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

Round 1

Reviewer 1 Report

I revised manuscript number jcm-2017211 entitled “Prevalence and predictors of unfavorable risk factors of trifecta in vacuum assisted mini-percutaneous nephrolithotomy: a 3 single center experience”.
In this study, the authors aimed to validate the trifecta criteria in vamPCNL and 67 and to investigate potential predictors of trifecta in a cohort of patients treated with 68 vamPCNL for kidney stones. Few comments need to be made before publication:

Materials and Methods

-       Postoperative evaluation:

o   What was the size of residual fragments?

o   Exclusion criteria: Should be at the beginning, perhaps in the last paragraph ot material and methods

o   “A final cohort of 287 patients who underwent vamPCNL for kidney stones 122 was considered for statistical analysis”: Must be in Results

Author Response

Prof. O. Traxer

Guest Editor

Journal of Clinical Medicine

Special Issue "Medical and Surgical Management of Urinary Tract Diseases”

Milan, November 1^st 2022

Dear Prof. O. Traxer,

Please fined enclosed the revised version of the manuscript “Prevalence and predictors of unfavourable risk factors of tri-fecta in vacuum assisted mini-percutaneous nephrolithotomy: a single center experience” (Manuscript ID jcm-2017211) to be considered for publication in Journal of Clinical Medicine.

We are very grateful to the Reviewers for their insightful comments to our paper.

List of the changes made in the manuscript:

REVIEWER#1

COMMENT#1.

What was the size of residual fragments?

A1. We thank the Reviewer#1 for this important comment. The size of residual fragments has been included in the Results section of the manuscript.

COMMENT#2.

Exclusion criteria: Should be at the beginning, perhaps in the last paragraph ot material and methods

“A final cohort of 287 patients who underwent vamPCNL for kidney stones 122 was considered for statistical analysis”: Must be in Results

A2. We thank the Reviewer#1 for these comments. The text has been revised accordingly.

We hope that the paper is now suitable to be considered for publication in the Original Articles section of the Journal of Clinical Medicine.

Sincerely yours,

Luca Boeri on behalf of all the authors

Luca Boeri, M.D.,

IRCCS Foundation Ca’ Granda, Ospedale Maggiore Policlinico, Department of Urology

University of Milan

Via della Commenda 15, 20122 Milan, Italy

Tel. +39 02 55034501; Fax +39 02 50320584

Email: dr.lucaboeri@gmail.com

Reviewer 2 Report

I would like to thank the authors team on their effort and emphasize the usefulness of aspiration during PCNL.

I have some comments that need to be adressed:

1) In my opinion the name of the study is too complicated. You mention trifecta but explain its meaning only in introduction. Please try to reconsider it if possible

2) In all article already published on this topic "vacuum assisted mini PCNL" mentioned as "vmPCNL" not "vamPCNL"

3) If trifecta status means SF in a single session with no complications so how come that among trifecta patients 70% had complications? (page 4 line 150)

4) Stone volume estimation using ellipsoid volume equation is not accurate although there is a positive correlation between manual and automatic volume calculation and it would be nice to show the cut of limit for the stone volume to achieve Trifecta

Author Response

Prof. O. Traxer

Guest Editor

Journal of Clinical Medicine

Special Issue "Medical and Surgical Management of Urinary Tract Diseases”

Milan, November 1^st 2022

Dear Prof. O. Traxer,

We are very grateful to the Reviewers for their insightful comments to our paper.

List of the changes made in the manuscript:

REVIEWER#2

COMMENT#1.

In my opinion the name of the study is too complicated. You mention trifecta but explain its meaning only in introduction. Please try to reconsider it if possible

A1. We thank the Reviewer#2 for this comment. We have revised the title as suggested. We found difficult to avoid using trifecta in the tile, but it is well explained in the abstract and full text. Moreover, trifecta has been previously used in different urologic diseases to score complications and outcomes; therefore, we believe it is well known in the scientific community.

COMMENT#2.

In all article already published on this topic "vacuum assisted mini PCNL" mentioned as "vmPCNL" not "vamPCNL

A2. We thank the Reviewer#2 for this comment. The text has been revised accordingly.

COMMENT#3.

If trifecta status means SF in a single session with no complications so how come that among trifecta patients 70% had complications? (page 4 line 150)

A3. Line 150 page 4 reports “Among -trifecta patients, 83 (70.9%) had postoperative complications, 51 (4.3%) required a second-look or auxillary procedures, and 51 (43.6%) were not stone free”. In this part we detail reasons for not achieving trifecta status (-trifecta) in the cohort of 117 patients who did not achieved trifecta. We have better clarified this point in the text.

COMMENT#4.

Stone volume estimation using ellipsoid volume equation is not accurate although there is a positive correlation between manual and automatic volume calculation and it would be nice to show the cut of limit for the stone volume to achieve Trifecta

A4. We thank the Reviewer#2 for this important comment. We performed a ROC curve analysis and we found that the cut-off limit of stone volume for trifecta achievement was 1.5 cm³ (76.3% sensitivity and 74.1% specificity). The text has been revised accordingly.