TY - JOUR
T1 - The Fate of Residual Fragments After Percutaneous Nephrolithotomy
T2 - Results from the Endourologic Disease Group for Excellence Research Consortium
AU - Wong, Victor K.F.
AU - Que, Jessica
AU - Kong, Emily K.
AU - Abedi, Garen
AU - Nimmagadda, Naren
AU - Emmott, Anthony S.
AU - Paterson, Ryan F.
AU - Lange, Dirk
AU - Lundeen, Colin J.
AU - Nevo, Amihay
AU - Shee, Kevin
AU - Moore, Jonathan
AU - Pais, Vernon
AU - Sur, Roger L.
AU - Bechis, Seth K.
AU - Miller, Nicole L.
AU - Hsi, Ryan
AU - Knudsen, Bodo E.
AU - Sourial, Michael
AU - Humphreys, Mitchell R.
AU - Stern, Karen L.
AU - Eisner, Brian H.
AU - Chew, Ben H.
N1 - Publisher Copyright:
© Copyright 2023, Mary Ann Liebert, Inc., publishers 2023.
PY - 2023/6/1
Y1 - 2023/6/1
N2 - Background: Residual fragments (RFs) after percutaneous nephrolithotomy (PCNL) have a significant impact on patients' quality of life and clinical course. There is a paucity of studies that evaluate the natural history of RFs after PCNL. The objective of this study is to compare rates of reintervention, complications, stone growth, and passage in patients with RFs >4, ≤4, and ≤2 mm after PCNL. Methods: Sites from the Endourologic Disease Group for Excellence (EDGE) research consortium examined data of PCNL patients from 2015 to 2019 with at least 1-year follow-up. RF passage, regrowth, reintervention, and complications were recorded and RFs were stratified into >4 and ≤4 mm groups, as well as >2 and ≤2 mm groups. Potential predictors for stone-related events after PCNL were determined using multivariable logistic regression analysis. It was hypothesized that larger RF thresholds would result in lower passage rates, faster regrowth, and greater clinically significant events (complications and reinterventions) than smaller RF thresholds. Results: A total of 439 patients with RFs >1 mm on CT postoperative day 1 were included in this study. For RFs >4 mm, rates of reintervention were found to be significantly higher and Kaplan-Meier curve analysis showed significantly higher rates of stone-related events. Passage and RF regrowth were not found to be significantly different compared with RFs ≤4 mm. However, RFs ≤2 mm had significantly higher rates of passage, and significantly lower rates of fragment regrowth (>1 mm), complications, and reintervention compared with RFs >2 mm. On multivariable analysis, older age, body mass index, and RF size were found to be predictive of stone-related events. Conclusions: With the largest cohort to date, this study by the EDGE research consortium further confirms that clinically insignificant residual fragment is problematic for patients after PCNL, particularly in older more obese patients with larger RFs. Our study underscores the importance of complete stone clearance post-PCNL and challenges the use of Clinically insignificant residual fragment (CIFR).
AB - Background: Residual fragments (RFs) after percutaneous nephrolithotomy (PCNL) have a significant impact on patients' quality of life and clinical course. There is a paucity of studies that evaluate the natural history of RFs after PCNL. The objective of this study is to compare rates of reintervention, complications, stone growth, and passage in patients with RFs >4, ≤4, and ≤2 mm after PCNL. Methods: Sites from the Endourologic Disease Group for Excellence (EDGE) research consortium examined data of PCNL patients from 2015 to 2019 with at least 1-year follow-up. RF passage, regrowth, reintervention, and complications were recorded and RFs were stratified into >4 and ≤4 mm groups, as well as >2 and ≤2 mm groups. Potential predictors for stone-related events after PCNL were determined using multivariable logistic regression analysis. It was hypothesized that larger RF thresholds would result in lower passage rates, faster regrowth, and greater clinically significant events (complications and reinterventions) than smaller RF thresholds. Results: A total of 439 patients with RFs >1 mm on CT postoperative day 1 were included in this study. For RFs >4 mm, rates of reintervention were found to be significantly higher and Kaplan-Meier curve analysis showed significantly higher rates of stone-related events. Passage and RF regrowth were not found to be significantly different compared with RFs ≤4 mm. However, RFs ≤2 mm had significantly higher rates of passage, and significantly lower rates of fragment regrowth (>1 mm), complications, and reintervention compared with RFs >2 mm. On multivariable analysis, older age, body mass index, and RF size were found to be predictive of stone-related events. Conclusions: With the largest cohort to date, this study by the EDGE research consortium further confirms that clinically insignificant residual fragment is problematic for patients after PCNL, particularly in older more obese patients with larger RFs. Our study underscores the importance of complete stone clearance post-PCNL and challenges the use of Clinically insignificant residual fragment (CIFR).
KW - endourology
KW - percutaneous nephrolithotomy
KW - renal stones
KW - urolithiasis
UR - http://www.scopus.com/inward/record.url?scp=85162172078&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85162172078&partnerID=8YFLogxK
U2 - 10.1089/end.2022.0561
DO - 10.1089/end.2022.0561
M3 - Article
C2 - 36960704
AN - SCOPUS:85162172078
SN - 0892-7790
VL - 37
SP - 617
EP - 622
JO - Journal of endourology
JF - Journal of endourology
IS - 6
ER -