Ansari Haris, Tomar Vinay, Yadav Sher Singh, Agarwal Neeraj
Department of Urology and Renal Transplantation, SMS Medical College and Hospital, Jaipur, Rajasthan, India.
Urol Ann. 2016 Jan-Mar;8(1):60-5. doi: 10.4103/0974-7796.164856.
To evaluate the factors that may influence the prolonged urinary leakage following percutaneous nephrolithotomy (PCNL).
A total of 936 consecutive patients underwent PCNL during the study period from April 2013 to December 2014 at our center, and data were recorded prospectively. Patients who required stage PCNL, chronic renal failure and diabetic patients, concurrent ureteric stone and patients in whom double-J stent was placed because of ureteropelvic injury, or pelvicalyceal extravasation were excluded from the study. After exclusion, 576 patients were included in the study. The predictive factors that may lead to prolonged urinary leakage after PCNL were broadly categorized into patient-related factors and procedure-related factors. Patients were divided into two groups: Group 1 (n = 32) - Required double-J stent placement due to prolonged urinary leakage (>48 h) after removal of the nephrostomy tube. Group 2 (n = 544) - Did not require double-J stent placement.
Patient-related factors such as stone complexity, grade of hydronephrosis, renal parenchymal thickness in access line, and intra-parenchymal renal pelvis were most important factors for prolonged urinary leakage (P < 0.05, P < 0.05, P < 0.05, and P < 0.05, respectively), while procedure-related factors such as multiple punctures, surgeon's experience, and residual stones were most important factors for prolonged urinary leakage (P < 0.05, P < 0.05, and P < 0.05, respectively).
In the present study, several factors appear to affect post-PCNL prolonged urinary leakage. We suggest that patients who are at increased risk of prolonged urinary leakage double-J stent should be placed at the end of PCNL procedure.
评估经皮肾镜取石术（PCNL）后导致长期尿漏的相关因素。
在2013年4月至2014年12月研究期间，共有936例患者在本中心接受了PCNL，并对数据进行前瞻性记录。需要分期PCNL的患者、慢性肾衰竭患者、糖尿病患者、合并输尿管结石的患者以及因输尿管肾盂损伤或肾盂肾盏外渗而放置双J支架的患者被排除在研究之外。排除后，576例患者纳入研究。PCNL后可能导致长期尿漏的预测因素大致分为患者相关因素和手术相关因素。患者分为两组：第1组（n = 32）——因拔除肾造瘘管后长期尿漏（>48小时）而需要放置双J支架。第2组（n = 544）——不需要放置双J支架。
患者相关因素如结石复杂性、肾积水程度、穿刺通道处肾实质厚度和肾内肾盂是导致长期尿漏的最重要因素（分别为P < 0.05、P < 0.05、P < 0.05和P < 0.05），而手术相关因素如多次穿刺、术者经验和残余结石是导致长期尿漏的最重要因素（分别为P < 0.05、P < 0.05和P < 0.05）。
在本研究中，有几个因素似乎会影响PCNL后的长期尿漏。我们建议，对于长期尿漏风险增加的患者，应在PCNL手术结束时放置双J支架。
