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Predictors of Immediate Postoperative Outcome of Single-tract Percutaneous Nephrolithotomy

      Objective

      To evaluate the efficacy of single tract percutaneous nephrolithotomy (sPCNL) and investigate the preoperative predictive factors associated with stone clearance after sPCNL.

      Methods

      A retrospective review of 351 cases of sPCNL performed at a single institution by 1 of 2 endourologists between January 2000 and March 2010 was performed. The primary outcome evaluated was stone-free rate (SFR) as assessed immediately after either an initial procedure or a second-look nephroscopy performed on postoperative day 2. Preoperative patient and stone factors, including age, sex, body mass index (BMI), preoperative hematocrit and creatinine, previous surgeries, comorbidities, renal anomalies, stone size, shape, location, and history of any previous treatment to the active stone burden were included in the univariate analysis. Significant or clinically relevant factors on univariate analysis were included in a logistic regression the multivariate analysis.

      Results

      SFR after either an initial procedure or a second-look nephroscopy was 76%. On univariate analysis, rising preoperative creatinine, hypertension, increasing stone diameter, complete staghorn stone, presence of stones in the upper pole and absence of prior SWL were associated with lower SFR. Stone size, presence of stones in the upper pole, and prior SWL for the active burden were independent predictors of SFR on multivariate analysis.

      Conclusion

      sPCNL is an efficient procedure to clear renal stones, especially when used in conjunction with routine second-look nephroscopy. Increasing stone size and upper pole stones are associated with lower rates of stone clearance, whereas SWL performed before percutaneous nephrolithotomy (PCNL) is associated with improved stone clearance. The role of SWL before PCNL warrants further prospective investigation.
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      Linked Article

      • Editorial Comment
        UrologyVol. 80Issue 1
        • Preview
          The American Urological Association Guidelines recommend percutaneous nephrolithotomy (PCNL) as the standard of care for patients with staghorn or large renal stones because of the high stone-free rates (SFRs) with minimal morbidity.1 Before the advent of flexible fiberoptic instruments and Holmium laser lithotripters, it was not unusual for PCNL to require multiple access tracts directly on calyces containing stones to achieve stone-free status. Some authors even suggested performing auxiliary procedures, such as shock wave lithotripsy (SWL) as combination or “sandwich” therapy with PCNL to fragment stones that could not be reached using rigid instruments.
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      • Re: Shahrour K et al.: Predictors of Immediate Postoperative Outcome of Single-tract Percutaneous Nephrolithotomy (Urology 2012;80:19-26)
        UrologyVol. 80Issue 6
        • Preview
          We read this report with interest and congratulate the authors for their study; however, some points need clarification. The authors titled the study “Predictors of Immediate Postoperative Outcome of Single-tract Percutaneous Nephrolithotomy” (PCNL), but they used retrograde intrarenal surgery (RIRS) to improve the stone-free rates during the initial procedure and during second look nephroscopy. We believe the title is misleading, because this study has considered PCNL and RIRS when documenting the stone-free rates.
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      • Re: Shahrour et al.: Predictors of Immediate Postoperative Outcome of Single-tract Percutaneous Nephrolithotomy (Urology 2012;80:19-26)
        UrologyVol. 81Issue 1
        • Preview
          We read the article on single-tract percutaneous nephrolithotomy (PCNL) in which the authors use a single-tract, flexible nephroscope (with holmium laser lithotripsy) and simultaneous retrograde flexible ureteroscopy to maximize stone clearance and thus avoid multitract PCNL and its complications. The authors, however, do not mention whether every patient required flexible instruments or whether their use was limited to select cases.
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