Does success in percutaneous nephrolithotomy depend only on stone size? Analysis of the predictive capacity for success and complications of the current nephrolithometry scoring systems and their relationship with the stone surface.

OBJECTIVE: To analyze the predictive capacity of the nephrolithometry scoring systems (GSS, STONE, CROES and S-ReSC) and stone surface regarding success and complications following percutaneous nephrolithotomy (PCNL). METHODS: We studied 392 patients who had undergone PCNL in our center. Only patients with a non-contrast CT (n = 240) were finally included for analysis. The predictive capacities for success and complications of the different scoring systems were evaluated using ROC curves and their area under the curve (AUC). RESULTS: Regarding success, the S-ReSC system had the highest predictive capacity with an AUC of 0.681 (95% CI 0.610-0.751), followed by the CROES with 0.667 (95% CI 0.595-0.738), the STONE with 0.654 (95% CI 0.579-0.728) and finally the GSS with 0.626 (95% CI 0.555-0.698). The stone surface as a single variable had an AUC of 0.641 (95% CI 0.565-0.718). As for complications, the S-ReSC had the highest AUC with 0.664 (95% CI 0.57-0.758), followed by STONE with 0.663 (95% CI 0.572-0.755), GSS with 0.626 (95% CI 0.555).-0.698) and CROES with 0.614 (95% CI 0.518-0.7). The stone surface alone had an AUC of 0.616 (95% CI 0.522-0.715). CONCLUSION: The nephrolithometry scales analyzed show a moderate predictive capacity for success and complications in patients undergoing PCNL in our center. Moreover, stone surface as an independent variable demonstrates moderate predictive capacity for both outcomes.

Initial results of endourological treatment of renoureteral lithiasis by means of flexible ureteroscopy and percutaneous surgery in an outpatient procedure in a tertiary care center.

OBJECTIVE: Urinary lithiasis is a prevalent disease with a high socioeconomic impact, where endourological surgery has shown excellent results with minimal complications. For its part, outpatient surgery is an efficient, safe and quality care model. We present our experience in the outpatient endourological treatment of lithiasis and a review of the main series. MATERIAL AND METHODS: Prospective analysis of 85 flexible or percutaneous procedures for the treatment of lithiasis, carried out in our center between January 2021 and April 2022. The main objective was to analyze the rate of unplanned admission and the success and incidence of complications as secondary objectives. The patients were selected following the inclusion criteria of the care process. RESULTS: The mean age was 56 ± 14 years. Urine culture was positive in 13.9% of the patients, 38% had a pre-surgical double-J catheter. Median stone surface was 55 mm 2 (961 ± 323 Hounsfield Units). 73 flexible and 12 percutaneous procedures were performed. 8 patients required immediate unplanned admission and another 2 during the first month. 94% were stone-free at the third month. No intraoperative complications were detected, although 16.5% of the patients presented some type of postoperative complication. CONCLUSION: In our experience, with a strict selection of patients and following a care process with multidisciplinary participation, endourological procedures are feasible and safe in the outpatient setting. Periodic monitoring of the results is essential for the sake of a constant improvement of the process.

Resultados iniciales del tratamiento endourológico de la litiasis renoureteral mediante ureteroscopia flexible y cirugía percutánea en régimen de cirugía mayor ambulatoria en un centro de tercer nivel / Initial results of endourological treatment of renoureteral lithiasis by means of flexible ureteroscopy and percutaneous surgery in an outpatient procedure in a tertiary care center

