Department of Urology, Okmeydanı Training and Research Hospital, Atakoy 5.Kısım, A/9, D: 75, 19 Mayıs street, Bakırköy, Istanbul, Turkey.
Department of Radiology, Okmeydanı Training and Research Hospital, Sisli, 34750, Istanbul, Turkey.
Urolithiasis. 2018 Jun;46(3):303-309. doi: 10.1007/s00240-017-0995-9. Epub 2017 Jun 23.
We analyzed our stone-free rates of PNL with regard to stone burden and its ratio to the renal collecting system volume. Data of 164 patients who underwent PNL were analyzed retrospectively. Volume segmentation of renal collecting system and stones were done using 3D segmentation software with the images obtained from CT data. Analyzed stone volume (ASV) and renal collecting system volume (RCSV) were measured and the ASV-to-RCSV ratio was calculated after the creation of a 3D surface volume rendering of renal stones and the collecting system. Univariate and multivariate statistical analyses were performed to determine factors affecting stone-free rates; also we assessed the predictive accuracy of the ASV-to-RCSV ratio using the receiving operating curve (ROC) and AUC. The stone-free rate of PNL monotherapy was 53% (164 procedures).The ASV-to-RCSV ratio and calyx number with stones were the most influential predictors of stone-free status (OR 4.15, 95% CI 2.24-7.24, <0.001, OR 2.62, 95% CI 1.38-4.97, p < 0.001, respectively). Other factors associated with the stone-free rate were maximum stone size (p < 0.029), stone surface area (p < 0.010), and stone burden volume (p < 0.001). Predictive accuracy of the ASV-to-RCSV ratio was AUC 0.76. Stone burden volume distribution in the renal collecting system, which is calculated using the 3D volume segmentation method, is a significant determinant of the stone-free rate before PCNL surgery. It could be used as a single guide variable by the clinician before renal stone surgery to predict extra requirements for stone clearance.
我们分析了经皮肾镜取石术（PNL）的无石率与结石负荷及其与肾集合系统体积的比值之间的关系。回顾性分析了 164 例行 PNL 的患者的数据。使用 3D 分割软件对肾集合系统和结石进行体积分割，该软件使用从 CT 数据获得的图像。分析结石体积（ASV）和肾集合系统体积（RCSV），并在创建肾结石和集合系统的 3D 表面体积渲染后计算 ASV 与 RCSV 的比值。进行单变量和多变量统计分析以确定影响无石率的因素；我们还使用接收者操作特征曲线（ROC）和 AUC 评估了 ASV 与 RCSV 比值的预测准确性。PNL 单一疗法的无石率为 53%（164 例手术）。ASV 与 RCSV 比值和有结石的肾盏数是无石状态的最具影响力的预测因素（OR 4.15，95%CI 2.24-7.24，<0.001，OR 2.62，95%CI 1.38-4.97，p<0.001）。与无石率相关的其他因素包括最大结石大小（p<0.029）、结石表面积（p<0.010）和结石负荷体积（p<0.001）。ASV 与 RCSV 比值的预测准确性为 AUC 0.76。使用 3D 体积分割方法计算的肾集合系统结石负荷分布是 PCNL 术前无石率的重要决定因素。在肾结石手术前，它可以作为临床医生的单一指导变量，用于预测清除结石的额外需求。
