Natural History of Residual Fragments Following Percutaneous Nephrostolithotomy

Jay Raman, Aditya Bagrodia, Amit Gupta, Karim Bensalah, Jeffrey A. Cadeddu, Yair Lotan, Margaret S. Pearle

Research output: Contribution to journalArticle

132 Citations (Scopus)

Abstract

Purpose: We reviewed the natural history of residual fragments after percutaneous nephrostolithotomy. Materials and Methods: From April 1999 to January 2007 a total of 728 patients underwent percutaneous nephrostolithotomy at our medical center including 527 with a minimum documented radiographic followup of 6 months. Of these patients 42 (8%) with residual fragments on postoperative computerized tomography were observed rather than subjected to second look flexible nephroscopy. Computerized tomography was reviewed to define location, size and number of residual fragments. The primary study end point was a stone related event defined as growth of a residual fragment, or need for emergency room visit, hospitalization or additional intervention attributable to the residual fragment. Univariate and multivariate analyses were performed to determine predictors of a stone related event. Results: The median residual fragment size was 2 mm (range, 1 to 12). There were 18 patients (43%) who experienced a stone related event at a median of 32 months after percutaneous nephrostolithotomy (range 4 to 95). On univariate analysis residual fragment location in the renal pelvis or ureter (p = 0.02), maximum residual fragment size larger than 2 mm (p = 0.03) and cumulative residual fragment size (p = 0.03) predicted a stone related event. On multivariate analysis only maximum residual fragment size larger than 2 mm (HR 3.9, p = 0.01) and location in the renal pelvis or ureter (HR 4.4, p = 0.01) independently predicted a stone event. Conclusions: The size and location of post-percutaneous nephrostolithotomy residual fragments correlate with stone related events. Larger fragments are more likely to require secondary surgical intervention. Second look flexible nephroscopy may be of benefit in patients with residual fragments larger than 2 mm or in those with fragments located in the renal pelvis or ureter.

Original languageEnglish (US)
Pages (from-to)1163-1168
Number of pages6
JournalJournal of Urology
Volume181
Issue number3
DOIs
StatePublished - Mar 1 2009

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Natural History
Kidney Pelvis
Ureter
Multivariate Analysis
Tomography
Hospital Emergency Service
Hospitalization
Growth

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Raman, J., Bagrodia, A., Gupta, A., Bensalah, K., Cadeddu, J. A., Lotan, Y., & Pearle, M. S. (2009). Natural History of Residual Fragments Following Percutaneous Nephrostolithotomy. Journal of Urology, 181(3), 1163-1168. https://doi.org/10.1016/j.juro.2008.10.162
Raman, Jay ; Bagrodia, Aditya ; Gupta, Amit ; Bensalah, Karim ; Cadeddu, Jeffrey A. ; Lotan, Yair ; Pearle, Margaret S. / Natural History of Residual Fragments Following Percutaneous Nephrostolithotomy. In: Journal of Urology. 2009 ; Vol. 181, No. 3. pp. 1163-1168.
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abstract = "Purpose: We reviewed the natural history of residual fragments after percutaneous nephrostolithotomy. Materials and Methods: From April 1999 to January 2007 a total of 728 patients underwent percutaneous nephrostolithotomy at our medical center including 527 with a minimum documented radiographic followup of 6 months. Of these patients 42 (8{\%}) with residual fragments on postoperative computerized tomography were observed rather than subjected to second look flexible nephroscopy. Computerized tomography was reviewed to define location, size and number of residual fragments. The primary study end point was a stone related event defined as growth of a residual fragment, or need for emergency room visit, hospitalization or additional intervention attributable to the residual fragment. Univariate and multivariate analyses were performed to determine predictors of a stone related event. Results: The median residual fragment size was 2 mm (range, 1 to 12). There were 18 patients (43{\%}) who experienced a stone related event at a median of 32 months after percutaneous nephrostolithotomy (range 4 to 95). On univariate analysis residual fragment location in the renal pelvis or ureter (p = 0.02), maximum residual fragment size larger than 2 mm (p = 0.03) and cumulative residual fragment size (p = 0.03) predicted a stone related event. On multivariate analysis only maximum residual fragment size larger than 2 mm (HR 3.9, p = 0.01) and location in the renal pelvis or ureter (HR 4.4, p = 0.01) independently predicted a stone event. Conclusions: The size and location of post-percutaneous nephrostolithotomy residual fragments correlate with stone related events. Larger fragments are more likely to require secondary surgical intervention. Second look flexible nephroscopy may be of benefit in patients with residual fragments larger than 2 mm or in those with fragments located in the renal pelvis or ureter.",
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Raman, J, Bagrodia, A, Gupta, A, Bensalah, K, Cadeddu, JA, Lotan, Y & Pearle, MS 2009, 'Natural History of Residual Fragments Following Percutaneous Nephrostolithotomy', Journal of Urology, vol. 181, no. 3, pp. 1163-1168. https://doi.org/10.1016/j.juro.2008.10.162

