Year: 2018
Type: article
Study design: Observational Study
Abstract: INTRODUCTION AND OBJECTIVES: Some patients who undergo ureteroscopy and laser lithotripsy (URS) have residual stone fragments (RFs).The goal of this study was to find out if the presence of RFs increased the risk of repeat surgery in the same renal unit among patients who underwent URS at our institution.METHODS: The study included 215 patients who had URS for nephrolithiasis at out hospital between 2008 to 2016, had imaging within 3 months after the intervention and at least one year of follow-up.Dusting technique of laser lithotripsy was used.Patients were divided into subgroups based on the presence of RFs and the size of the largest fragment seen on the first postoperative imaging.Most patients had plain abdominal X-rays (71%), while computerized tomography was done in 16% and ultrasound in 13%.Multivariate Cox regression analysis was performed to compare the risk of repeat surgery among patients with different volumes of residual nephrolithiasis to that in patients with no stones on the first postoperative imaging.RESULTS: No RFs were found in 134 (62.3%) patients while 17 (7.9%),21 (9.8%), 14 (6.5%) and 29 (13.5%) had stones of up to 2 mm, 3-4 mm, 5-6 mm and more than 6 mm respectively.Over a median follow-up of 2.2 years (mean 2.9, IQR 1.5-3.9years) 61 (28.4%) patients required another surgery on the same renal unit for symptomatic stone disease.Table 1 demonstrates results of the multivariate Cox regression analysis which compared the treatment-free survival depending on the postoperative stone burden.The risk of repeat surgery was increased in all subgroups of patients with RFs, however it was lowest among patients with stones less than 2 mm and 3-4 mm in size.These patients were combined into one group for the Figure 1 which shows the repeat surgery-free survival curves.CONCLUSIONS: Our findings suggest that even small residual stone burden seen on the imaging after URS is associated with increased risk of repeat surgical interventions.
Source: The Journal of Urology
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2795458314