists are optimistic surgeons: prevalence and predictors of discordance between intraoperative stone-free rate and cross-sectional imaging evaluation after vacuum-assisted mini-percutaneous nephrolithotomy
title_full Urologists are optimistic surgeons: prevalence and predictors of discordance between intraoperative stone-free rate and cross-sectional imaging evaluation after vacuum-assisted mini-percutaneous nephrolithotomy
title_fullStr Urologists are optimistic surgeons: prevalence and predictors of discordance between intraoperative stone-free rate and cross-sectional imaging evaluation after vacuum-assisted mini-percutaneous nephrolithotomy
title_full_unstemmed Urologists are optimistic surgeons: prevalence and predictors of discordance between intraoperative stone-free rate and cross-sectional imaging evaluation after vacuum-assisted mini-percutaneous nephrolithotomy
title_short Urologists are optimistic surgeons: prevalence and predictors of discordance between intraoperative stone-free rate and cross-sectional imaging evaluation after vacuum-assisted mini-percutaneous nephrolithotomy
title_sort urologists are optimistic surgeons: prevalence and predictors of discordance between intraoperative stone-free rate and cross-sectional imaging evaluation after vacuum-assisted mini-percutaneous nephrolithotomy
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9427905/
https://www.ncbi.nlm.nih.gov/pubmed/35831471
http://dx.doi.org/10.1007/s00345-022-04091-3
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