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• W2018096394 abstract "No AccessJournal of UrologyAdult urology1 Jan 2006Intraoperative Fragment Detection During Percutaneous Nephrolithotomy: Evaluation of High Magnification Rotational Fluoroscopy Combined With Aggressive Nephroscopyis corrected byErratum Andrew J. Portis, Mark A. Laliberte, Stephanie Drake, Cindy Holtz, Michael S. Rosenberg, and Carl A. Bretzke Andrew J. PortisAndrew J. Portis Metropolitan Urologic Specialists P. A., St. Paul, Minnesota HealthEast Kidney Stone Institute at St. Joseph’s Hospital, St. Paul, Minnesota Financial interest and/or other relationship with Karl Storz Endoscopy America, Boston Scientific and Pfizer. More articles by this author , Mark A. LaliberteMark A. Laliberte HealthEast Kidney Stone Institute at St. Joseph’s Hospital, St. Paul, Minnesota More articles by this author , Stephanie DrakeStephanie Drake HealthEast Kidney Stone Institute at St. Joseph’s Hospital, St. Paul, Minnesota More articles by this author , Cindy HoltzCindy Holtz Metropolitan Urologic Specialists P. A., St. Paul, Minnesota More articles by this author , Michael S. RosenbergMichael S. Rosenberg St. Paul Radiology P. A., St. Paul, Minnesota More articles by this author , and Carl A. BretzkeCarl A. Bretzke St. Paul Radiology P. A., St. Paul, Minnesota More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)00052-2AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Percutaneous nephrolithotomy effectively treats large volume renal calculi but relies on postoperative imaging to judge success. We evaluated the effectiveness of maximizing intraoperative imaging through combined high resolution fluoroscopy and flexible nephroscopy. Materials and Methods: Percutaneous nephrolithotomy was performed cooperatively with a radiologist in an interventional radiology suite equipped with a ceiling mounted, high resolution C-arm. Aggressive rigid and flexible nephroscopy was performed. At the conclusion patients were prospectively classified as radiologically and/or endoscopically stone-free. Postoperative noncontrast CT allowed fragment classification as stone-free, 2 mm or less, 2 to 4 mm and greater than 4 mm. Results: The average stone dimension ± SEM was 579 ± 77 mm2 in 25 consecutive renal units. CT demonstrated that 15 renal units (60%) were stone-free after the primary procedure, while 2 (8%), 5 (20%) and 3 (12%) had fragments 2 or less, 2 to 4 and greater than 4 mm, respectively. Of 21 renal units considered endoscopically and fluoroscopically stone-free postoperative CT demonstrated that 6 had residual fragments, of which all were less than 4 mm. All 4 renal units not considered radiologically and endoscopically stone-free had fragments on CT. Intraoperative fluoroscopy after nephroscopy demonstrated fragments in 36% of renal units, of which after further nephroscopy 78% were stone-free on CT. The sensitivity of intraoperative imaging with reference to the gold standard of postoperative CT was 40%, 38% and 100% at thresholds of 0, 2 and 4 mm, respectively. Specificity was 100%, 94% and 95%, respectively. Conclusions: Flexible nephroscopy combined with high magnification rotational fluoroscopy allows sensitive and specific intraoperative detection of residual fragments, enabling immediate removal or the planning of necessary second look nephroscopy. References 1 : Percutaneous nephrolithotomy: an update. Curr Opin Urol2003; 13: 235. Google Scholar 2 : Sensitivity of noncontrast helical computerized tomography and plain film radiography compared to flexible nephroscopy for detecting residual fragments after percutaneous nephrostolithotomy. J Urol1999; 162: 23. Link, Google Scholar 3 : Computed tomography after percutaneous renal stone extraction. Acta Radiol1987; 28: 55. Google Scholar 4 : Comparison of endoscopic and radiological residual fragment rate following percutaneous