Background: Scoring metrics to assess and compare outcomes of percutaneous nephro- lithotomy (PCNL) are needed. We aim to evaluate prevalence and predictors of trifecta in a cohort of patients treated with vacuum-assisted mini-percutaneous nephrolithotomy (vmPCNL) for kid- ney stones. Methods: Data from 287 participants who underwent vmPCNL were analysed. Patients’ and stones’ characteristics as well as operative data were collected. Stone-free was defined as no residual stones. The modified Clavien classification was used to score postoperative complications. Trifecta was defined as stone-free status without complications after a single session and no auxil- iary procedures. Descriptive statistics and logistic regression models tested the association between predictors and trifecta outcome. Results: After vmPCNL, 219 (76.3%) patients were stone-free, and 81 (28.2%) had postoperative complications (any Clavien). Of 287, 170 (59.2%) patients achieved trifecta criteria. Patients who achieved trifecta status had smaller stone volume (p < 0.001), a higher rate of single stones (p < 0.001), shorter operative time (p < 0.01), and a higher rate of single percuta- neous tract (p < 0.01) than −trifecta patients. Trifecta status decreased with the number of calyces involved, being 77.1%, 18.8%, and 4.1% in patients with 1, 2, or 3 calyces with stones, respectively (p < 0.001). Multivariable logistic regression analysis showed that stone volume (OR 1.1, p = 0.02) and multiple calyces being involved (OR 2.8 and OR 4.3 for two- and three-calyceal groups, respec- tively, all p < 0.01) were independent unfavourable risk factors for trifecta after accounting for age, BMI, gender, operative time, and number of access tracts. Conclusions: Trifecta status was achieved in 6 out of 10 patients after vmPCNL. Stone distribution in multiple calyceal groups and stone vol- ume were independent unfavourable risk factors for trifecta.

Validation of the Trifecta Scoring Metric in Vacuum-AssistedùMini-Percutaneous Nephrolithotomy: ASingle-Center Experience / E. Pozzi, M. Malfatto, M. Turetti, C. Silvani, L.M.I. Jannello, S. Garbagnati, G. Galbiati, S.P. Zanetti, F. Longo, E. De Lorenzis, G. Albo, A. Salonia, E. Montanari, L. Boeri. - In: JOURNAL OF CLINICAL MEDICINE. - ISSN 2077-0383. - 11:(2022 Nov), pp. 6788.1-6788.9. [10.3390/jcm11226788]

Validation of the Trifecta Scoring Metric in Vacuum-AssistedùMini-Percutaneous Nephrolithotomy: ASingle-Center Experience

E. Pozzi
Primo
;
M. Malfatto
Secondo
;
M. Turetti;C. Silvani;L.M.I. Jannello;S. Garbagnati;G. Galbiati;S.P. Zanetti;G. Albo;E. Montanari
Penultimo
;
L. Boeri
Ultimo
2022

Abstract

Background: Scoring metrics to assess and compare outcomes of percutaneous nephro- lithotomy (PCNL) are needed. We aim to evaluate prevalence and predictors of trifecta in a cohort of patients treated with vacuum-assisted mini-percutaneous nephrolithotomy (vmPCNL) for kid- ney stones. Methods: Data from 287 participants who underwent vmPCNL were analysed. Patients’ and stones’ characteristics as well as operative data were collected. Stone-free was defined as no residual stones. The modified Clavien classification was used to score postoperative complications. Trifecta was defined as stone-free status without complications after a single session and no auxil- iary procedures. Descriptive statistics and logistic regression models tested the association between predictors and trifecta outcome. Results: After vmPCNL, 219 (76.3%) patients were stone-free, and 81 (28.2%) had postoperative complications (any Clavien). Of 287, 170 (59.2%) patients achieved trifecta criteria. Patients who achieved trifecta status had smaller stone volume (p < 0.001), a higher rate of single stones (p < 0.001), shorter operative time (p < 0.01), and a higher rate of single percuta- neous tract (p < 0.01) than −trifecta patients. Trifecta status decreased with the number of calyces involved, being 77.1%, 18.8%, and 4.1% in patients with 1, 2, or 3 calyces with stones, respectively (p < 0.001). Multivariable logistic regression analysis showed that stone volume (OR 1.1, p = 0.02) and multiple calyces being involved (OR 2.8 and OR 4.3 for two- and three-calyceal groups, respec- tively, all p < 0.01) were independent unfavourable risk factors for trifecta after accounting for age, BMI, gender, operative time, and number of access tracts. Conclusions: Trifecta status was achieved in 6 out of 10 patients after vmPCNL. Stone distribution in multiple calyceal groups and stone vol- ume were independent unfavourable risk factors for trifecta.
percutaneous nephrolithotomy; vacuum-assisted percutaneous nephrolithotomy; stone-free rate; complications; trifecta
Settore MED/24 - Urologia
Article (author)
File in questo prodotto:
File Dimensione Formato  
jcm-11-06788.pdf

accesso aperto

Tipologia: Publisher's version/PDF
Dimensione 344.41 kB
Formato Adobe PDF
344.41 kB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/945884
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus ND
  • ???jsp.display-item.citation.isi??? ND
social impact