Residual Fragments after Percutaneous Nephrolithotomy

Year 2012, , 230 - 235, 01.03.2012

Kaan Özdedeli Mete Çek

https://doi.org/10.5152/balkanmedj.2012.082

Abstract

Clinically insignificant residual fragments (CIRFs) are described as asymptomatic, noninfectious and nonobstructive stone fragments (≤4 mm) remaining in the urinary system after the last session of any intervention (ESWL, URS or PCNL) for urinary stones. Their insignificance is questionable since CIRFs could eventually become significant, as their presence may result in recurrent stone growth and they may cause pain and infection due to urinary obstruction. They may become the source of persistent infections and a significant portion of the patients will have a stone-related event, requiring auxilliary interventions. CT seems to be the ultimate choice of assessment. Although there is no concensus about the timing, recent data suggests that it may be performed one month after the procedure. However, imaging can be done in the immediate postoperative period, if there are no tubes blurring the assessment. There is some evidence indicating that selective medical therapy may have an impact on decreasing stone formation rates. Retrograde intrarenal surgery, with its minimally invasive nature, seems to be the best way to deal with residual fragments.

Keywords

Nephrolithotomy, percutaneous, urinary stones

Residual Fragments after Percutaneous Nephrolithotomy

Abstract

References

• Osman MM, Alfano Y, Kamp S, Haecker A, Alken P, Michel MS, et al. 5-year follow-up of patients with clinically insignificant residual fragments after extracorporeal shockwave lithotripsy. EurUrol 2005;47:860-4. [CrossRef]
• Pearle MS, Watamull LM, Mullican MA. Sensitivity of noncon- trast helical computerized tomography and plain film radiog- raphy compared to flexible nephroscopy for detecting resid- ual fragments after percutaneous nephrostolithotomy. J Urol 1999;162:23-6. [CrossRef]
• Skolarikos A, Papatsoris AG. Diagnosis and management of postpercutaneous nephrolithotomy residual stone fragments. JEndourol 2009;23:1751-5. [CrossRef]
• Daggett LM, Harbaugh BL, Collum LA. Post-ESWL, clinically insignifi- cant residual stones: Reality or myth? Urology 2002;59:20-4. [CrossRef]
• Osman Y, El-Tabey N, Refai H, Elnahas A, Shoma A, Eraky I, et al. Detection of residual stones after percutaneous nephrolithoto- my: Role of noneennhanced spiral computerized tomography. J Urol 2008;179:198-200. [CrossRef]
• Rassweiler JJ, Renner C, Chaussy C, Thuroff S. Treatment of renal stones by extracorporeal shockwave lithotripsy: an update. EurU- rol 2001; 39:187- 99. [CrossRef]
• Carr LK, D’A Honey J, Jewett MA, Ibanez D, Ryan M, Bombar- dier C. New stone formation: A comparison of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy. J Urol 1996;155:1565-7. [CrossRef]
• Candau C, Saussine C, Lang H, Roy C, Faure F, Jacqmin D. Natu- ral history of residual renal stone fragments after ESWL. EurUrol 2000;37:18-22. [CrossRef]
• Ganpule A, Desai M. Fate of residual stones after percutaneous neph- rolithotomy: A critical analysis. J Endourol2009; 23:399-403. [CrossRef]
• Raman JD, Bagrodia A, Gupta A, Bensalah K, Cadeddu JA, Lotan Y, et al. Natural history of residual fragments following percuta- neous nephrostolithotomy. J Urol 2009;181:1163-8. [CrossRef]
