Editorial: Stone-free rate (SFR) after stone treatment modalities is the main endpoint of much research. This variable is used for comparing the outcomes of a variety of articles. It could be measured by plain radiography and ultrasonography, or computed tomography (CT) scan. The miniaturized percutaneous lithotomy (MPCNL) is a new technique in the management of renal stones. This technique has achieved acquiring recently to increase operational morbidity with acceptable results. Smaller Ampltz sheaths (usually 16-20 Fr) are used for MPCNL instead of conventional 20-30Fr Amplatz sheath to have less damage to the renal parenchyma. Advantages of this technique are lower morbidity, less blood loss, decrease need for analgesics, and shorter hospital stays (1). When it comes to stone-free rate (SFR) measurement, we believe that using plain radiography and ultrasonography for this estimation is not sufficient and it is considered an old method. Pearle and co-workers in 1999 proved that computed tomography (CT) scan have 100% sensitivity for detecting residual stones after PCNL, by evaluating 36 patients with both ﬂexible nephroscopy and CT scan (2). In 2020, the Campbell-Walsh urology textbook mentioned that a CT scan is the primary method for evaluation of residual stone fragments after PCNL due to its high sensitivity and wide availability. But, there must be a balance with the need to minimize unnecessary radiation exposure in patients (3).
On the other hand, regarding MPCNL, some studies showed that the actual SFR after MPNL might be overestimated, when relying only on the ultrasound or X-ray. Because CT scan achieved the highest sensitivity (93%) and specificity (97%) for the detection of kidney stones (4). Some authors define residual stones after MPCNL as larger than 3 millimeters, which cannot be detected by ultrasonography (5). Although we know that there are some concerns about radiation exposure in children using CT scans, we believe that small stone fragments after MPCNL are not vividly visible in ultrasound or x-ray. Thus, performing a CT scan is more indispensable in the MPCNL technique to detect small residual stone fragments.
We believe that using CT scan in follow up of MPCNL patients, rather than plain radiography and ultrasonography, is more accurate to detect residual fragments and estimate SFR as one of the important outcomes of this operations.
AMFY and DT contributed equally. Both authors reviewed and approved the final version of the manuscript.
Special thanks to Urology Research Center, Sina Hospital, Tehran University of Medical Sciences.
Conflict of interest
Both authors declare that there are no conflicts of interest regarding the publication of this manuscript.
The authors received no financial support for this research.
CT Computed tomography
MPCNL Miniaturized percutaneous lithotomy
PCNL Percutaneous nephrolithotomy
SFR Stone free rate