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      Validation of the Trifecta Scoring Metric in Vacuum-Assisted Mini-Percutaneous Nephrolithotomy: A Single-Center Experience.

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          Abstract

          Background: Scoring metrics to assess and compare outcomes of percutaneous nephrolithotomy (PCNL) are needed. We aim to evaluate prevalence and predictors of trifecta in a cohort of patients treated with vacuum-assisted mini-percutaneous nephrolithotomy (vmPCNL) for kidney stones. Methods: Data from 287 participants who underwent vmPCNL were analysed. Patients’ and stones’ characteristics as well as operative data were collected. Stone-free was defined as no residual stones. The modified Clavien classification was used to score postoperative complications. Trifecta was defined as stone-free status without complications after a single session and no auxiliary procedures. Descriptive statistics and logistic regression models tested the association between predictors and trifecta outcome. Results: After vmPCNL, 219 (76.3%) patients were stone-free, and 81 (28.2%) had postoperative complications (any Clavien). Of 287, 170 (59.2%) patients achieved trifecta criteria. Patients who achieved trifecta status had smaller stone volume (p < 0.001), a higher rate of single stones (p < 0.001), shorter operative time (p < 0.01), and a higher rate of single percutaneous tract (p < 0.01) than −trifecta patients. Trifecta status decreased with the number of calyces involved, being 77.1%, 18.8%, and 4.1% in patients with 1, 2, or 3 calyces with stones, respectively (p < 0.001). Multivariable logistic regression analysis showed that stone volume (OR 1.1, p = 0.02) and multiple calyces being involved (OR 2.8 and OR 4.3 for two- and three-calyceal groups, respectively, all p < 0.01) were independent unfavourable risk factors for trifecta after accounting for age, BMI, gender, operative time, and number of access tracts. Conclusions: Trifecta status was achieved in 6 out of 10 patients after vmPCNL. Stone distribution in multiple calyceal groups and stone volume were independent unfavourable risk factors for trifecta.

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          Author and article information

          Journal
          J Clin Med
          Journal of clinical medicine
          MDPI AG
          2077-0383
          2077-0383
          Nov 16 2022
          : 11
          : 22
          Affiliations
          [1 ] Department of Urology, Foundation IRCCS Ca' Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy.
          [2 ] Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy.
          [3 ] Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, Italy.
          Article
          jcm11226788
          10.3390/jcm11226788
          9697932
          36431265
          8a513642-9ce5-4c42-9dd5-e31d05d9e177
          History

          complications,percutaneous nephrolithotomy,stone-free rate,trifecta,vacuum-assisted percutaneous nephrolithotomy

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