TY - JOUR T1 - Intraoperative Assessment of Stone Free Status for Percutaneous Nephrolithotomy Surgery: Surgeon’s Eye TT - Perkütan Nefrolitotomi Ameliyatında Taşsızlığın İntraoperatif Değerlendirilmesi: Cerrahın Gözü AU - Yalçın, Mehmet Yiğit AU - Ergani, Batuhan AU - Çetin, Taha AU - Karabıçak, Mustafa AU - Özbilen, Mert Hamza AU - Bildirici, Çağdaş AU - Karaca, Erkin AU - Yoldaş, Mehmet AU - Kısa, Erdem AU - Özgen, Tufan Suel AU - Koç, Gökhan AU - Çakmak, Özgür AU - Boyacıoğlu, Hayal AU - İlbey, Yusuf Özlem PY - 2023 DA - May DO - 10.54233/endouroloji.20231502-1282074 JF - Endoüroloji Bülteni JO - Endourol Bull PB - Endourology Association WT - DergiPark SN - 2148-0532 SP - 52 EP - 60 VL - 15 IS - 2 LA - en AB - Objective: In patients who underwent percutaneous nephrolithotomy (PNL),it was aimed to determinethe accuracy of the surgeon’s intraoperative stone-free status (SFS) prediction, the factors affecting it, thepredictors that cause incorrect estimation, and finally to evaluate the reliability of the “surgeon’s eye”.Material and Methods: The data of 1025 patients who underwent PNL and met the inclusion criteriawere evaluated retrospectively. Since the basis of our study was based on the evaluation of the surgeon’sstone-free prediction, patients identified as “absence of residual stone fragment (RF)” by the surgeon weregrouped and compared with postoperative computed tomography imaging according to the presence of RF.Results: Sensitivity, specificity, positive predictive value and negative predictive value were calculated as67.87%, 96.23%, 91.67% and 83.04%, respectively. In our study, it was found that the “surgeon’s eye” predictedSFS incorrectly at a rate of 16.9%. There was no statistically significant relationship between gender,-stone side,stone density and hemoglobin decrease between the two groups. Stone size,operation time,fluoroscopy time, location of the stone,number of stones in the calyces and GUY’s stone score (GSS) werefound to be statistically significant in relation to the “surgeon’s eye”. As a result of multivariate logistic regressionanalysis stone size, number of stones in the calyces and GSS were significant predictors of theparameters that had a statistically significant relationship with the surgeon’s eye.Conclusion: The most important determinants of “surgeon’s eye” in PNL were stone size,number of stonesin the calyces and GSS. These predictors can be used as an effective criterion in the use of methods to reduceradiation exposure in postoperative imaging of patients who are predicted to be stone-free. KW - stones KW - percutaneous nephrolithotomy KW - stone-free status KW - intraoperative evaluation KW - surgeon’s eye N2 - Amaç: Perkütan nefrolitotomi (PNL) uygulanan hastalarda cerrahın intraoperatif taşsızlık kanısının doğruluğunu,bunu etkileyen faktörleri, yanlış tahminine sebep olan prediktörleri saptamak ve sonuç olarak “cerrah gözü” ‘nüngüvenilirliğini değerlendirmek amaçlandı.Gereç ve Yöntemler: PNL uygulanan ve dahil etme kriterlerine uyan 1025 hastanın verileri retrospektif olarak incelendi.Çalışmamızın temeli cerrahın taşşsızlığı değerlendirmesi üzerine olması sebebiyle, cerrahın intraoperatifrezidü taş (RT) kalmadığı kanaatini belirttiği ancak postoperatif bilgisayarlı tomografi görüntülemede RT olan veolmayan hasta grupları değişkenlere göre karşılaştırıldı.Bulgular: Cerrah gözü‘nün sensitivitesi %67,87, spesifitesi %96,23, pozitif prediktif değeri %91,67 ve negatif prediktifdeğeri %83,04 bulundu. Çalışmamızda “cerrahın gözü” ‘nün %16,9 oranında yanlış taşsızlık tahmin ettiğisaptandı. Her iki grup arasında cinsiyet, taşın tarafı, taşın yoğunluğu ve hemoglobin düşüşü arasında istatistikselanlamlı ilişki saptanmadı. Taş boyutu, operasyon süresi, floroskopi süresi, taşın konumu, kaliks taşlarının sayısıve GUY’s nefrolitometri skoru (GSS) cerrahın gözü ile istatistiksel anlamlı ilişkili saptandı. Cerrahın gözü ile istatistikselanlamlı ilişki saptanan parametrelerin çok değişkenli (multivariate) lojistik regresyon analizi sonucundasırasıyla taş boyutu, kaliks taşlarının sayısı ve GSS anlamlı prediktörler olarak bulundu.Sonuç: PNL’ de “cerrah gözü” nün en önemli prediktörleri taş boyutu, kaliks taş sayısı ve GSS idi. Bu prediktörlertaşsızlık öngörülen hastaların postoperatif görüntülemelerinde, radyasyon maruziyetini azaltacak yöntemlerinkullanılmasında etkili bir kriter olarak kullanılabilir. CR - 1. Turk C, Petřik A, Sarica K, et al. 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Utility of the Guy’s stone score based on computed tomographic scan findings for predicting percutaneous nephrolithotomy outcomes. Urology 2014;83: 1248–53. doi:10.1016/j. urology.2013.12.041 UR - https://doi.org/10.54233/endouroloji.20231502-1282074 L1 - https://dergipark.org.tr/en/download/article-file/3079542 ER -