Objetivo La litiasis urinaria es una enfermedad prevalente y con elevado impacto socioeconómico, donde la cirugía endourológica ha demostrado excelentes resultados con mínimas complicaciones. Por su parte, la cirugía ambulatoria es un modelo asistencial eficiente, seguro y de calidad. Presentamos nuestra experiencia en el tratamiento endourológico ambulatorio de la litiasis renoureteral y una revisión de las principales series. Material y métodos Análisis prospectivo de 85 procedimientos flexibles o percutáneos para el tratamiento de la litiasis, llevados a cabo en nuestro centro entre enero de 2021 y abril de 2022. Se estableció como objetivo principal analizar la tasa de ingreso no planificado y como objetivos secundarios el éxito e incidencia de complicaciones. Los pacientes fueron seleccionados siguiendo los criterios del proceso asistencial. Resultados La edad media fue de 56±14 años. El urocultivo fue positivo en 13,9% de los pacientes, siendo portadores de doble J prequirúrgico 38%. Mediana de superficie litiásica de 55 mm2, con 961±323 Unidades Hounsfield. Se realizaron 73 procedimientos flexibles y 12 percutáneos. Ocho pacientes requirieron ingreso no planificado inmediato y otros dos durante el primer mes. Al tercer mes, 94% se encontraban libre de litiasis. No se detectaron complicaciones intraoperatorias, aunque 16,5% de los pacientes presentaron algún tipo de complicación postoperatoria. Conclusión En nuestra experiencia, con una estricta selección de los pacientes y siguiendo un proceso asistencial con participación multidisciplinar, los procedimientos endourológicos son factibles y seguros en el ámbito ambulatorio. La monitorización periódica de los resultados es fundamental en aras de una mejora constante del proceso (AU)

Objective Urinary lithiasis is a prevalent disease with a high socioeconomic impact, where endourological surgery has shown excellent results with minimal complications. For its part, outpatient surgery is an efficient, safe and quality care model. We present our experience in the outpatient endourological treatment of lithiasis and a review of the main series. Material and methods Prospective analysis of 85 flexible or percutaneous procedures for the treatment of lithiasis, carried out in our center between January 2021 and April 2022. The main objective was to analyze the rate of unplanned admission and the success and incidence of complications as secondary objectives. The patients were selected following the inclusion criteria of the care process. Results The mean age was 56±14 years. Urine culture was positive in 13.9% of the patients, 38% had a pre-surgical double-J catheter. Median stone surface was 55 mm2 (961±323 Hounsfield Units). 73 flexible and 12 percutaneous procedures were performed. 8 patients required immediate unplanned admission and another 2 during the first month. 94% were stone-free at the third month. No intraoperative complications were detected, although 16.5% of the patients presented some type of postoperative complication. Conclusion In our experience, with a strict selection of patients and following a care process with multidisciplinary participation, endourological procedures are feasible and safe in the outpatient setting. Periodic monitoring of the results is essential for the sake of a constant improvement of the process (AU)

Safety of percutaneous nephrolithotomy in patients on chronic anticoagulant or antiplatelet therapy.

In developed countries, the incidence of cardiovascular disease is increasing, therefore, anticoagulant and antiplatelet drugs are a widespread treatment nowadays. Percutaneous nephrolithotomy (PNL) is the first-line treatment for large or complex stones (> 2 cm) and remains an alternative for the smaller ones. The objective of this study is to analyze whether PNL surgery is a safe procedure in patients under a treatment discontinuation protocol for anticoagulant or antiplatelet therapies. We retrospectively studied 301 patients who underwent PNL in our hospital between 2008 and 2016 and identified 46 patients on chronic antiplatelet or anticoagulation treatment. With respect to PNL outcomes, the stone-free rate was similar (78 vs 74%, p = 0.762) in both groups, without any significant differences in the overall postoperative complications (17 vs 26%, p = 0.203). The incidence of hemorrhagic complications was similar between groups (12 vs 9%, p = 0.492), as demonstrated by the mean drop in hemoglobin (Hb), which was comparable in both cohorts (2.2 ± 1.3 vs 2.0 ± 1.4 p = 0.270) and the blood transfusion rate (14% in group A and 8% in group B, p = 0.205). No thromboembolic events were found within the year after the PNL procedure. PNL is a safe and effective intervention in patients under a treatment discontinuation protocol for anticoagulant or antiplatelet therapies. Although our study demonstrates the feasibility of this protocol, new scientific evidence aims to stratify the thromboembolic and bleeding risk of each patient to individualize the perioperative management thereafter.