Residual fragments after percutaneous nephrolithotomy: is it mandatory to treat them all?

IF 2 2区医学 Q2 UROLOGY & NEPHROLOGY

Urolithiasis Pub Date : 2025-06-04 DOI:10.1007/s00240-025-01775-4

Andrea Li Puma, Federica Passarelli, Elisa De Lorenzis, Emanuele Montanari, Giancarlo Albo, Luca Boeri

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Abstract

To investigate complication rates, stone growth and passage according to residual fragments (RFs) size in a cohort of patients treated with miniPCNL (mPCNL). We retrospectively analysed data from 572 patients who underwent mPCNL between 01/2018 and 11/2023. We identified 105 (19.4%) patients with RFs and at least 1-year follow up. Demographics and RFs passage, regrowth and complications were recorded by chart review and phone interviews. RFs were stratified into ≤ 5 mm; 6-9 mm and ≥ 10 mm groups. Descriptive statistics and logistic regression models were applied to test the association between RFs size and stone related events. Median number and diameter of RFs were 2 (1-3) and 8 (5-10) mm, respectively. RFs of ≤ 5 mm (Group 1), 6-9 mm (Group 2) and ≥ 10 mm (Group 3) were detected in 27 (25.7%), 47 (44.7%) and 31 (29.6%) cases, respectively, after mPCNL. Overall, 23 (21.9%), 20 (19%) and 9 (8.5%) patients had a stone related event [emergency room (ER) admission], stone growth and passage during follow up, respectively. Renal colic requiring ER admission were more frequent in Group 2 compared to the ≥ 10 and ≤ 5 mm one (36.1% vs. 9.6% vs. 11.1%, p = 0.01). Conversely, Group 1 showed higher rates of stone growth compared to the other groups (37.0% vs. 17.0% vs. 6.4%, p = 0.02). No difference in the rate of UTIs and stone passage was reported according to RFs size. Multivariable logistic regression analysis showed that RFs of 6-9 mm had higher risk of stone related events (OR 5.5, p = 0.04) compared to the other groups, even after adjusting for patients' BMI. Conversely, patients with RFs ≤ 5 mm had higher risk of stone growth (OR 9.6, p = 0.04), compared to the other RFs groups, after adjusting for patients' BMI. RFs after mPCNL have different impact on patient's clinical course, according to their size. Large RFs are less likely to grow or cause stone-related events. Conversely, RFs of medium size (6-9 mm) are associated with higher risk of ER admission and should be promptly treated. Small RFs can increase in size, but conservative management or delayed surgery may be considered, as they typically remain asymptomatic during follow-up.

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经皮肾镜取石术后残留碎片：是否必须全部治疗？

研究miniPCNL （mPCNL）患者队列中根据残留碎片（RFs）大小的并发症发生率、结石生长和通过情况。我们回顾性分析了2018年1月至2023年11月期间接受mPCNL的572例患者的数据。我们确定了105例（19.4%）RFs患者，并进行了至少1年的随访。通过图表回顾和电话访谈记录人口统计学和RFs通道、再生和并发症。RFs按≤5 mm分层；6 ~ 9mm组和≥10mm组。采用描述性统计和逻辑回归模型检验RFs大小与结石相关事件之间的关系。RFs的中位数和直径分别为2（1-3）和8 (5-10)mm。mPCNL术后RFs≤5 mm（1组）、6-9 mm（2组）、≥10 mm（3组）分别为27例（25.7%）、47例（44.7%）、31例（29.6%）。总体而言，随访期间分别有23例（21.9%）、20例（19%）和9例（8.5%）患者发生结石相关事件（急诊室入院）、结石生长和结石排出。与≥10 mm组和≤5 mm组相比，第2组需要接受ER治疗的肾绞痛发生率更高（36.1%比9.6%比11.1%,p = 0.01）。相反，与其他组相比，第1组的结石生长率更高（37.0% vs. 17.0% vs. 6.4%, p = 0.02）。根据RFs的大小，尿路感染和结石排出率没有差异。多变量logistic回归分析显示，即使在调整了患者的BMI后，与其他组相比，RFs为6-9 mm的患者发生结石相关事件的风险更高（OR 5.5, p = 0.04）。相反，在调整患者的BMI后，RFs≤5 mm的患者与其他RFs组相比，结石生长的风险更高（OR 9.6, p = 0.04）。mPCNL后RFs的大小不同，对患者临床病程的影响也不同。较大的RFs不太可能生长或引起与结石相关的事件。相反，中等大小的RFs （6- 9mm）与较高的ER入院风险相关，应及时治疗。小的RFs可能会增大，但可以考虑保守治疗或延迟手术，因为它们在随访期间通常没有症状。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Urolithiasis UROLOGY & NEPHROLOGY-

CiteScore

4.50

自引率

6.50%

发文量

期刊介绍： Official Journal of the International Urolithiasis Society The journal aims to publish original articles in the fields of clinical and experimental investigation only within the sphere of urolithiasis and its related areas of research. The journal covers all aspects of urolithiasis research including the diagnosis, epidemiology, pathogenesis, genetics, clinical biochemistry, open and non-invasive surgical intervention, nephrological investigation, chemistry and prophylaxis of the disorder. The Editor welcomes contributions on topics of interest to urologists, nephrologists, radiologists, clinical biochemists, epidemiologists, nutritionists, basic scientists and nurses working in that field. Contributions may be submitted as full-length articles or as rapid communications in the form of Letters to the Editor. Articles should be original and should contain important new findings from carefully conducted studies designed to produce statistically significant data. Please note that we no longer publish articles classified as Case Reports. Editorials and review articles may be published by invitation from the Editorial Board. All submissions are peer-reviewed. Through an electronic system for the submission and review of manuscripts, the Editor and Associate Editors aim to make publication accessible as quickly as possible to a large number of readers throughout the world.