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Residual stones after PNL: problems of diagnosis and treatments (literature review) DOI: 10.29188/2222-8543-2019-11-1-57-62
- Gorelov D.S. – urologist of the department of urology No. 2 (extracorporeal shock wave lithotripsy and endovideosurgery), clinic of urology, First Saint-Petersburg State Medical University n. a. I. P. Pavlov; е-mail: dsgorelov@mail.ru; ORCID 0000-0003-4521-5112
- Gadzhiev N.K. – PhD, head of the department of urology No. 2 (extracorporeal shock wave lithotripsy and endovideosurgery), clinic of urology, First Saint-Petersburg State Medical University n. a. I. P. Pavlov; е-mail: nariman.gadjiev@gmail.com; ORCID 0000-0002-6255-0193
- Akopyan G.N. – Dr. Sc., associate professor of the Department of Urology, First Moscow State Medical University. I. M. Sechenov; e-mail: docgagik@mail.ru
- Ivanov A.O. – chief of the department of urology No. 2 (extracorporeal shock wave lithotripsy and endovideosurgery), clinic of urology, First Saint-Petersburg State Medical University n. a. I. P. Pavlov; е-mail: andrey_ivanov_62@bk.ru
- Schukin V.L. – urologist, of Department of Surgery of the City Hospital №20. Saint-Petersburg; е-mail: yankovicspb@mail.ru
- Talyshinskiy A.E. – urologist of department of urology No. 2 (extracorporeal shock wave lithotripsy and endovideosurgery), clinic of urology, First Saint-Petersburg State Medical University n. a. I. P. Pavlov; е-mail: ali-ma@mail.ru
- Talyshinskiy A.E. – urologist of department of urology No. 2 (extracorporeal shock wave lithotripsy and endovideosurgery), clinic of urology, First Saint-Petersburg State Medical University n. a. I. P. Pavlov; е-mail: ali-ma@mail.ru
1180 Relevance: Modern minimally invasive methods of treatment of nephrolithiasis can improve the effectiveness of treatment with a significant reduction in the trauma of surgical interventions and the frequency of complications. Currently, the "gold standard " treatment of large (more than 2 cm) kidney stones is percutaneous nephrolithotomy (PCNL). One of the key criteria for evaluating the effectiveness is "SFR" (Stone Free Rate – the frequency of complete release of the kidney from stones). Previously, it was believed that residual stones less than 4 mm are clinically insignificant, however, according to modern studies, residual stones of any size should be regarded as potentially clinically significant.
Objective: to analyze the effectiveness of methods for predicting the abandonment of residual stones after PCNL, the informativeness of various methods of intra – and postoperative diagnosis, as well as the effectiveness of methods of treatment of residual stones.
Materials and methods: literature was searched in two databases: PUBMED and Google Scholar. Keywords: urolithiasis, percutaneous nephrolithotomy, residual stones. A comparative analysis of the nomograms used to predict SFR, such diagnostic methods as ultrasound, survey urography, multispiral computed tomography and endoscopic inspection of the kidney. Various methods of treatment of residual stones were also analyzed: extracorporeal shock wave lithotripsy (ESWL), second-look nephroscopy, repeated PCNL, retrograde intrarenal surgery (RIRS), drug therapy
Results: The use of specialized nomograms at the preoperative stage makes it possible to predict the probability of achieving SFR. Computed tomography has the highest resolution detection of residual stones. Its implementation in the early postoperative period allows not only to identify residual stones, but also to choose the optimal treatment tactics.
Conclusion: The problem of residual stones is very urgent today. Achieving maximum SFR is possible through prediction and selection of optimal methods of diagnosis and treatment of residual stones, depending on their size, number, location and composition.
Authors declare lack of the possible conflicts of interests.
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