| Confident intraoperative decision making during percutaneous nephrolithotomy: does this patient need a second look? | |
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MedLine Citation:
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PMID: 18308087 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: To evaluate intraoperative decision making regarding the necessity of second-look nephroscopy after percutaneous nephrolithotomy. METHODS: Percutaneous nephrolithotomy was performed cooperatively by a urologist and radiologist equipped with a high-resolution C-arm. Ultrasonic lithotripsy was performed followed by thorough flexible nephroscopy and fluoroscopy. At conclusion patients were prospectively classified as radiologically and/or endoscopically stone free. If confident that complete stone clearance had been atraumatically achieved, a ureteral stent was placed. If there was suspicion of trauma or residual calculi, a nephrostomy tube was inserted. Postoperative CT was performed and allowed fragment classification as stone free, less than 2 mm, 2 to 4 mm, or 4 mm or greater. RESULTS: Average stone dimensions were 640.2 +/- 412.5 mm2 in 39 consecutive renal units. Computed tomographic imaging demonstrated that 26 renal units (66.7%) were stone free after primary procedure, with 5 (12.8%), 5 (12.8%), and 3 (7.7%) having fragments less than 2 mm, 2 to 4 mm, and greater than 4 mm, respectively. Of the 34 renal units considered endoscopically and fluoroscopically stone free, postoperative CT demonstrated 9 with residual fragments, all less than 4 mm. Of the 5 renal units not considered radiologically and endoscopically stone free, 4 had fragments on CT. Nephrostomy tubes were avoided in 33 patients. This intraoperative decision was supported by negative predictive values of 100%, 88%, and 73% at postoperative CT fragment detection thresholds of 4 mm, 2 mm, and 0 mm, respectively. CONCLUSIONS: Rigorous fragment detection allows confident intraoperative decision making regarding the necessity of second-look nephroscopy. |
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Authors:
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Andrew J Portis; Mark A Laliberte; Cindy Holtz; Wenjun Ma; Michael S Rosenberg; Carl A Bretzke |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Urology Volume: 71 ISSN: 1527-9995 ISO Abbreviation: Urology Publication Date: 2008 Feb |
Date Detail:
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Created Date: 2008-02-29 Completed Date: 2008-04-08 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0366151 Medline TA: Urology Country: United States |
Other Details:
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Languages: eng Pagination: 218-22 Citation Subset: IM |
Affiliation:
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Metropolitan Urologic Specialists PA, St. Paul, Minnesota, USA. aportis@metro-urology.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Endoscopy* Female Humans Intraoperative Care* Kidney Calculi / therapy* Male Middle Aged Nephrostomy, Percutaneous* Second-Look Surgery / utilization* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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