Gauhar Vineet, Castellani Daniele, Chew Ben Hall, Smith Daron, Chai Chu Ann, Fong Khi Yung, Teoh Jeremy Yuen-Chun, Traxer Olivier, Somani Bhaskar Kumar, Tailly Thomas
Department of Urology, Ng Teng Fong General Hospital, Singapore, Singapore.
Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Via Conca 71, Ancona 60126, Italy.
Ther Adv Urol. 2023 Sep 8;15:17562872231198629. doi: 10.1177/17562872231198629. eCollection 2023 Jan-Dec.
Assessment of residual fragments (RFs) is a key step after treatment of kidney stones.
To evaluate differences in RFs estimation based on unenhanced computerized tomography (CT) X-rays/ultrasound after retrograde intrarenal surgery (RIRS) for kidney stones.
A retrospective analysis of data from 20 centers of adult patients who had RIRS was done (January 2018-August 2021).
Exclusion criteria: ureteric stones, anomalous kidneys, bilateral renal stones. Patients were divided into two groups (group 1: CT; group 2: plain X-rays or combination of X-rays/ultrasound within 3 months after RIRS). Clinically significant RFs (CSRFs) were considered RFs ⩾ 4 mm. One-to-one propensity score matching for age, gender, and stone characteristics was performed. Multivariable logistic regression analysis was performed to evaluate independent predictors of CSRFs.
A total of 5395 patients were included (1748 in group 1; 3647 in group 2). After matching, 608 patients from each group with comparable baseline and stone characteristics were included. CSRFs were diagnosed in 1132 patients in the overall cohort (21.0%). Post-operative CT reported a significantly higher number of patients with RFs ⩾ 4 mm, before (35.7% 13.9%, < 0.001) and after matching (43.1% 23.9%, < 0.001). Only 21.8% of patients in the matched cohort had an ancillary procedure post-RIRS which was significantly higher in group 1 (74.8% 47.6%, < 0.001). Age [OR 1.015 95% confidence interval (CI) 1.009-1.020, < 0.001], stone size (OR 1.028 95% CI 1.017-1.040, < 0.001), multiple stones (OR 1.171 95% CI 1.025-1.339, = 0.021), lower pole stone (OR 1.853 95% CI 1.557-2.204, < 0.001) and the use of post-operative CT scan (OR 5.9883 95% CI 5.094-7.037, < 0.001) had significantly higher odds of having CSRFs.
CT is the only reliable imaging to assess the burden of RFs following RIRS and urologist should consider at least one CT scan to determine the same and definitely plan reintervention only based on CT rather than ultrasound and X-ray combination.
评估残余结石碎片（RFs）是肾结石治疗后的关键步骤。
评估逆行性肾内手术（RIRS）治疗肾结石后，基于非增强计算机断层扫描（CT）、X线平片/超声对RFs估计的差异。
对20个中心2018年1月至2021年8月接受RIRS的成年患者的数据进行回顾性分析。
排除标准：输尿管结石、肾脏异常、双侧肾结石。患者分为两组（第1组：CT；第2组：RIRS术后3个月内的X线平片或X线/超声联合检查）。具有临床意义的RFs（CSRFs）定义为RFs⩾4mm。对年龄、性别和结石特征进行一对一倾向评分匹配。进行多变量逻辑回归分析以评估CSRFs的独立预测因素。
共纳入5395例患者（第1组1748例；第2组3647例）。匹配后，每组纳入608例基线和结石特征可比的患者。整个队列中有1132例患者被诊断为CSRFs（21.0%）。术后CT报告RFs⩾4mm的患者数量在匹配前（35.7%对13.9%，P<0.001）和匹配后（43.1%对23.9%，P<0.001）均显著更高。匹配队列中只有21.8%的患者在RIRS术后进行了辅助手术，第1组显著更高（74.8%对47.6%，P<0.001）。年龄[比值比（OR）1.015，95%置信区间（CI）1.009 - 1.020，P<0.001]、结石大小（OR 1.028，95%CI 1.017 - 1.040，P<0.001）、多发结石（OR 1.171，95%CI 1.025 - 1.339，P = 0.021）、下极结石（OR 1.853，95%CI 1.557 - 2.204，P<0.001）以及术后CT扫描的使用（OR 5.9883，95%CI 5.094 - 7.037，P<0.001）与发生CSRFs的几率显著更高相关。
CT是评估RIRS后RFs负担的唯一可靠影像学检查，泌尿外科医生应至少进行一次CT扫描以确定RFs情况，并仅基于CT而非超声和X线联合检查来明确计划再次干预。
