| Intraoperative fragment detection during percutaneous nephrolithotomy: evaluation of high magnification rotational fluoroscopy combined with aggressive nephroscopy. | |
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MedLine Citation:
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PMID: 16406897 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: Percutaneous nephrolithotomy effectively treats large volume renal calculi but relies on postoperative imaging to judge success. We evaluated the effectiveness of maximizing intraoperative imaging through combined high resolution fluoroscopy and flexible nephroscopy. MATERIALS AND METHODS: Percutaneous nephrolithotomy was performed cooperatively with a radiologist in an interventional radiology suite equipped with a ceiling mounted, high resolution C-arm. Aggressive rigid and flexible nephroscopy was performed. At the conclusion patients were prospectively classified as radiologically and/or endoscopically stone-free. Postoperative noncontrast CT allowed fragment classification as stone-free, 2 mm or less, 2 to 4 mm and greater than 4 mm. RESULTS: The average stone dimension +/- SEM was 579 +/- 77 mm(2) in 25 consecutive renal units. CT demonstrated that 15 renal units (60%) were stone-free after the primary procedure, while 2 (8%), 5 (20%) and 3 (12%) had fragments 2 or less, 2 to 4 and greater than 4 mm, respectively. Of 21 renal units considered endoscopically and fluoroscopically stone-free postoperative CT demonstrated that 6 had residual fragments, of which all were less than 4 mm. All 4 renal units not considered radiologically and endoscopically stone-free had fragments on CT. Intraoperative fluoroscopy after nephroscopy demonstrated fragments in 36% of renal units, of which after further nephroscopy 78% were stone-free on CT. The sensitivity of intraoperative imaging with reference to the gold standard of postoperative CT was 40%, 38% and 100% at thresholds of 0, 2 and 4 mm, respectively. Specificity was 100%, 94% and 95%, respectively. CONCLUSIONS: Flexible nephroscopy combined with high magnification rotational fluoroscopy allows sensitive and specific intraoperative detection of residual fragments, enabling immediate removal or the planning of necessary second look nephroscopy. |
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Authors:
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Andrew J Portis; Mark A Laliberte; Stephanie Drake; Cindy Holtz; 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: The Journal of urology Volume: 175 ISSN: 0022-5347 ISO Abbreviation: J. Urol. Publication Date: 2006 Jan |
Date Detail:
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Created Date: 2006-01-12 Completed Date: 2006-02-28 Revised Date: 2006-03-09 |
Medline Journal Info:
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Nlm Unique ID: 0376374 Medline TA: J Urol Country: United States |
Other Details:
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Languages: eng Pagination: 162-5; discussion 165-6 Citation Subset: AIM; IM |
Affiliation:
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Metropolitan Urologic Specialists P. A., St. Paul, Minnesota, USA. aportis@metro-urology.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Endoscopy* Fluoroscopy / methods Humans Intraoperative Period Kidney Calculi / diagnosis*, ultrasonography* Male Middle Aged Nephrostomy, Percutaneous* Reproducibility of Results |
| Comments/Corrections | |
Erratum In:
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J Urol. 2006 Mar;175(3 Pt 1):1176 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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