Natural History of Residual Fragments Following Percutaneous Nephrostolithotomy. / Raman, Jay; Bagrodia, Aditya; Gupta, Amit; Bensalah, Karim; Cadeddu, Jeffrey A.; Lotan, Yair; Pearle, Margaret S.

In: Journal of Urology, Vol. 181, No. 3, 01.03.2009, p. 1163-1168.

Research output: Contribution to journalArticle

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T1 - Natural History of Residual Fragments Following Percutaneous Nephrostolithotomy

AU - Raman, Jay

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AU - Gupta, Amit

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AU - Cadeddu, Jeffrey A.

AU - Lotan, Yair

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N2 - Purpose: We reviewed the natural history of residual fragments after percutaneous nephrostolithotomy. Materials and Methods: From April 1999 to January 2007 a total of 728 patients underwent percutaneous nephrostolithotomy at our medical center including 527 with a minimum documented radiographic followup of 6 months. Of these patients 42 (8%) with residual fragments on postoperative computerized tomography were observed rather than subjected to second look flexible nephroscopy. Computerized tomography was reviewed to define location, size and number of residual fragments. The primary study end point was a stone related event defined as growth of a residual fragment, or need for emergency room visit, hospitalization or additional intervention attributable to the residual fragment. Univariate and multivariate analyses were performed to determine predictors of a stone related event. Results: The median residual fragment size was 2 mm (range, 1 to 12). There were 18 patients (43%) who experienced a stone related event at a median of 32 months after percutaneous nephrostolithotomy (range 4 to 95). On univariate analysis residual fragment location in the renal pelvis or ureter (p = 0.02), maximum residual fragment size larger than 2 mm (p = 0.03) and cumulative residual fragment size (p = 0.03) predicted a stone related event. On multivariate analysis only maximum residual fragment size larger than 2 mm (HR 3.9, p = 0.01) and location in the renal pelvis or ureter (HR 4.4, p = 0.01) independently predicted a stone event. Conclusions: The size and location of post-percutaneous nephrostolithotomy residual fragments correlate with stone related events. Larger fragments are more likely to require secondary surgical intervention. Second look flexible nephroscopy may be of benefit in patients with residual fragments larger than 2 mm or in those with fragments located in the renal pelvis or ureter.

AB - Purpose: We reviewed the natural history of residual fragments after percutaneous nephrostolithotomy. Materials and Methods: From April 1999 to January 2007 a total of 728 patients underwent percutaneous nephrostolithotomy at our medical center including 527 with a minimum documented radiographic followup of 6 months. Of these patients 42 (8%) with residual fragments on postoperative computerized tomography were observed rather than subjected to second look flexible nephroscopy. Computerized tomography was reviewed to define location, size and number of residual fragments. The primary study end point was a stone related event defined as growth of a residual fragment, or need for emergency room visit, hospitalization or additional intervention attributable to the residual fragment. Univariate and multivariate analyses were performed to determine predictors of a stone related event. Results: The median residual fragment size was 2 mm (range, 1 to 12). There were 18 patients (43%) who experienced a stone related event at a median of 32 months after percutaneous nephrostolithotomy (range 4 to 95). On univariate analysis residual fragment location in the renal pelvis or ureter (p = 0.02), maximum residual fragment size larger than 2 mm (p = 0.03) and cumulative residual fragment size (p = 0.03) predicted a stone related event. On multivariate analysis only maximum residual fragment size larger than 2 mm (HR 3.9, p = 0.01) and location in the renal pelvis or ureter (HR 4.4, p = 0.01) independently predicted a stone event. Conclusions: The size and location of post-percutaneous nephrostolithotomy residual fragments correlate with stone related events. Larger fragments are more likely to require secondary surgical intervention. Second look flexible nephroscopy may be of benefit in patients with residual fragments larger than 2 mm or in those with fragments located in the renal pelvis or ureter.

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