, Volume 46, Issue 3, pp 303–309 | Cite as

Evaluation of stone volume distribution in renal collecting system as a predictor of stone-free rate after percutaneous nephrolithotomy: a retrospective single-center study

  • Hasan Anıl Atalay
  • Lutfi Canat
  • Recep Bayraktarlı
  • Ilter Alkan
  • Osman Can
  • Fatih Altunrende
Original Paper


We analyzed our stone-free rates of PNL with regard to stone burden and its ratio to the renal collecting system volume. Data of 164 patients who underwent PNL were analyzed retrospectively. Volume segmentation of renal collecting system and stones were done using 3D segmentation software with the images obtained from CT data. Analyzed stone volume (ASV) and renal collecting system volume (RCSV) were measured and the ASV-to-RCSV ratio was calculated after the creation of a 3D surface volume rendering of renal stones and the collecting system. Univariate and multivariate statistical analyses were performed to determine factors affecting stone-free rates; also we assessed the predictive accuracy of the ASV-to-RCSV ratio using the receiving operating curve (ROC) and AUC. The stone-free rate of PNL monotherapy was 53% (164 procedures).The ASV-to-RCSV ratio and calyx number with stones were the most influential predictors of stone-free status (OR 4.15, 95% CI 2.24–7.24, <0.001, OR 2.62, 95% CI 1.38–4.97, p < 0.001, respectively). Other factors associated with the stone-free rate were maximum stone size (p < 0.029), stone surface area (p < 0.010), and stone burden volume (p < 0.001). Predictive accuracy of the ASV-to-RCSV ratio was AUC 0.76. Stone burden volume distribution in the renal collecting system, which is calculated using the 3D volume segmentation method, is a significant determinant of the stone-free rate before PCNL surgery. It could be used as a single guide variable by the clinician before renal stone surgery to predict extra requirements for stone clearance.


Percutaneous nephrolithotomy Three dimensional Stone-free rate Volume segmentation 



Percutaneous nephrolithotomy


Stone-free rate


Three dimensional


Computed tomography


Body mass index


Renal collecting system volume


Analyzed stone burden volume


Area under the curve


Digital imaging and communications in medicine


Odds ratio


Receiver operating characteristic



We thank Ertan Koç for assistance with statistics that greatly improved the manuscript.

Compliance with ethical standards

Conflict of interest

No competing financial interests exist.


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Hasan Anıl Atalay
    • 1
  • Lutfi Canat
    • 1
  • Recep Bayraktarlı
    • 2
  • Ilter Alkan
    • 1
  • Osman Can
    • 1
  • Fatih Altunrende
    • 1
  1. 1.Department of UrologyOkmeydanı Training and Research HospitalIstanbulTurkey
  2. 2.Department of RadiologyOkmeydanı Training and Research HospitalIstanbulTurkey

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