• Altunrende F, Tefekli A, Stein RJ, Autorino R, Yuruk E, Laydner H, et al. Clinically insignificant residual fragments after percu- taneous nephrolithotomy: medium-term follow-up. J Endourol 2011;25:941-5. [CrossRef]
• Olcott EW, Sommer FG, Napel S. Accuracy of detection and measurement of renal calculi: in vitro comparison of three-dimen- sional spiral CT, radiography and nephrotomography. Radiology. 1997;204:19-25.
• Ray AA, Ghiculete PKT, Honey RJ. Limitations to ultrasound in the detection and measurement of urinary tract calculi. Urology 2010;76:295-300. [CrossRef]
• Dundee P, Bouchier-Hayes D, Haxhimolla H, Dowling R, Costello A. Renal tract calculi: comparison of stone size on plain radiography and noncontrast spiral CT scan. J Endourol 2006;20:1005-9. [CrossRef]
• Van Appledorn S, Ball AJ, Patel VR, Kim S, Leveillee RJ. Limita- tions of noncontrast CT for measuring ureteral stones. J Endourol 2003;17:851-4. [CrossRef]
• Sacks E, Fajardo L, Hillman B, Drach G, Gaines J, Claypool H, et al: Prospective comparison of plain abdominal radiogra- phy with conventional and digital renal tomography in assess- ing renal extracorporeal shock wave lithotripsy patients. J Urol 1990;144:1341-6.
• Jewett M, Bombardier C, Caron D, Ryan M, Gray R, St. Louis E, et al. Potential for inter-observer and intra-observer variability in x-ray review to establish stone-free rates after lithotripsy. J Urol 1992;147:559-62.
• Palmer J, Donaher E, O’Riordan M and Dell K. Diagnosis of pedi- atric urolithiasis: role of ultrasound and computerized tomogra- phy. J Urol 2005;174:1413-6. [CrossRef]
• Park J, Hong B, Park T, Park HK. Effectiveness of non- contrast computed tomography in evaluation of residual stones after per- cutaneous nephrolithotomy. J Endourol 2007;21:684-7. [CrossRef]
• Jackman SV, Potter SR, Regan F, Jarrett TW. Plain abdominal x- ray versus computerized tomography screening: sensitivity for stone localization after nonenhanced spiral computerized to- mography. J Urol 2000;164:308-10. [CrossRef]
• Eisner BH, McQuaid JW, Hyams E, Matlaga BR. Nephrolithiasis: what surgeons need to know. AJR 2011;196:1274-8. [CrossRef]
• Portis AJ, Laliberte MA, Holtz C, Ma W, Rosenberg MS, Bretzke CA. Confident intra- operative decision making during percuta- neous nephrolithotomy: Does this patient need a second look? Urology 2008;71:218-22 [CrossRef]
• Hemal AK, Goel A, Aron M, Seth A, Dogra PN, Gupta NP. Evalu- ation of fragmentation with single or multiple pulse setting of Lithoclast for renal calculi during percutaneous nephrolithotripsy and its impact on clearance. Urol Int 2003;70:265-8. [CrossRef]
• Preminger GM, Assimos DG, Lingeman JE. AUA guideline on management of staghorn calculi: diagnosis and treatment rec- ommendations. J Urol 2005;173:1991-2000. [CrossRef]
• Hegarty NJ, Desai MM. Percutaneous nephrolithotomy requiring multiple tracts: comparison of morbidity with single-tract proce- dures. J Endourol 2006;20:753-60. [CrossRef]
• Aron M, Yadav R, Goel R, Kolla SB, Gautam G, Hemal AK, et al. Multi tract percutaneous nephrolithotomy for large complete staghorn calculi. UrolInt 2005;75:327-32. [CrossRef]
• Akman T, Sari E, Binbay M, Yuruk E, Tepeler A, Kaba M, et al. Comparison of Outcomes After Percutaneous Nephrolithotomy of Staghorn Calculi in Those with Single and Multiple Accesses J Endourol. June 2010;24:955-60.
• Kang DE, Maloney MM, Haleblian GE, et al. Effect of medical management on recurrent stone formation following percutane- ous nephrolithotomy. J Urol 2007;177:1785-9. [CrossRef]
