Longer‐term effects of intraoperative cone‐beam computed tomography in percutaneous nephrolithotomy: 18‐month retrospective randomised controlled trial analysis

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OBJECTIVES: To assess the longer-term impact of intraoperative cone-beam computed tomography (CBCT) on stone-related morbidity after percutaneous nephrolithotomy (PCNL), since intraoperative CBCT allows for the detection and removal of residual fragments during the same procedure, improving stone clearance and thereby potentially diminishing stone-related morbidity. PATIENTS AND METHODS: This study was a retrospective analysis of a previously conducted single-centre randomised controlled trial at a tertiary complex endourology centre, in which patients were randomised intraoperatively to PCNL with intraoperative CBCT or conventional PCNL. We analysed 18-month follow-up data to assess differences in stone-related events (SREs), including re-interventions, emergency department visits, and hospital admissions. Stone-free rates and time to stone recurrence, as determined by follow-up CT scans, were also evaluated. RESULTS: The CBCT group (n = 80) had a significantly lower detection rate of new or residual fragments >4 mm (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.38-0.97), with 29 (36%) cases during 18 months of follow-up compared to 40 (50%) cases in the conventional PCNL group (n = 80). The restricted mean (standard deviation [SD]) time to fragment detection was 420 (44) days in the CBCT group vs 318 (53) days in the conventional PCNL group. In the CBCT group, 15 (19%) cases experienced 26 SREs, compared to 23 (29%) cases with 39 SREs in the conventional PCNL group. The restricted mean (SD) time to SRE was 499 (26) days for CBCT cases, compared to 447 (39) days for conventional PCNL cases. The rate of SREs did not decrease significantly when comparing CBCT-PCNL to conventional PCNL (HR 0.61, 95% CI 0.32-1.17). CONCLUSION: This study found 10% fewer patients with SREs in the 18-month period after PCNL with intraoperative CBCT compared to conventional PCNL. This difference is likely due to the notable increase in stone-free rates following a single PCNL with intraoperative CBCT.

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