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| Definition, treatment and outcome of residual fragments in staghorn stones |
Osman Ermisa,*( ),Bhaskar Somanib,Thomas Reevesb,Selcuk Guvena,Pilar Laguna Pesa,Arun Chawlac,Padmaraj Hegdec,Jean de la Rosettea
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a Istanbul Medipol University, School of Medicine, Department of Urology, Istanbul, Turkey
b University Hospital Southampton NHS Trust, Department of Urology, Southampton, UK
c Kasturba Medical College, Manipal Academy of Higher Education, Department of Urology, Manipal, India |
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Abstract Technological advances in minimally invasive treatment of stone disease and its integration with concomitant clinical practice are amongst the most important achievements in urology. Despite the wealth of information accumulated over the years and the richness of existing literature, the knowledge about the definition, treatment and outcomes of residual stone fragments after percutaneous nephrolithotomy (PNL) is still insufficient. Due to the high stone load a lot of patients with staghorn stones have residual fragments (RFs) after treatment with PNL, which depends on the size of tract, definition of stone free rate (SFR), timing of evaluation and the imaging used. No consensus exists on the imaging modality or their timing in the evaluation of possible RFs. The treatment of residual stones is apparently different depending on the facilities of the department and the preference of the surgeon, which includes active surveillance, shock wave lithotripsy (SWL), retrograde intrarenal surgery (RIRS) or a second look PNL.
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Received: 30 January 2019
Available online: 31 December 2019
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Corresponding Authors:
Osman Ermis
E-mail: osermis@gmail.com
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| References | Definition of RF | Definition of SFR | Imaging modality | SFR | | Al-Kohlany et al. [7] | CIRF: nonsymptomatic, nonobstructing and noninfected fragments of less than 4 mm in diameter | Completely clearances of stones were considered stone free | KUB and USS (at discharge home and during follow-up) | 49% | | Zeng et al. [19] | - | The absence of any diameter RF | KUB or CT (at discharge and after auxiliary procedures if necessary) | Initial SFR: 66.4%Final SFR: 86.1% (after auxillary procedures) | | Liatsikos et al. [24] | - | The absence of any diameter RF | Non-contrast CT ornephrostography (postoperative) | 87% | | Netto et al. [25] | - | The absence of any diameter RF after all treatment modalities done | Non-contrast CT or KUB (afterinitial PCNL and allauxiliary procedure) | 82.3% | | Desai et al. [26] | - | The absence of any diameter RF in the postoperation 30th day and following examinations | - | 56.9% | | Armitage et al. [27] | - | The absence of any diameter RF | KUB, USG or CT (postoperative day 1) | 47% | | Soucy et al. [28] | - | The absence of significant residual stone | Initial SFR: KUB, CT orantegrade Initial SFR: KUB, CT or antegrade nephrostography at discharge Final SFR: KUB or USS ( 3 or 6 months) | Initial SFR: 77.8%Final SFR: 90.5% (after auxillary procedures) | | Qi et al. [17] | - | The absence of any diameter RF | Initial SFR: KUB and USS (3 days) Final SFR: KUB and USS (3 months) | Initial SFR: 61.6% Final SFR: 79.0% | | Atmoko et al. [23] | - | The absence of any diameter RF | KUB, CT orantegradpyelografi (1 or 2 day after operation) | 62.6% |
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Different authors presenting definitions of RF and SFR, imaging modality used and SFR outcome (%).
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Illustrating stone size and location pre- and postoperative illustrating differences in SFR outcome based on imaging modality used. (A) KUB X-ray preoperative; (B) KUB X-ray postoperative; (C and D) CT postoperative. SFR, stone free rate; KUB, kidney-ureter-bladder; CT, computerized tomography.
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