Using Intraoperative Portable CT Scan to Minimize Reintervention Rates in Percutaneous Nephrolithotomy: A Prospective Trial

Patel, Parth M.; Kandabarow, Alexander M.; Chuang, Eric Y.; McKenzie, Kevin; Druck, Aleksander; Seffren, Christopher; Blanco-Martinez, Enrique; Capoccia, Edward; Farooq, Ahmer; Branch, Jeffrey; Türk, Thomas; Baldea, Kristen

doi:10.1089/end.2022.0049

Cited by 7 publications

(5 citation statements)

References 11 publications

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“…Two included studies emphasized effective radiation dose (ERD) measurement and comparison. Patel et al observed a lower CT-based ERD of 8.4 mSv in the experimental group versus 14.6 mSv in the retrospective cohort ( 13 ). Likewise, Glover et al reported an 83% reduction in longitudinal radiation exposure in the ICT group (15.80 to 2.68 mSv, p < 0.001) ( 14 ).…”

Section: Resultsmentioning

confidence: 96%

“…The included studies employed various intraoperative CT imaging devices, showcasing the diverse approaches to enhancing stone-free outcomes. Patel et al and Van den Broeck et al utilized cone beam computed tomography machines coupled to O-arm and C-arm, respectively ( 12 , 13 ). In Glover et al both types, C and O-arm, were used depending on the availability of the hybrid room ( 14 ) ( Figure-7 ).…”

Section: Discussionmentioning

confidence: 99%

“…Regarding Glover et al populations, supine positioning and tubeless procedures were significantly more used in the ICT group (92% vs 30%, p < 0.001 and 50% vs 7%, p = 0.001, respectively) (14). Cohorts in Patel et al were similar in baseline characteristics (13). Other baseline characteristics of included studies, including the ICT model used in each study are presented in Table-1 for a comprehensive view.…”

Section: Study Selection and Characteristicsmentioning

confidence: 95%

“…Initial experiences of new imaging technologies in the endourology field were performed in 2006 utilizing high magnification rotational fluoroscopy and later in 2017, when promising initial results using the Uro Dyna-CT scan intraoperatively during PCNL were published (10,11). Since then, the viability of using ICT and comparisons to the standard fluoroscopy assessment of residual stones has been increasingly targeted for research (12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative computed tomography for detection of residual stones in endourology procedures: systematic review and meta-analysis

Lepine,

Vicentini,

Mazzucchi

et al. 2024

Int. braz j urol.

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Background: Success rates in endourological procedures, notably percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS), have demonstrated suboptimal outcomes, leading to more reinterventions and radiation exposure. Recently, the use of intraoperative computed tomography (ICT) scans has been hypothesized as a promising solution for improving outcomes in endourology procedures. With this considered, we conducted a comprehensive systematic review and meta-analysis encompassing all available studies that evaluate the impact of the use of intraoperative CT scans on surgical outcomes compared to conventional fluoroscopic-guided procedures.Methods: This systematic review was conducted in accordance with PRISMA guidelines.Multiple databases were systematically searched up to December of 2023. This study aimed to directly compare the use of an ICT scan with the standard non-ICT-guided procedure. The primary endpoint of interest was success rate, and the secondary endpoints were complications and reintervention rates, while radiation exposure was also evaluated. Data extraction and quality assessment were performed following Cochrane recommendations. Data was presented as an Odds ratio with 95%CI across trials and a random-eff ects model was selected for pooling of data.Results: A comprehensive search yielded 533 studies, resulting in the selection of 3 cohorts including 327 patients (103 ICT vs 224 in non-ICT). Primary outcome was significantly higher in the experimental group versus the control group (84.5% vs 41.4% respectively, 307 patients; 95% CI [3.61, 12.72]; p<0.00001; I2=0). Reintervention rates also decreased from 32.6% in the control to 12.6% in the ICT group (OR 0.34; 95%CI [0.12,0.94]; p =0.04; I2= 48%), whereas complication rates did not exhibit significant diff erences. Radiation exposure was also significantly reduced in two of the included studies. Conclusion:This meta-analysis highlights a favorable outcome with intraoperative CT scan use in PCNL procedures, showing a considerable increase in SFR when compared to standard fluoroscopy and nephroscopy. Despite limited studies, our synthesis underscores the potential of ICT scans to significantly reduce residual stones and their consequences for endourology patients, as reinterventions and follow-up ionizing radiation studies.

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Section: Resultsmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Study Selection and Characteristicsmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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Intraoperative computed tomography for detection of residual stones in endourology procedures: systematic review and meta-analysis

Lepine,

Vicentini,

Mazzucchi

et al. 2024

Int. braz j urol.

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“…One such technology is intraoperative portable computed tomography (CT) imaging. Patel et al [29 ▪▪ ] reported a prospective trial in which 60 patients underwent a single intraoperative CT abdomen followed by an ipsilateral antegrade ureteroscopy if stone was visible on the intraoperative CT imaging. These patients were compared with a retrospective cohort without the intraoperative imaging.…”

Section: New Technologymentioning

confidence: 99%

Percutaneous management of upper tract stones: from mini to maxi percutaneous nephrolithotomy

Stern¹

2023

Current Opinion in Urology

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Purpose of reviewPercutaneous nephrolithotomy (PCNL) continues as the gold standard for the surgical management of large renal stones. This short review is intended to highlight recent publications on PCNL of all tract sizes, from mini to standard. Recent findingsLiterature on PCNL in the last 2 years has focused on several main themes --decreasing complications, improving postoperative pain control, and new technology to improve outcomes. Mini-PCNL continues to prove effective and safe, with a new vacuum sheath showing promise of improving stone-free rates and decreasing infections. In terms of infections, preoperative midstream urine culture continues to be a poor indicator of postoperative infection. One of the biggest changes to PCNL practice is the reintroduction of tranexamic acid, which has shown to significantly decrease bleeding and improve outcomes. In terms of postoperative pain control, local blocks are effective and low risk.

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Radiation Hazards in Endourology

Farkouh,

Baldwin

2023

Percutaneous Renal Surgery

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Using Intraoperative Portable CT Scan to Minimize Reintervention Rates in Percutaneous Nephrolithotomy: A Prospective Trial

Cited by 7 publications

References 11 publications

Intraoperative computed tomography for detection of residual stones in endourology procedures: systematic review and meta-analysis

Intraoperative computed tomography for detection of residual stones in endourology procedures: systematic review and meta-analysis

Percutaneous management of upper tract stones: from mini to maxi percutaneous nephrolithotomy

Radiation Hazards in Endourology

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