Pd28-11 a proposed mathematical model to help preoperative planning between rirs and miniperc for renal stones between 10 and 20 mm using holmium:yag laser (cyber ho): the stone management according to size-hardness (smash) score

You have accessJournal of UrologyCME1 Apr 2023PD28-11 A PROPOSED MATHEMATICAL MODEL TO HELP PREOPERATIVE PLANNING BETWEEN RIRS AND MINIPERC FOR RENAL STONES BETWEEN 10 AND 20 MM USING HOLMIUM:YAG LASER (CYBER HO): THE STONE MANAGEMENT ACCORDING TO SIZE-HARDNESS (SMASH) SCORE Davide Perri, Umberto Besana, Lorenzo Berti, Federica Mazzoleni, Andrea Pacchetti, Elena Morini, Roberta Spasciani, Maria Chiara Sighinolfi, Bernardo Rocco, Javier Romero Otero, Jean Baptiste Roche, and Giorgio Bozzini Davide PerriDavide Perri More articles by this author , Umberto BesanaUmberto Besana More articles by this author , Lorenzo BertiLorenzo Berti More articles by this author , Federica MazzoleniFederica Mazzoleni More articles by this author , Andrea PacchettiAndrea Pacchetti More articles by this author , Elena MoriniElena Morini More articles by this author , Roberta SpascianiRoberta Spasciani More articles by this author , Maria Chiara SighinolfiMaria Chiara Sighinolfi More articles by this author , Bernardo RoccoBernardo Rocco More articles by this author , Javier Romero OteroJavier Romero Otero More articles by this author , Jean Baptiste RocheJean Baptiste Roche More articles by this author , and Giorgio BozziniGiorgio Bozzini More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003313.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We performed a prospective randomized comparison between Retrograde IntraRenal Surgery (RIRS) and MiniPerc (MP) for stones between 10 and 20 mm to evaluate the performance of a mathematical model to drive preoperative planning. METHODS: Patients with a single renal stone between 10-20 mm were enrolled. Exclusion criteria were age<18 or >75, presence of acute infection, coagulation impairments, cardiovascular or pulmonary comorbidities. For each patient a mathematical model named Stone Management According to Size-Hardness (SMASH) score was so calculated: hounsfield units (HU) x stone maximum size (cm) / 100. Patients were divided into 4 groups according to type of treatment and SMASH score: RIRS with score<15 (Group A), RIRS with score≥15 (Group B), MP with score<15 (Group C), MP with score≥15 (Group D). In all groups the Cyber Ho laser device was used. A CT scan after 3 months was performed. A negative CT scan or asymptomatic patients with stone fragments<3 mm were the criteria to assess the stone-free status. A statistical analysis was carried out to assess efficacy and safety of each procedure. RESULTS: 350 patients were enrolled (87 in Group A, 88 in Group B, 82 in Group C, 93 in Group D). Mean stone size was 13.1 vs 13.3 mm in Group A vs B (p=0.18) and 16.2 vs 18.1 mm in Group C vs D (p=0.12). The overall stone free rate (SFR) was 82%, 61%, 75% and 85% for Group A, B, C and D, respectively. SFR was comparable when comparing Group C and D (p=0.32) and Group A and C (p=0.22). On the contrary, SFR was significantly higher in Group A over B (p=0.03) and in Group D over B (p=0.02). Complication rate was 2.2%, 3.4%, 12.1% and 12.9% for Groups A, B, C and D, respectively. The difference was significant between Groups A and C (p=0.02) and Groups B and D (p=0.02). CONCLUSIONS: RIRS and MP are both safe and effective to obtain a postoperative SFR with Cyber Ho. The mathematical model taking into account HU with the proposed cut-off allowed a proper allocation of the patients between endoscopic and percutaneous approach. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e823 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Davide Perri More articles by this author Umberto Besana More articles by this author Lorenzo Berti More articles by this author Federica Mazzoleni More articles by this author Andrea Pacchetti More articles by this author Elena Morini More articles by this author Roberta Spasciani More articles by this author Maria Chiara Sighinolfi More articles by this author Bernardo Rocco More articles by this author Javier Romero Otero More articles by this author Jean Baptiste Roche More articles by this author Giorgio Bozzini More articles by this author Expand All Advertisement PDF downloadLoading ...