Exploring key factors affecting stone retention rates in percutaneous nephrolithotomy from a three-dimensional...

Area of Science:

• Nephrology
• Urology
• Medical Imaging

Background:

• Percutaneous nephrolithotomy (PCNL) is a standard treatment for kidney stones.
• Residual calculi after PCNL present a significant clinical challenge.
• Optimizing preoperative planning is crucial for successful stone clearance.

Purpose of the Study:

• To investigate if target calyx morphology predicts stone clearance from non-target calyces during PCNL.
• To develop a predictive model for residual stone risk after PCNL.

Main Methods:

• Retrospective analysis of 105 PCNL cases with distinct puncture and target calyces.
• 3D reconstruction from CT urography to measure calyceal anatomical parameters.
• Binary logistic regression and nomogram construction to identify predictors.

Main Results:

• Punctured calyx L/W ratio, inter-calyceal axis angle, and target calyx L/W ratio were independent predictors.
• The model demonstrated high discrimination (AUC=0.905) and good calibration.
• Internal validation confirmed model stability and reliability (AUC=0.829).

Conclusions:

• A predictive model integrating calyceal morphology and spatial angles effectively predicts stone clearance.
• This model aids in optimizing calyx selection for enhanced PCNL outcomes.
• The model serves as a valuable tool for improving stone-free rates in PCNL.