Minerva Urology and Nephrology 2021 Mar 26

DOI: 10.23736/S2724-6051.21.04046-7

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

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

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