nephrolithotripsy. J Urol1991; 145: 703. Link, Google Scholar 5 : Intraoperative roentgenography in the surgical removal of renal calculi. J Urol1981; 125: 284. Abstract, Google Scholar 6 : Unenhanced computerized axial tomography to detect retained calculi after percutaneous ultrasonic lithotripsy. J Urol1999; 162: 312. Abstract, Google Scholar 7 : Plain abdominal x-ray versus computerized tomography screening: sensitivity for stone localization after nonenhanced spiral computerized tomography. J Urol2000; 164: 308. Link, Google Scholar 8 : Comparison of helical computerized tomography and plain radiography for estimating urinary stone size. J Urol2002; 167: 1235. Link, Google Scholar 9 : Urinary stone size: comparison of abdominal plain radiography and noncontrast CT measurements. J Endourol2003; 17: 725. Google Scholar 10 : Ureteral calculi in patients with flank pain: correlation of plain radiography with unenhanced helical CT. Radiology1997; 204: 27. Google Scholar 11 : Lower pole II: initial results from a comparison of shock wave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrostolithotomy (PNL) for lower pole nephrolithiasis. J Urol2003; 169: 486. abstract 1821,. Google Scholar 12 : Expanding role of flexible nephroscopy in the upper urinary tract. J Endourol1999; 13: 93. Google Scholar © 2006 by American Urological AssociationFiguresReferencesRelatedDetailsCited byGücük A, Kemahlı E, Üyetürk U, Tuygun C, Yıldız M and Metin A (2018) Routine Flexible Nephroscopy for Percutaneous Nephrolithotomy for Renal Stones with Low Density: A Prospective, Randomized StudyJournal of Urology, VOL. 190, NO. 1, (144-148), Online publication date: 1-Jul-2013.Raman J, Bagrodia A, Gupta A, Bensalah K, Cadeddu J, Lotan Y and Pearle M (2018) Natural History of Residual Fragments Following Percutaneous NephrostolithotomyJournal of Urology, VOL. 181, NO. 3, (1163-1168), Online publication date: 1-Mar-2009.Bagrodia A, Gupta A, Raman J, Bensalah K, Pearle M and Lotan Y (2018) Predictors of Cost and Clinical Outcomes of Percutaneous NephrostolithotomyJournal of Urology, VOL. 182, NO. 2, (586-590), Online publication date: 1-Aug-2009.Osman Y, El-Tabey N, Refai H, Elnahas A, Shoma A, Eraky I, Kenawy M and El-Kapany H (2018) Detection of Residual Stones After Percutaneous Nephrolithotomy: Role of Nonenhanced Spiral Computerized TomographyJournal of Urology, VOL. 179, NO. 1, (198-200), Online publication date: 1-Jan-2008.Portis A, Rygwall R, Holtz C, Pshon N and Laliberte M (2018) Ureteroscopic Laser Lithotripsy for Upper Urinary Tract Calculi With Active Fragment Extraction and Computerized Tomography FollowupJournal of Urology, VOL. 175, NO. 6, (2129-2134), Online publication date: 1-Jun-2006.Related articlesJournal of Urology9 Nov 2018Erratum Volume 175Issue 1January 2006Page: 162-165 Advertisement Copyright & Permissions© 2006 by American Urological AssociationKeywordskidneykidney calculinephrostomypercutaneoustomographyx-ray computedfluoroscopyMetricsAuthor Information Andrew J. Portis Metropolitan Urologic Specialists P. A., St. Paul, Minnesota HealthEast Kidney Stone Institute at St. Joseph’s Hospital, St. Paul, Minnesota Financial interest and/or other relationship with Karl Storz Endoscopy America, Boston Scientific and Pfizer. More articles by this author Mark A. Laliberte HealthEast Kidney Stone Institute at St. Joseph’s Hospital, St. Paul, Minnesota More articles by this author Stephanie Drake HealthEast Kidney Stone Institute at St. Joseph’s Hospital, St. Paul, Minnesota More articles by this author Cindy Holtz Metropolitan Urologic Specialists P. A., St. Paul, Minnesota More articles by this author Michael S. Rosenberg St. Paul Radiology P. A., St. Paul, Minnesota More articles by this author Carl A. Bretzke St. Paul Radiology P. A., St. Paul, Minnesota More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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