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Residual stones after percutaneous nephrolithotomy: comparison of intraoperative assessment and postoperative non-contrast computerized tomography

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Abstract

Objectives

To compare the intraoperative surgeon perspective for detection of residual fragments (RFs) after percutaneous nephrolithotomy (PNL) with postoperative NCCT.

Methods

A prospective study of adult patients who underwent PNL between March and September 2014 was conducted. Stone complexity was evaluated using the Guy’s stone score (GSS). All patients were evaluated by pre- and postoperative NCCT. After the procedure, the surgeon had been asked whether there were residual stones or not. The sensitivity, specificity and predictive values were tested against postoperative NCCT. Predictors of accurate intraoperative assessment were determined using univariate and multivariate statistical analyses.

Results

The study included 306 consecutive patients. The surgeons reported no residual stones in 236 procedures; of whom 170 (72%) were reported stone-free by NCCT. On the other hand, 65 out of 70 procedures (93%) reported with residual stones by the surgeons were true by NCCT. The sensitivity was 50% and the NPV was 72%, while the specificity was 97% and the PPV was 93%. On multivariate analysis, only lower GSS (p < 0.001) was independently associated with true negative surgeon opinion.

Conclusions

Although there was a high surgeon ability to detect post-PNL residual stones, postoperative imaging is mandatory because of the high false negative rates and low NPV. The surgeon opinions can be judged only in stones with lower GSS. The NPV could be enhanced if a consistent definition of clinically significant RFs is introduced.

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Author’s contribution

AMH was involved in protocol/project development and manuscript writing/editing and data analysis. YO developed protocol/project development. ARE analyzed the data and edited and wrote the manuscript. AAE, IF and OM collected the data. AEA edited the manuscript. AAS was involved in protocol/project development and data management.

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Authors and Affiliations

  1. Urology and Nephrology Center, Mansoura University, Mansoura, Egypt

    Ahmed M. Harraz, Yasser Osman, Ahmed R. EL-Nahas, Amr A. Elsawy, Islam Fakhreldin, Osama Mahmoud, Ahmed El-Assmy & Ahmed A. Shokeir

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  1. Ahmed M. Harraz
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  2. Yasser Osman
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  3. Ahmed R. EL-Nahas
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  4. Amr A. Elsawy
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  5. Islam Fakhreldin
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  6. Osama Mahmoud
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  7. Ahmed El-Assmy
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  8. Ahmed A. Shokeir
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Correspondence to Ahmed M. Harraz.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Harraz, A.M., Osman, Y., EL-Nahas, A.R. et al. Residual stones after percutaneous nephrolithotomy: comparison of intraoperative assessment and postoperative non-contrast computerized tomography. World J Urol 35, 1241–1246 (2017). https://doi.org/10.1007/s00345-016-1990-4

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  • DOI: https://doi.org/10.1007/s00345-016-1990-4

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