Does previous standard percutaneous nephrolithotomy impair retrograde intrarenal surgery outcomes?
Kidney Calculi
Nephrolithotomy, Percutaneous
Ureteroscopy; Kidney Calculi
Journal
International braz j urol : official journal of the Brazilian Society of Urology
ISSN: 1677-6119
Titre abrégé: Int Braz J Urol
Pays: Brazil
ID NLM: 101158091
Informations de publication
Date de publication:
Historique:
received:
29
03
2021
accepted:
01
08
2021
entrez:
1
9
2021
pubmed:
2
9
2021
medline:
10
9
2021
Statut:
ppublish
Résumé
The objective of this study is to evaluate the impact of a previous standard percutaneous nephrolithotomy (PCNL) on the outcomes of retrograde intrarenal surgery (RIRS). Outcomes of RIRS performed from January 2017 to January 2020 in adult patients with residual stone fragments ≤20mm after a standard PCNL (Post-PCNL) and symptomatic adult patients with kidney stones ≤20mm (Control) were prospectively studied. Stone-free rate (SFR) was evaluated on a postoperative day 90 non-contrast computed tomography. Surgical complications based on Clavien-Dindo classification during the 90 days of follow-up were recorded. Outcomes of 55 patients and 57 renal units of the post-PCNL group were compared to 92 patients and 115 renal units of the control group. SFR was lower in post-PCNL group than in control (28/57, 49.1% vs. 86/115, 74.8%, p < 0.001). Overall complications were more frequent in post-PCNL group (p=0.004). Infundibula strictures were identified and incised with laser in 15/57 (26.3%) renal units of the post-PCNL group. Thirteen renal units had infundibulum stricture at the site of previous percutaneous tract (13/15; 86.7%, p=0.004) and one renal unit had three infundibula strictures. Postoperative complications were not affected by the treatment of infundibula strictures (p=0.198). Previous standard PCNL significantly impairs the outcomes of RIRS. Infundibula strictures can be found in 26.3% of the patients with residual stone fragments after standard PCNL for large burden kidney stones. The main site of infundibulum stricture after standard PCNL is the infundibulum of the entry calyx.
Identifiants
pubmed: 34469672
doi: 10.1590/S1677-5538.IBJU.2021.0253
pii: IBJU20210253
pmc: PMC8486447
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1198-1206Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright® by the International Brazilian Journal of Urology.
Déclaration de conflit d'intérêts
None declared.
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