Home > Journals > Minerva Urology and Nephrology > Past Issues > Articles online first > Minerva Urology and Nephrology 2021 Mar 26

CURRENT ISSUE
 

JOURNAL TOOLS

eTOC
To subscribe
Submit an article
Recommend to your librarian
 

ARTICLE TOOLS

Publication history
Reprints
Permissions
Cite this article as
Share

 

 

Minerva Urology and Nephrology 2021 Mar 26

DOI: 10.23736/S2724-6051.21.04046-7

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Introducing Trifecta for percutaneous nephrolithotomies: a proposal for standard reporting outcomes after treatment for renal stones

Giorgio MAZZON 1 , Simon CHOONG 2, Nicola PAVAN 3, Guohua ZENG 4, Wenqi WU 4, Otas DURUTOVIC 5, Marco PIROZZI 1, Jiehui ZHONG 4, Maida BADA 1, Antonio CELIA 1

1 Department of Urology, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy; 2 Institute of Urology, University College Hospital of London, London, UK; 3 Department of Urology, University of Trieste, Trieste, Italy; 4 Department of Urology, minimally invasive Centre, the first affiliated hospital of Guangzhou Medical University, Guangzhou, China; 5 Department of Urology, University of Belgrade, Belgrade, Serbia


PDF


BACKGROUND: In literature, the reports of outcomes after percutaneous nephrolithotomies are rather heterogeneous. This may influence studies comparison, it may also render difficult to evaluate surgical adequacy, peri-operative morbidity and patient’s quality of life between studies. For this reason, we propose to introduce PNL-Trifecta as composite measure to standardize data reporting outcomes after percutaneous nephrolithotomies.
METHODS: We performed a prospective multicentric study on consecutive patients undergone PNL to treat renal stones between 2018 and 2020. Successful PNL-trifecta was considered achieved when procedures obtained the three following results: no residual fragments > 2mm at unenhanced CT scan at 3 months post-op, no complications (defined as Clavien-Dindo Score 0) and operation carried out without placing a nephrostomy tube (tubeless or totally tubeless). We compared results of standard versus mini-PNL and between stones of different complexity (evaluated with Guy’s Stone Score and S.T.O.N.E. nephrolithometry Score). Univariate analysis was utilized to identify other factors influencing achievement of PNL-Trifecta.
RESULTS: 245 patients fulfilled inclusion/exclusion criteria and have been enrolled in the study (median age: 56, IQR 48-57). The overall PNL-Trifecta achievement rate was 22.85% (28.66% in the mini-PNL group and 13.68% in the standard-PNL group, p=0.010). The stone free rate, CD 0 rate and tubeless/totally tubeless rate in the mini-PNL group were 60.66%, 89.33% and 51.33% respectively. In the standard-PNL group they were 44.21%, 40.00% and 15.78% respectively. At the univariate analysis, differences between Guy’s Stone Score groups in achieving PNL-Trifecta were significant (p=0.001). Also, the level of upper puncture (p=0.010) and utilization of device with active suction (p=0.002) showed statistically significant differences. Furthermore, the length of stay in the patient’s group achieving Trifecta was 2.28 versus a mean length of stay of 4.64 days in the group of patients not achieving Trifecta (p=0.046).
CONCLUSIONS: We present Trifecta for PNLs as a potential tool to evaluate quality of percutaneous nephrolithotomies and to provide an instrument for an adequate standard data reporting. It can represent a valid way to assess and monitor surgeon’s learning curves. It will require further external validation and studies to evaluate its correlation with mid- and long-term results and patient’s health related quality of life outcomes.


KEY WORDS: Percutaneous nephrolithotomy; Tubeless; Renal stone; Stone free; Clavien-Dindo; Trifecta

top of page