Journal article
The Impact of Stone Multiplicity on Surgical Decisions for Patients with Large Stone Burden: Results from ReSKU
Journal of endourology, Vol.33(9), pp.742-749
09/01/2019
DOI: 10.1089/end.2019.0130
PMCID: PMC6748398
PMID: 31044624
Abstract
Introduction:
American Urological Association (AUA) guidelines recommend percutaneous nephrolithotomy (PCNL) for total stone burden greater than 20 mm, yet it is unclear if the number of stones affects adherence to this guideline. We aim to assess the impact of stone multiplicity on the choice of ureteroscopy (URS)
vs
PCNL as a first-line therapy for patients with high burden (>20 mm), and examine whether the AUA guideline-discordant care impacts patient outcomes.
Materials and Methods:
Data were collected from the Registry for Stones of the Kidney and Ureter (ReSKU) database, a prospectively collected registry of patients with stone disease. Multivariate logistic regression (MLR) was used to estimate the association between stone multiplicity and the decision to perform URS for high stone burden (>20 mm) patients. MLR was further used to estimate the association between performing URS and the following outcomes: stone-free rate, need for a second operation, and complications. Postoperative hospital stay was compared between patients receiving URS
vs
PCNL using Student's
t
-test.
Results:
One hundred twenty-five patients were included in this analysis. For patients with total stone burden exceeding 20 mm, those with more than three stones had roughly nine times the likelihood of undergoing URS over PCNL compared with patients with a single stone (adjusted odds ratio 9.21, confidence interval [95% CI] 2.55–40.58,
p
= 0.001). Stone-free rates, Clavien–Dindo scores, and frequency of second-look operations did not differ significantly between URS and PCNL patients. URS patients were discharged an average of 1.26 days earlier than patients who received PCNL (95% CI 0.72–1.81,
p
< 0.001).
Discussion:
Stone multiplicity strongly predicts which patients with stone burden >20 mm will undergo URS and who will undergo PCNL. These deviations from AUA guidelines do not appear to worsen patient outcomes. These results suggest that careful consideration of each patient may warrant deviation from guidelines.
Details
- Title: Subtitle
- The Impact of Stone Multiplicity on Surgical Decisions for Patients with Large Stone Burden: Results from ReSKU
- Creators
- Samuel Zetumer - University of California, San FranciscoScott Wiener - University of California, San FranciscoDavid B. Bayne - University of California, San FranciscoManuel Armas-Phan - University of California - San Francisco School of MedicineSamuel L. Washington - University of California, San FranciscoDavid T. Tzou - University of ArizonaMarshall Stoller - University of California, San FranciscoThomas Chi - University of California, San Francisco
- Resource Type
- Journal article
- Publication Details
- Journal of endourology, Vol.33(9), pp.742-749
- Publisher
- Mary Ann Liebert, Inc., publishers
- DOI
- 10.1089/end.2019.0130
- PMID
- 31044624
- PMCID
- PMC6748398
- ISSN
- 0892-7790
- eISSN
- 1557-900X
- Language
- English
- Date published
- 09/01/2019
- Academic Unit
- Internal Medicine
- Record Identifier
- 9984695832902771
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