Predicting calyceal access for percutaneous nephrolithotomy with computed tomography multiplanar reconstruction
AUTOR(ES)
Guglielmetti, Giuliano B., Danilovic, Alexandre, Torricelli, Fabio C.M., Coelho, Rafael F., Mazzucchi, Eduardo, Srougi, Miguel
FONTE
Clinics
DATA DE PUBLICAÇÃO
2013-06
RESUMO
OBJECTIVES: Objective parameters in computed tomography (CT) scans that could predict calyceal access during percutaneous nephrolithotomy have not been evaluated. These parameters could improve access planning for percutaneous nephrolithotomy. We aimed to determine which parameters extracted from a preoperative multiplanar reconstructed CT could predict renal calyceal access during a percutaneous nephrolithotomy. METHODS: From January 2009 through April 2011, 230 patients underwent 284 percutaneous nephrolithotomies at our institution. Sixteen patients presented with complete staghorn calculi, and 11 patients (13 renal units) were analyzed. Five parameters were extracted from a preoperative reconstructed CT and compared with the surgical results of percutaneous nephrolithotomy. RESULTS: Fifty-eight calyces were studied, with an average of 4.4 calyces per procedure. A rigid nephroscope was used to access a particular calyx, and a univariate analysis showed that the entrance calyx had a smaller length (2.7 vs. 3.98 cm, p = 0.018). The particular calyx to be accessed should have a smaller length (2.22 vs. 3.19 cm, p = 0.012), larger angles (117.6 vs. 67.96, p<0.001) and larger infundibula (0.86 vs. 0.61 cm, p = 0.002). In the multivariate analysis, the only independent predictive factor for accessing a particular calyx was the angle between the entrance calyx and the calyx to be reached (OR 1.15, 95% confidence interval [CI], 1.053-1.256, p = 0.002). CONCLUSION: The angle between calyces obtained by multiplanar CT reconstruction is the only predictor of calyx access.
Documentos Relacionados
- Development of a computer assisted gantry system for gaining rapid and accurate calyceal access during percutaneous nephrolithotomy
- Multiplanar Anatomy of the Head and Neck for Computed Tomography
- Supracostal access: does it affect tubeless percutaneous nephrolithotomy efficacy and safety?
- Computed tomography-guided percutaneous drainage of tension pneumomediastinum
- Ultrasound - guided access during percutaneous nephrolithotomy: entering desired calyx with appropriate entry site and angle