Preoperative assessment of stone free rate following percutaneous nephrolithotomy
Keywords:Percutaneous Nephrolithotomy,clavin –Dindo classification system,Clinically Significant Residual Fragements, postoperative complications.
Introduction: Renal stones are one of the most common reason for patient’s visit to Urologic outpatient department. PCNL is novel minimally invasive modality for renal stone management and approved by the European Association of Urology (EAU) as 1st line approach. Inspite of high success rates, PCNL can be associated with wide range of complications, ranging from 20-83%.A scoring system which can pre-operatively grade the extent of stone disease, its possible impact on treatment outcomes and occurrence of complications are not only essential but should become an integral part of the care plan.Guy’s score has been externally validated in many studies. In this study we use this Guy’s score in predicting Post op stone free rate following PCNL and also assess the complications of PCNL. Materials and methods: This is retrospective observational Study conducted in Department of urology, Nizam Institute of Medical Sciences, Hyderabad between November 2018 and October2020. Information was obtained from previous records of total 100 patients and analysed retrospectively. All patients with renal calculi > 18 years of age , posted electively for Percutaneous Nephrolithotomy were included in the study. Patients with severe comorbid illness and who underwent Percutaneous Nephrolithotomy in pastwere excluded. Results: Total number of patient included in the study were 100 , (n=100). Majority of the patients were in the 5th decade (27%) Among them males were 64 (64%) and females were 36 (36%). Patient with comorbid conditions were 28 (28%) . Among the comorbidities, Diabetes mellitus was present in 16% of patients.Patients were classified using Guy’s Stone Scoring system to assess the preoperative complexity of the calculus and predict the stone free rate and the complications. Most of the patients were included in the category of Guy’s stone score –1.All patients were evaluated for residual fragments by post PCNL ultrasound on post-operative day 1. Clinically Insignificant Residual Fragments (CIRF)were defined as <4mm, non- obstructive and asymptomatic residual fragments. All perioperative complications were stratified by clavin –Dindo classification system. Peri-operative complications includes intraoperative and post operative complications including CSRF. Total number of patients who had complications include 25 (25%) . Of them 9 patients had grade 1 complication., 6 had grade-2, 7 had grade -3 and 3 had grade -4 complications. Statistical analysis showed significant association between Clinically Significant Residual Fragements, number of punctures required and post operative stay with Guys Stone Score. There is no significant association between Guys stone score and complications graded as per modified ClavienDindoclassification , but there is non significant increased incidence of complication grade with increase in stone score. Conclusion: Guys stone score significantly predict, number of punctures required for PCNL, Stone free rate, Post operative hospital stay.
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Copyright (c) 2021 Dheeraj SS, G.V. Charan Kumar, Rahul Devraj, Vidyasagar, Ramachandraiah, Ramreddy Ch
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