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• W2017088568 abstract "No AccessJournal of UrologyAdult Urology1 Dec 2012Residual Fragments Following Ureteroscopic Lithotripsy: Incidence and Predictors on Postoperative Computerized Tomography Christopher A. Rippel, Lucas Nikkel, Yu Kuan Lin, Zeeshan Danawala, Vincent Olorunnisomo, Ramy F. Youssef, Margaret S. Pearle, Yair Lotan, and Jay D. Raman Christopher A. RippelChristopher A. Rippel More articles by this author , Lucas NikkelLucas Nikkel More articles by this author , Yu Kuan LinYu Kuan Lin More articles by this author , Zeeshan DanawalaZeeshan Danawala More articles by this author , Vincent OlorunnisomoVincent Olorunnisomo More articles by this author , Ramy F. YoussefRamy F. Youssef More articles by this author , Margaret S. PearleMargaret S. Pearle More articles by this author , Yair LotanYair Lotan More articles by this author , and Jay D. RamanJay D. Raman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.08.040AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Residual fragments following ureteroscopy for calculi may contribute to stone growth, symptoms or additional interventions. We reviewed our experience with ureteroscopy for calculus disease to define the incidence and establish factors predictive of residual fragments. Materials and Methods: Records associated with 667 consecutive ureteroscopic lithotripsy procedures for upper urinary calculi were reviewed. In 265 procedures (40%) computerized tomography was done between 30 and 90 days postoperatively. They comprised the study group. Residual fragments were defined as any residual ipsilateral stone greater than 2 mm. Results: Included in the study were 121 men and 127 women with a mean age of 47 years. Mean target stone diameter was 7.6 mm. The stone location was the kidney in 30% of cases, ureter in 50%, and kidney and ureter in 20%. Residual fragments were detected on computerized tomography after 101 of 265 procedures (38%). Pretreatment stone size was associated with residual fragments at a rate of 24%, 40% and 58% for stones 5 or less, 6 to 10 and greater than 10 mm, respectively (p <0.001). Additionally, stone location in the kidney (p <0.001) or the kidney and ureter (p = 0.044), multiple calculi (p = 0.003), longer operative time (p = 0.008) and exclusive use of flexible ureteroscopy (p = 0.029) were associated with residual fragments. In a multivariate model only pretreatment stone diameter greater than 5 mm was independently associated with residual fragments after ureteroscopy (diameter 6 to 10 and greater than 10 mm OR 2.03, p = 0.03 and OR 3.74, p = 0.003, respectively). Conclusions: Of patients who underwent ureteroscopic lithotripsy for calculi 38% had residual fragments by computerized tomography criteria, including more than 50% with stones 1 cm or greater. Such data may guide expectations regarding the success of ureteroscopy in attaining stone-free status. References 1 : 2007 Guideline for the management of ureteral calculi. Eur Urol2007; 52: 1610. Google Scholar 2 : The contemporary management of renal and ureteric calculi. BJU Int2006; 98: 1283. Google Scholar 3 : Ureteral access strategies: pro-access sheath. Urol Clin North Am2004; 31: 71. Google Scholar 4 : Assessment of a new tipless nitinol stone basket and comparison with an existing flat-wire basket. J Endourol1998; 12: 529. Google Scholar 5 : Changing trends in the use of ureteroscopic instruments from 1996 to 2008. J Endourol2010; 24: 361. Google Scholar 6 : Ureteropyeloscopic treatment of ureteral and intrarenal calculi. Urol Clin North Am2000; 27: 623. 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Google Scholar 27 : Impact of stone location on success rates of endoscopic lithotripsy for nephrolithiasis. Urology2008; 71: 214. Google Scholar 28 : Natural history of residual fragments following percutaneous nephrolithotomy. J Urol2009; 181: 1163. Link, Google Scholar Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, and Department of Urology, University of Texas Southwestern Medical Center (ZD, VO, RFY, MSP, YL), Dallas, Texas© 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byIremashvili V, Li S, Penniston K, Best S, Hedican S and Nakada S (2018) Role of Residual Fragments on the Risk of Repeat Surgery after Flexible Ureteroscopy and Laser Lithotripsy: Single Center StudyJournal of Urology, VOL. 201, NO. 2, (358-363), Online publication date: 1-Feb-2019.Mannil M, von Spiczak J, Hermanns T, Poyet C, Alkadhi H and Fankhauser C (2018) Three-Dimensional Texture Analysis with Machine Learning Provides Incremental Predictive Information for Successful Shock Wave Lithotripsy in Patients with Kidney StonesJournal of Urology, VOL. 200, NO. 4, (829-836), Online publication date: 1-Oct-2018.Pearle M (2016) Is Ureteroscopy as Good as We Think?Journal of Urology, VOL. 195, NO. 4 Part 1, (823-824), Online publication date: 1-Apr-2016.Connors B, Evan A, Blomgren P, Hsi R, Harper J, Sorensen M, Wang Y, Simon J, Paun M, Starr F, Cunitz B, Bailey M and Lingeman J (2013) Comparison of Tissue Injury from Focused Ultrasonic Propulsion of Kidney Stones Versus Extracorporeal Shock Wave LithotripsyJournal of Urology, VOL. 191, NO. 1, (235-241), Online publication date: 1-Jan-2014. Volume 188Issue 6December 2012Page: 2246-2251 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Keywordsuretertomographylithotripsyx-ray computedkidneyureteroscopyMetricsAuthor Information Christopher A. Rippel More articles by this author Lucas Nikkel More articles by this author Yu Kuan Lin More articles by this author Zeeshan Danawala More articles by this author Vincent Olorunnisomo More articles by this author Ramy F. Youssef More articles by this author Margaret S. Pearle More articles by this author Yair Lotan More articles by this author Jay D. Raman More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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