Natural History Of Residual Fragments Following Percutaneous Nephrostolithotomy

Main Category: Urology / Nephrology
Article Date: 14 Apr 2009 - 0:00 PDT

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UroToday.com - Residual stone fragments following percutaneous nephrolithotomy may not necessarily be indicative of future stone-related events. However, rendering the renal pelvis and ureter free of calculis > 2 mm is critical.

Dr. Margaret Pearle and colleagues performed a retrospective review of 527 patients with CT scan follow-up of at least six months. Using univariate and multivariate analysis,this study shows that stone fragments > 2 mm in size, in the renal pelvis and ureter, are the most predictive of future stone events (i.e. stone growth, ER visit, hospitalization or additional intervention). Interestingly, caliceal residual stone fragments were not predictive of a future stone event especially if small in size and this was of importance for the maximum residual fragment being < 2 mm, but not for the cumulative residual stone size.

CT scan imaging post PCNL is extremely sensitive for picking up residual stone fragments. Therefore, it is reassuring to have these guidelines for determining when second look nephroscopy or ancillary ureteroscopic stone extraction may be indicated in the follow-up of PCNL patients.

Raman JD, Bagrodia A, Gupta A, Bensalah K, Cadeddu JA, Lotan Y, Pearle MS
J Urol. 2009 Mar;181(3):1163-8
10.1016/j.juro.2008.10.162

Written by UroToday.com Contributing Editor Elspeth M. McDougall, MD, FRCSC, MHPE

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