• Lojanapiwat B; Tanthanuch M; Pripathanont C; Ratchanon S; Srinualnad S; Taweemonkongsap T; Kanyok S; Lammongkolkul. Alkaline citrate reduces stone recurrence and regrowth after shockwave lithotripsy and percutaneous nephrolithotomy. Int. braz j urol. vol.37 no.5 Rio de Janeiro Sept.Oct. 2011
• Streem SB, Yost A, Dolmatch B. Combination ‘‘sandwich’’ therapy for extensive renal calculi in 100 consecutive patients: Immedi- ate, long-term and stratified results from a 10-year experience. J Urol 1997;158:342-5. [CrossRef]
• Merhej S, Jabbour M, Samaha E, Chalouhi E, Moukarzel M, Khour R, et al. Treatment of staghorn calculi by percutaneous nephro- lithotomy and SWL: The Hotel Dieu de France experience. J En- dourol 1998;12:5-8. [CrossRef]
• Denstedt JD, Clayman RV, Picus DD. Comparison of endoscopic and radiological residual fragment rate following percutaneous nephrolithotripsy. J Urol 1991;145:703-5.
• Pearle MS, Watamull LM, Mullican MA. Sensitivity of non- con- trast helical computerized tomography and plain film radiog- raphy compared to flexible nephroscopy for detecting resid- ual fragments after percutaneous nephrostolithotomy. J Urol 1999;162:23-6. [CrossRef]
• Breda A, Ogunyemi O, Leppert JT, Lam JS, Schulam PG. Flexible ureteroscopy and laser lithotripsy for single intrarenal stones 2 cm or greater - is this the new frontier? J Urol 2008;179:981-4. [CrossRef]
• Traxer O, Dubosq F, Jamali K, Gattegno B, Thibault P. New- gen- eration flexible ureterorenoscopes are more durable than previ- ous ones. Urology 2006;68:276-80. [CrossRef]
• Akman T, Binbay M, Ozgor F et al. Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2-4 cm stones: a matched-pair analysis. BJU Int 2011.
• Valdivia Uría JG, Valle Gerhold J, López López JA, Villarroya Rodri- guez S, Ambroj Navarro C, Ramirez Fabián M, et al. Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position. J Urol 1998;160:1975-8. [CrossRef]
• Ibarluzea G, Scoffone CM, Cracco CM, Poggio M, Porpiglia F, Terrone C, et al. Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological ac- cess. BJU Int 2007;100:233-6. [CrossRef]
• Scoffone CM, Cracco CM, Cossu M, Grande S, Poggio M, Scarpa RM. Endoscopic combined intrarenal surgery in Galdakao-mod- ified supine Valdivia position: a new standard for percutaneous nephrolithotomy? EurUrol 2008;54:1393-403. [CrossRef]
• Hoznek A, Rode J, Ouzaid I, Faraj B, Kimuli M, de la Taille A, et al. Modified Supine Percutaneous Nephrolithotomy for Large Kidney and Ureteral Stones: Technique and Results. EurUrol 2012;61:164-70. [CrossRef]
• Woodside JR, Stevens GF, Stark GL, Borden TA, Ball WS. Percu- taneous stone removal in children.J Urol 1985;134:1166-7.
• Jackman SV, Hedican SP, Peters CA, Docimo SG. Percutaneous nephrolithotomy in infants and preschool age children: experi- ence with a new technique. Urology 1998;52:697-701. [Cross- Ref]
• Desai MR, Kukreja RA, Patel SH, Bapat SD. Percutaneous nephro- lithotomy for complex pediatric renal calculus disease. J Endou- rol 2004;18:23-7. [CrossRef]
• Dawaba MS, Shokeir AA, Hafez AT, Shoma AM, El-Sherbiny MT, Mokhtar A, et al. Percutaneous nephrolithotomy in children: early and late anatomical and functional results. J Urol 2004;172:1078-81. [CrossRef]
• Afshar K, McLorie G, Papanikolaou F, Malek R, Harvey E, Pippi- Salle JL, et al. Outcome of small residual stone fragments follow- ing shock wave lithotripsy in children. J Urol 2004;172:1600-3. [CrossRef]