Abstract
Certain observations become quite clear and corroborate many heretofore assumed but undocumented biases. PCNL works well (76% stone free rate) and is associated with a relatively low complication rate. Bleeding and the need for transfusion are similarly within an acceptable range: 8% and 6% respectively. PCNL works well for all types of calculi, regardless of size or location. Also, the urologist has taken complete control of the procedure and, indeed, obtains access in 90% of cases and does so well enough that the need for multiple tracts is small (8%); indeed, this occurred despite there being over 1000 staghorn (27%) stones in the series.
Not surprisingly, as with all first efforts, there are multiple areas of limitations that will no doubt be overcome in future offerings from CROES. These limitations include inconsistent follow-up from some of the institutions, 42% of the patients came from just 3 countries (India, Romania, and Turkey), stone free rates are not overly reliable as ultrasound, plane radiograph and the gold standard CT scan (used in only 14%) were employed to varying extents, the absence of indications for performing PCNL, and the general lumping of all stones into one group.
However, while some may view the foregoing as deficiencies, others will view them as opportunities for further data mining. For example, as noted, 27% of the calculi were staghorn stones providing a platform for an individual to do an in-depth study and produce a manuscript with the largest number of staghorn stones reported to date; a paper of this nature could be further subdivided based on location (North America, Europe, Asia or another country) and volume. Other future publications could focus on a variety of questions: the method of obtaining access for a given type of stone as 10% of cases used ultrasound alone, prone vs. supine positioning, causes of hemorrhage/transfusion with PCNL, and, as the authors note, evaluation of stone removal in anomalous as well as solitary kidneys. The possibilities are nearly endless.
It is the clear expectation and aspiration of the executive committee of the Endourological Society that future CROES studies will be of a more controlled nature with the development of multicenter retrospective controlled studies as well as prospective randomized clinical research. The creation of these types of data will empower clinical researchers to better evaluate the various technologies that are being developed much to the benefit of urologic patients worldwide. Dr. Jean de la Rosette and his staff are to be congratulated for bringing to life that which a mere two years ago was only an exciting concept. He has accomplished this feat with verve and a commitment that has benefitted both the Endourological Society and Urology in general.