Salvage Percutaneous Nephrolithotomy: Analysis of Outcomes following Initial Treatment Failure

Abstract

Introduction Percutaneous nephrolithotomy (PCNL) has potential for morbidity or failure. There are limited data regarding risk factors for failure and no published reports of surgical outcomes among patients with prior failed attempts at percutaneous stone removal. Methods Patients referred to three medical centers after prior failed attempts at PCNL were identified. Retrospective chart review was performed analyzing reasons for initial failure and outcomes of salvage PCNL. Outcomes were compared to a prospectively maintained database of over 1200 patients undergoing primary procedures. Results Thirty-one patients underwent salvage PCNL. Unsuitable access to the stone was the leading reason for failure (80%). Other reasons included infection, bleeding, and inadequate instrument availability (6.5% each). Compared to patients undergoing primary PCNL, those undergoing salvage were more likely to have staghorn calculi (61.3% vs. 31.4%, p<0.01), larger maximum stone diameter (3.7 cm vs. 2.5 cm, P<0.01), and require secondary procedures (65.5% vs. 42.1%, p<0.01). There was no significant difference between cohorts for the remainder of demographics or perioperative outcomes. All patients were deemed completely stone free except one who elected to observe a 3 mm non-obstructing fragment. Conclusions Despite the more challenging nature and prior unsuccessful attempts at treatment, outcomes of salvage PCNL were nearly similar to primary PCNL.

Prediction of preoperative the Stone-Free rate in percutaneous nephrolithotomy based on CT clinical-radiomics nomogram: a comparative study with Guy’s stone score and S.T.O.N.E score.

“…For most patients with kidney stones,PCNL can not only relieve pain,but also greatly help symptoms such as nausea, urinary discomfort, and mental distress.In addition,PCNL intervention has a tendency to improve renal function damaged by kidney stones before surgery [19][20] .Due to the different conditions of patients and the characteristics of stones,residual stones will still occur in PCNL. The number, size, and location of stones are considered to be related to the residual stones after PCNL.The remaining stones will signi cantly extend the hospitalization time and increase the number of secondary visit risks of surgery [21][22] .There have been a variety of scoring systems used to predict the stone-free rate of patients with kidney stones after PCNL.Guy's stone score is used to comprehensively evaluate the number of stones,stone shape and anatomical distribution,and classi es kidney stone patients into -grades.The higher it is,the more complex the stones are,and the higher the risk of residual stones after PCNL [23] . The S.T.O.N.E score comprehensively evaluates the complexity of kidney stones by quantifying the maximum cross-sectional area of stones, stone density, degree of kidney damage and PCNL puncture channel,thereby predicting the postoperative outcomes of PCNL.In addition, the stone score relies on multi-center data to establish The CROES nomogram and the S-ReSC score,which focuses on the distribution of stones in the collecting system,also play a certain role in the stone-free rate after PCNL [24][25] .Although traditional stone scores have certain value in post-PCNL outcomes,they have shown shortcomings when compared with machine learning and arti cial intelligence [26][27] .With the successful application of radiomics in renal cancer, prostate cancer, etc.…”

Comparative study between a new screwed Amplatz sheath and the ordinary one in percutaneous nephrolithotomy

“…The cause of failure in both groups was related to failure to gain access. Borofsky et al [ 27 ] stated that access failure was the main cause for aborted PNL.…”

Safety and Feasibility of Salvage Endoscopic Combined Intrarenal Surgery in Embolized Kidney

“…2 Unsuitable access to the stone is the most common reason for prior failed attempt with 80% of salvage procedures associated with prior difficulty with accessing and treating the stone. Other reasons include infection (hemodynamic instability in the presence of purulent urine) and excess bleeding.…”

“…Salvage PCNL is defined as PCNL performed on patients, referred from another provider after an initial unsuccessful attempt, that was made to treat an upper tract stone using a percutaneous access. 2 Unsuitable access to the stone is the most common reason for prior failed attempt with 80% of salvage procedures associated with prior difficulty with accessing and treating the stone. Other reasons include infection (hemodynamic instability in the presence of purulent urine) and excess bleeding.…”

“…Many studies defined the learning curve for PCNL, jointly suggesting that at least 50 to 60 procedures are needed to acquire reliable competence in obtaining access to the kidney and a success rate between 82.5% and 97.6%. 4 , 5 Although salvage PCNL data on its safety and cogency, after previous unsuccessful PCNL, are available, 2 this is not yet for salvage ECIRS although its effectiveness has already been demonstrated as primary procedure. 6 , 7 We wanted to provide ECIRS feasibility in a salvage setting after previous failed PCNL.…”