CT monitoring in predicting the effectiveness of treatment of residual concretions after puncture nephrolithotripsy

CT monitoring in predicting the effectiveness of treatment of residual concretions after puncture nephrolithotripsy

Rossolovskii AN, Kriuchkov IA, Chekhonatskaia ML, Nikolenko VN, Bobylev DA, Kondrateva OA, Rossolovskaia KA, Chekhonatskii IA.

To substantiate the feasibility of MSCT monitoring after puncture nephrolithotripsy (PNLT) in the search for predictors of the treatment effectiveness of residual concretions in patients with coralloid nephrolithiasis.

Materials and methods. The results of treatment of 400 patients with coralloid nephrolithiasis who received surgical treatment by PNLT in the Urology Clinic of the S. R. Mirovortsev Clinical Hospital of SSMU in the period from 2016 to 2018 were analyzed. In 63 (15.8%) of the total number of operated patients, residual stones were diagnosed, which in 17 (27%) cases required additional surgical treatment. The remaining 46 (73%) patients with postoperative residual concretions less than 5 mm in size were prescribed conservative therapy for a period of 3 months upon discharge from the hospital. All 46 patients underwent MSCT examination of the kidneys before discharge from the hospital, followed by active monitoring of the patients. Long-term results of conservative treatment were evaluated with repeated renal MSCT 3 months after PNLT surgery.

Results. Based on the data of CT monitoring performed on the 7th-10th day after PNLT surgery, and subsequent MSCT monitoring of long-term results of conservative management 3 months after PNLT, the prognostic parameter of the effectiveness of conservative tactics in the treatment of patients with CN with residual concretions was determined. Between the value of this indicator and the achievement of the state of complete release of the kidney from the concretion as a result of conservative therapy, there is a noticeable inverse statistically significant (r=-0.62, with p<0.05) dependence. The "CT homogeneity" indicator is highly sensitive and specific, the area under the curve (AUC) was 0.86±0.037.

Conclusion. The data obtained indicate that MSCT monitoring conducted in the early postoperative period allows us to objectively and with a high probability (about 85%) predict the long-term result of post-PNLT metaphylaxis of residual concretions, carried out, in the vast majority of cases, remotely from the center for high-tech surgical treatment of coralloid concretions K1-K3.

1 - V.I. Razumovsky Saratov State Medical University. Saratov, Russia.

2 - I.M. Sechenov First Moscow State Medical University (Sechenov University). Moscow, Russia.

3 - M.V. Lomonosov Moscow State University. Moscow, Russia.

4 - Russian Medical Academy of Postgraduate Education. Moscow, Russia.

 

Keywords: urolithiasis, residual calculi, multispiral computed tomography.

 

Corresponding author:  Kriuchkov IA, e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Rossolovskii AN, Kriuchkov IA, Chekhonatskaia ML, Nikolenko VN, Bobylev DA, Kondrateva OA, Rossolovskaia KA, Chekhonatskii IA. CT monitoring in predicting the effectiveness of treatment of residual concretions after puncture nephrolithotripsy. REJR 2021; 11(2):199-208. DOI: 10.21569/2222-7415-2021-11-2-199-208.

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Received:       19.02.21 Accepted:     25.03.21