Percutaneous Nephrolithotomy with Intraoperative Computed Tomography Scanning Improves Stone-Free Rates

作者：Thomas Van den Broeck, Xiaoye Zhu, Anneke Kusters, Jurgen J. Fütterer, Johan F. Langenhuijsen, Frank d’Ancona · 发表于：Journal of Endourology · 年份：2020 · DOI：10.1089/end.2020.0365 · 被引用次数：12 · 研究领域：Kidney Stones and Urolithiasis Treatments、Pediatric Urology and Nephrology Studies、Radiation Dose and Imaging

Introduction: The use of fluoroscopy during percutaneous nephrolithotomy (PCNL) may lead to an overestimation of stone-free rates. The objective of this study is to demonstrate the feasibility of intraoperative CT-guided PCNL compared with standard of care (SoC) PCNL. Patients and Methods: A prospective feasibility study (20 patients undergoing PCNL with an intraoperative CT scan between June 2017 and February 2020) and a retrospective study of a historical cohort (20 consecutive patients undergoing SoC PCNL between September 2015 and September 2016) were conducted. All procedures were performed by an expert endourologist in a tertiary referral hospital. Follow-up was performed at 6 weeks postoperatively. The primary goal is to investigate the practicality and potential benefits and harms of intraoperative CT scanning during PCNL. Secondary outcomes are a stone-free rate after the 6-week follow-up, perioperative radiation exposure, the need for postoperative imaging, and peri- and postoperative complications. Statistical significance was considered at p < 0.05. Results: The initial stone-free rate in the CT scan group was 65% ( n = 13). In 25% ( n = 5) of patients, residual stone fragments were removed after the perioperative CT scan. In the SoC group, 85% ( n = 17) of patients were thought to be stone free perioperatively. At the 6-week follow-up, 80% ( n = 16) in the CT scan group vs 50% in the SoC group ( n = 10) were found to be stone free. Radiation exposure, perioper...