Clinically Insignificant Residual Fragments: An Acceptable Term in the Computed Tomography Era?

Osman, Yasser; Harraz, Ahmed M.; El-Nahas, Ahmed R.; Awad, Bassam A.; El‐Tabey, Nasr; Shebel, Haytham; Shoma, Ahmed M.; Eraky, Ibrahim; El-Kenawy, Mahmoud R.

doi:10.1016/j.urology.2013.01.011

Cited by 53 publications

(39 citation statements)

References 14 publications

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“…In a retrospective study of 75 patients with at least one residual fragment after PCNL, the clinical relevance of asymptomatic, noninfectious residual frag ments ≤5 mm, as detected by CT was investigated. 19 In this series, with a mean followup duration of 36 months, presence of residual fragments >3 mm was a signifi cant predictor of stone growth, with up to onethird of patients requiring secondary interventions.…”

Section: Defining Stone-freementioning

confidence: 63%

What is the stone-free rate following flexible ureteroscopy for kidney stones?

2015

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Flexible ureteroscopy (URS) is increasingly being used as the first-line treatment for patients with renal stones. Despite this increase in use, substantial variations exist in the reported stone-free rates (SFR) following flexible URS. These variations are a result of inconsistencies in the definition of 'stone-free', which reflect variations in the type of imaging used to assess the presence of stones postoperatively and the timing of the assessment. Other possible factors such as the importance of residual fragments following stone surgery, and the size and position of the stones might also account for variations in stone-free rates. In order to obtain an accurate estimate of the SFR, especially within subgroups defined by stone characteristics and exact technique, we compare reported SFRs from studies that use imaging other than CT for follow-up and those that use only CT. We also review the evidence on the importance of active retrieval of fragments during flexible URS and whether this technique improves the outcomes of patients with kidney stones.

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Section: Defining Stone-freementioning

confidence: 63%

What is the stone-free rate following flexible ureteroscopy for kidney stones?

2015

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“…When the renal pelvic pressure exceeds 30 mmHg, pelvic reflux might be induced. In the case of intrapelvic hyperpressure, the longer the operation time, the more chance and quantity of bacteria or endotoxin can be absorbed through the pelvic reflux [20]. Small-caliber ureteral access sheath was identified as an independent risk factor for systemic inflammatory response syndrome after flexible ureteroscope lithotripsy [9].…”

Section: Discussionmentioning

confidence: 98%

Risk Factors for Systemic Inflammatory Response Syndrome Induced by Flexible Ureteroscope Combined with Holmium Laser Lithotripsy

Meng

et al. 2020

BioMed Research International

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Objective. To investigate the risk factors of systemic inflammatory response syndrome (SIRS) induced by flexible ureteroscope combined with Holmium laser lithotripsy. Patients and Methods. The clinical data from 216 consecutive patients who had undergone flexible ureteroscope combined with Holmium laser lithotripsy between August 2015 and May 2019 were retrospectively analyzed. To identify the risk factors of systemic inflammatory response syndrome induced by flexible ureteroscope combined with Holmium laser lithotripsy, the cases were divided into two groups according to whether they developed postoperative SIRS: SIRS group (21 cases) and non-SIRS group (195 cases). Age, gender, body mass index, stone size, surgery time, stone location, hydronephrosis, urine culture, hospital stay, stone-free rate, ureteral access sheath, and diabetes mellitus were collected. Univariate analysis was performed to calculate the potential factors. In order to determine the independence of the various factors, factors that potentially contributed to SIRS were compared between the SIRS group and the non-SIRS group. Furthermore, multivariate logistic regression analysis was used to identify the risk factors of systemic inflammatory response syndrome induced by flexible ureteroscopic lithotripsy. Results. All patients were successfully treated with flexible ureteroscopic lithotripsy. The incidence of SIRS after flexible ureteroscopic lithotripsy was 9.7%. The univariate analysis demonstrated the potential risk factors of systemic inflammatory response syndrome induced by flexible ureteroscopic lithotripsy were stone size (p=0.002), surgery time (p=0.01), urine culture (p≤0.001), and ureteral access sheath (p=0.001). Multivariable logistic regression analysis showed that stone size (p=0.002, OR=1.618; 95% CI, 0.452-0.844), surgery time (p≤0.001, OR=1.025; 95% CI, 1.016-1.034), urine culture (p≤0.001, OR=25.795; 95% CI, 22.131-30.065), and ureteral access sheath (p≤0.001, OR=6.101; 95% CI, 5.109-7.284) were independent risk factors for SIRS induced by flexible ureteroscopic lithotripsy. Conclusions. Stone size, surgery time, urine culture, and ureteral access sheath are independent risk factors for SIRS induced by flexible ureteroscopic lithotripsy. Patients with these high-risk factors should be carefully evaluated to reduce systemic inflammatory response syndrome.

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“…6,9,10 However, the proposed definition of clinically insignificant residual urinary calculi (<3 mm) together with a mean stone size of 7.09 mm minimizes the probability to overestimate the SFR in our study. 3,20,30 We present the largest series for the treatment of LPS with fURS so far with high primary SFR and low CR over a 6-year period. However, there is a lack of evidence for the treatment of LPS with only few high quality PRTs, which we cannot enhance with our retrospective data.…”

Section: Yearmentioning

confidence: 99%