Does previous standard percutaneous nephrolithotomy impair retrograde intrarenal surgery outcomes?
Int. braz. j. urol
;
47(6): 1198-1206, Nov.-Dec. 2021. tab, graf
Article
in English
| LILACS
| ID: biblio-1340028
ABSTRACT
ABSTRACT Purpose:
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). Materials andMethods:
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.Results:
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).Conclusions:
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.
Full text:
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Index:
LILACS (Americas)
Main subject:
Nephrostomy, Percutaneous
/
Kidney Calculi
/
Nephrolithotomy, Percutaneous
Limits:
Adult
/
Humans
Language:
English
Journal:
Int. braz. j. urol
Journal subject:
Urology
Year:
2021
Type:
Article
Affiliation country:
Brazil
/
France
Institution/Affiliation country:
Faculdade de Medicina da Universidade de São Paulo/BR
/
Faculdade de Medicina da Universidade de São Paulo/FR
/
Sorbonne Université/FR
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