J Urol. 2018 Jan;199(1):193-199. doi: 10.1016/j.juro.2017.08.039. Epub 2017 Aug 12.
Renal pelvic pressure may vary during percutaneous nephrolithotomy. We sought to determine the relationship of postoperative pain to endoscope caliber, renal pelvic pressure and hospital stay.
We reviewed the records of 20 percutaneous nephrolithotomies done under ureteroscopic guidance with renal pelvic pressure monitoring. The ureteroscope working channel was connected to a pressure transducer and used to determine renal pelvic pressure at baseline, when irrigating with a 26Fr rigid nephroscope and a 16Fr flexible nephroscope, and during suction. Patient demographics, operative characteristics, Likert pain scores and length of hospital stay were compared as stratified by average renal pelvic pressure. The Mann-Whitney U and Fisher exact tests were used with p <0.05 considered significant.
A total of 220 measurements were recorded in 20 patients undergoing single access percutaneous nephrolithotomy. Mean patient age was 55.2 years (range 20 to 77) and mean body mass index was 32.4 kg/m (range 18 to 53.3). Rigid nephroscopy resulted in significantly higher average renal pelvic pressure than flexible nephroscopy (30.3 vs 12.9 mm Hg, p = 0.007). Average renal pelvic pressure was 30 mm Hg or greater in 7 patients (35%) undergoing rigid nephroscopy and in none (0%) undergoing flexible nephroscopy (p <0.01). Patients exposed to an average renal pelvic pressure of 30 mm Hg or greater during rigid nephroscopy had significantly higher average pain scores (p = 0.004) and longer hospital stays (p = 0.04) than patients with renal pelvic pressure less than 30 mm Hg. Average renal pelvic pressure 30 mm Hg or greater during rigid nephroscopy was also associated with a longer skin to calyx distance (105.5 vs 79.7 mm, p = 0.03).
Knowledge of the factors that influence renal pelvic pressure and methods to control pressure extremes may improve patient outcomes during percutaneous nephrolithotomy.
经皮肾镜取石术中肾盂压力可能会发生变化。我们旨在确定术后疼痛与内窥镜口径、肾盂压力和住院时间之间的关系。
我们回顾了 20 例在输尿管镜引导下进行的经皮肾镜取石术的记录，术中监测肾盂压力。输尿管镜工作通道连接到压力换能器，用于在基线时、用 26Fr 硬性肾镜和 16Fr 软性肾镜冲洗时以及抽吸时确定肾盂压力。根据平均肾盂压力对患者人口统计学特征、手术特点、Likert 疼痛评分和住院时间进行分层比较。采用 Mann-Whitney U 检验和 Fisher 确切概率法，p<0.05 为差异有统计学意义。
20 例接受单通道经皮肾镜取石术的患者共记录了 220 次测量。患者平均年龄为 55.2 岁（范围 20 至 77 岁），平均体重指数为 32.4kg/m²（范围 18 至 53.3）。硬性肾镜检查导致的平均肾盂压力明显高于软性肾镜检查（30.3 与 12.9mmHg，p=0.007）。7 例（35%）接受硬性肾镜检查的患者平均肾盂压力为 30mmHg 或更高，而无一例（0%）接受软性肾镜检查的患者（p<0.01）。接受硬性肾镜检查时平均肾盂压力为 30mmHg 或更高的患者疼痛评分明显更高（p=0.004），住院时间更长（p=0.04），而肾盂压力低于 30mmHg 的患者则没有（p<0.01）。硬性肾镜检查时平均肾盂压力为 30mmHg 或更高也与肾盂到肾盏的距离更长有关（105.5 与 79.7mm，p=0.03）。
了解影响肾盂压力的因素和控制压力极值的方法可能会改善经皮肾镜取石术患者的预后。
