A novel nomogram and a simple scoring system for urinary leakage after percutaneous nephrolithotomy

Abstract

Introduction:The present study aimed to investigate the factors of prolonged urinary leakage (PUL) after percutaneous nephrolithotomy (PCNL) and develop a new and simple scoring system to predict it. Patients and Methods: We retrospectively reviewed patients with renal stones who underwent PCNL at the University of Health Sciences Izmir Bozyaka Training and Research Hospital between April 2011 and January 2020. The patients were divided into two groups according to the presence of PUL, and their preoperative and perioperative data were compared. A multivariate regression analysis was applied to examine the relationship between perioperative descriptors and PUL, and a nomogram was developed using significant predictors. Then, the individual components of the nomogram were assigned points to form a scoring system. Results: There were 92 and 840 patients in the groups with and without PUL, respectively. The results of the univariate logistic regression analysis showed that hydronephrosis grade, parenchymal thickness, duration of nephroscopy, and duration of nephrostomy catheter were significantly associated with PUL. Subsequently, a multivariate regression analysis was carried out with these four factors as possible independent risk factors of PUL after PCNL. Based on the results of this analysis, a nomogram prediction model was developed with an area under the curve value of 0.811, which was consequently used to develop a new simple score system consisting of three characteristics: parenchymal thickness (1-5 points), duration of nephroscopy (1-3 points), and hydronephrosis grade (1-3 points). Conclusion: A novel scoring system is a useful tool for predicting PUL in patients who have undergone percutaneous nephrolithotomy.

Comparing Balloon Dilation to Non-Balloon Dilation for Access in Ultrasound-Guided Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

“…In our study, Ren et al reported a significantly higher rate of successful dilation with balloon dilation in patients without a history of open renal surgery for staghorn stones ( 14 ). However, the meta-analysis conducted in this study did not show any significant differences in the successful dilation rat atheter were significantly associated with prolonged urinary leakage ( 30 ). Whether balloon dilation is effective in lowering complication rates remains controversial.…”

“…However, there was inconsistency in the classification of complications among the included studies, which may have influenced the results of the statistical analysis. Sahan et al ( 30 ) found that hydronephrosis grade, parenchymal thickness, duration of nephroscopy, and duration of nephrostomy c parenchyma during the dilation process ( 32 , 33 ). Furthermore, performing balloon dilation under ultrasound guidance allows for direct visualization, reducing the risk of damage to the collecting system.…”

One week pre-operative oral antibiotics for percutaneous nephrolithotomy reduce risk of infection: a systematic review and meta-analysis

“…Percutaneous nephrolithotomy (PCNL) is the current gold standard treatment for kidney stones > 20 mm (1). Although effective, PCNL is associated with complications such as prolonged urinary leakage in up to 10% and blood transfusion in up to 7% of the patients (2)(3)(4)(5). Approximately 10% of the patients develop a postoperative fever after PCNL, while sepsis is reported in 0.3% to 0.5% (5,6).…”

Modified biplanar (0-90o) endoscopic-guided puncture technique for percutaneous nephrolithtomy: refinement with endoscopic combined intrarrenal surgery to reduce fluoroscopy and operative time

“…She managed to pass the distal stone but remained with the double J and a 20mm stone (1300HU) in the right renal pelvis. The shared decision was for the actual standard of care ( 3 , 4 ) endoscopic combined intrarenal surgery (ECIRS). The MiniECIRS started with flexible ureteroscopy and a posterior calix which gave direct access to the stone was chosen.…”