Advertisement

Urolithiasis

, 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

Abstract

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.

Keywords

Percutaneous nephrolithotomy Three dimensional Stone-free rate Volume segmentation 

Abbreviations

PNL

Percutaneous nephrolithotomy

SFR

Stone-free rate

3D

Three dimensional

CT

Computed tomography

BMI

Body mass index

RCSV

Renal collecting system volume

ABV

Analyzed stone burden volume

AUC

Area under the curve

DICOM

Digital imaging and communications in medicine

OR

Odds ratio

ROC

Receiver operating characteristic

Notes

Acknowledgements

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.

References

  1. 1.
    Preminger GM, Clayman RV, Hardeman SW et al (1985) Percutaneous nephrostolithotomy vs open surgery for renal calculi: a comparative study. JAMA 254:1054–1058CrossRefPubMedGoogle Scholar
  2. 2.
    De La Rosette J, Assimos D, Mahesh D et al (2011) The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study. J Endourol 25(1):11–17CrossRefPubMedGoogle Scholar
  3. 3.
    Desai M, De Lisa A, Turna B et al (2011) The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study: Staghorn versus nonstaghorn stones. J Endourol 25:1263–1268CrossRefPubMedGoogle Scholar
  4. 4.
    Ghani KR, Patel U, Anson K (2009) Computed tomography for percutaneous renal access. J Endourol 23:1633–1639CrossRefPubMedGoogle Scholar
  5. 5.
    Zhu Z, Wang S, Xi Q et al (2011) Logistic regression model for predicting stone-free rate after minimally invasive percutaneous nephrolithotomy. Urology 78:32–36CrossRefPubMedGoogle Scholar
  6. 6.
    Shahrour K, Tomaszewski J, Ortiz T et al (2012) Predictors of immediate postoperative outcome of single-tract percutaneous nephrolithotomy. Urology 80:19–25CrossRefPubMedGoogle Scholar
  7. 7.
    Tiselius HG (2008) How efficient is extracorporeal shockwave lithotripsy with modern lithotripters for removal of ureteral stones? J Endourol 22:249–255CrossRefPubMedGoogle Scholar
  8. 8.
    Ackermann D, Dunthorn M, Newman RC et al (1989) Calculation of stone volume and urinary stone staging with computer assistance. J Endourol 3:355–359CrossRefGoogle Scholar
  9. 9.
    El-Nahas AR, Eraky I, Shokeir AA et al (2012) Factors affecting stone-free rate and complications of percutaneous nephrolithotomy for treatment of staghorn stone. Urology 79(6):1236–1241CrossRefPubMedGoogle Scholar
  10. 10.
    Soucy F, Ko R, Duvdechai M et al (2009) Percutaneous nephrolithotomy for staghorn calculi: a single center experience of 15 years. J Endourol 23(10):1669–1673CrossRefPubMedGoogle Scholar
  11. 11.
    Gadzhiev N, Brovkin S, Grigoryev V et al (2015) Sculpturing in urology, or how to make percutaneous nephrolithotomy easier. J Endourol 29(5):512–517CrossRefPubMedGoogle Scholar
  12. 12.
    Thomas K, Smith NC, Hegarty N et al (2011) The Guy’s stone score–grading the complexity of percutaneous nephrolithotomy procedures. Urology 78:277–281CrossRefPubMedGoogle Scholar
  13. 13.
    Okhunov Z, Friedlander JI, George AK et al (2013) S.T.O.N.E. nephrolithometry: novel surgical classification system for kidney calculi. Urology 81:1154–1159CrossRefPubMedGoogle Scholar
  14. 14.
    Smith A, Averch TD, Shahrour K et al (2013) A nephrolithometric nomogram to predict treatment success of percutaneous nephrolithotomy. J Urol 190:149–156CrossRefPubMedGoogle Scholar

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

Personalised recommendations