REGULAR CONTENT
Final ID
521
Type
Original Scientific Research-Oral or Pos
Authors
K Kobayashi1, D Quinzi1, M Samuel2, P Skummer3, M Jawed4, D Zhang5, O Shapiro1, M Karmel6
Institutions
1SUNY Upstate Medical University, Syracuse, NY, 2SUNY Upstate Medical University, Ramsey, NJ, 3SUNY Upstate Medical University Hospital, Syracuse, NY, 4SUNY Upstate, Syracuse, NY, 5SUNY Upstate Medical University, Indianapolis, IN, 6Upstate Medical University, Syracuse, NY
Purpose
To evaluate feasibility and safety of nephroureteral access (NU access) for radiolucent stones and compare with those for radiopaque stones in patients undergoing percutaneous nephrolithotomy (PCNL).
Materials & Methods
Between April 2012 and July 2016, 152 kidneys in 142 patients (70 male, median age:55) were percutaneously accessed for same day PCNL. Of these, 15 kidneys (10%) in 14 patients had radiolucent stones. Per the urologists' request, a stone-containing calyx was accessed under fluoroscopic guidance. Adjunctive techniques to visualize the radiolucent stone(s) were used, such as an intravenous pyelogram or an antegrade nephrostogram via access to the renal pelvis with a double J stent as a landmark if present, or under ultrasound guidance. In patients with pelvic stone(s) without caliceal stones, a posterior lower pole calyx was usually accessed. Technical success rates of NU access (overall and through the stone-containing calyx), stone clearance (no residual stones > 5 mm on post-PCNL imaging), procedure time (minutes), and incidence of complications related to NU access (which resulted in cancellation of same day PCNL) were compared between patients with radiolucent stones (radiolucent group) and those with radiopaque stones (radiopaque group). Stone composition was also recorded.
Results
The overall technical success rate of NU access and success rate through the stone-containing calyx in radiolucent group were 100% (15/15), 100% (11/11), respectively, which were not statistically different from those in radiopaque group (96.4% (132/137), 90.8% (109/120)) (P= 0.53, 0.52). No statistical difference in stone clearance rate (71.4% vs 60.6%, P=0.43) and mean fluoroscopy time (11.6 vs 15.9, P=0.29) were seen between the two groups. Complications were seen in one patient in radiolucent group (7.1%, pelvic perforation) and in 11 in radiopque group (8.6%, infection (n=8) and bleeding (n=3)) (P=0.66). The radiolucent and radiopaque stones were mostly composed of uric acid and calcium oxalate, respectively.
Conclusions
NU access with adjunctive techniques for radiolucent stones was feasible, without increased incidence of complications or procedure time compared with that for radiopaque stones.
Final ID
521
Type
Original Scientific Research-Oral or Pos
Authors
K Kobayashi1, D Quinzi1, M Samuel2, P Skummer3, M Jawed4, D Zhang5, O Shapiro1, M Karmel6
Institutions
1SUNY Upstate Medical University, Syracuse, NY, 2SUNY Upstate Medical University, Ramsey, NJ, 3SUNY Upstate Medical University Hospital, Syracuse, NY, 4SUNY Upstate, Syracuse, NY, 5SUNY Upstate Medical University, Indianapolis, IN, 6Upstate Medical University, Syracuse, NY
Purpose
To evaluate feasibility and safety of nephroureteral access (NU access) for radiolucent stones and compare with those for radiopaque stones in patients undergoing percutaneous nephrolithotomy (PCNL).
Materials & Methods
Between April 2012 and July 2016, 152 kidneys in 142 patients (70 male, median age:55) were percutaneously accessed for same day PCNL. Of these, 15 kidneys (10%) in 14 patients had radiolucent stones. Per the urologists' request, a stone-containing calyx was accessed under fluoroscopic guidance. Adjunctive techniques to visualize the radiolucent stone(s) were used, such as an intravenous pyelogram or an antegrade nephrostogram via access to the renal pelvis with a double J stent as a landmark if present, or under ultrasound guidance. In patients with pelvic stone(s) without caliceal stones, a posterior lower pole calyx was usually accessed. Technical success rates of NU access (overall and through the stone-containing calyx), stone clearance (no residual stones > 5 mm on post-PCNL imaging), procedure time (minutes), and incidence of complications related to NU access (which resulted in cancellation of same day PCNL) were compared between patients with radiolucent stones (radiolucent group) and those with radiopaque stones (radiopaque group). Stone composition was also recorded.
Results
The overall technical success rate of NU access and success rate through the stone-containing calyx in radiolucent group were 100% (15/15), 100% (11/11), respectively, which were not statistically different from those in radiopaque group (96.4% (132/137), 90.8% (109/120)) (P= 0.53, 0.52). No statistical difference in stone clearance rate (71.4% vs 60.6%, P=0.43) and mean fluoroscopy time (11.6 vs 15.9, P=0.29) were seen between the two groups. Complications were seen in one patient in radiolucent group (7.1%, pelvic perforation) and in 11 in radiopque group (8.6%, infection (n=8) and bleeding (n=3)) (P=0.66). The radiolucent and radiopaque stones were mostly composed of uric acid and calcium oxalate, respectively.
Conclusions
NU access with adjunctive techniques for radiolucent stones was feasible, without increased incidence of complications or procedure time compared with that for radiopaque stones.