Division of Urology, Men's Health Centre, Hospital Brigadeiro, Sao Paulo, SP, Brazil.
BJU Int. 2018 Apr;121(4):640-646. doi: 10.1111/bju.14129. Epub 2018 Feb 1.
To present the experience with percutaneous nephrolithotomy (PCNL) at a high-volume Brazilian centre and to evaluate Guy's stone score (GSS) as a predictor of success and complications in PCNL.
We prospectively evaluated patients who underwent PCNL between June 2011 and October 2016. Indications for PCNL included renal stones >2 cm in size and stones <2 cm in size in which first-line techniques had failed. All patients underwent a complete preoperative evaluation, including non-contrast-enhanced abdominal computed tomography (CT). Stone complexity was assessed using GSS. Success was defined as the absence of fragments >2 mm on CT on postoperative day 1. Complications were classified according to the Clavien grade.
A total of 1 066 PCNLs were performed on 891 patients. In all, 20.2% were classified as GSS1, 27.4% as GSS2, 35.0% as GSS3, and 17.4% as GSS4. The mean operating time was 108.44 min, and the mean fluoroscopy time was 13.57 min. The overall immediate success rate based on postoperative day 1 CT was 43.8%. Complications occurred in 14.9% of cases, and the mean length of hospital stay was 54.55 h. Stratifying patients according to GSS, success rate was inversely proportional to the calculus complexity: GSS1: 87.9%; GSS2: 62.1%; GSS3: 44.0%; and GSS4: 24.3% (P < 0.001). Higher GSS categories were significantly correlated with the number of puncture tracts (P < 0.001), operating time (P < 0.001), fluoroscopy time (P < 0.001), blood transfusion rate (P < 0.001), complications (P < 0.001) and length of stay (P < 0.001).
In a high-volume centre, PCNL was a reliable surgical technique, with low morbidity and short hospital stay. GSS was confirmed to be a very useful tool for predicting the outcomes of PCNL, and its use should be encouraged.
介绍在一家高容量的巴西中心进行经皮肾镜取石术（PCNL）的经验，并评估 Guy 结石评分（GSS）作为预测 PCNL 成功率和并发症的指标。
我们前瞻性评估了 2011 年 6 月至 2016 年 10 月期间接受 PCNL 的患者。PCNL 的适应证包括大小 >2cm 的肾结石和一线技术失败的大小 <2cm 的肾结石。所有患者均接受完整的术前评估，包括非增强腹部计算机断层扫描（CT）。使用 GSS 评估结石复杂性。术后第 1 天 CT 无 >2mm 碎片定义为成功。并发症根据 Clavien 分级进行分类。
共对 891 名患者的 1066 例 PCNL 进行了评估。总体而言，20.2%为 GSS1，27.4%为 GSS2，35.0%为 GSS3，17.4%为 GSS4。平均手术时间为 108.44 分钟，平均透视时间为 13.57 分钟。基于术后第 1 天 CT 的总体即刻成功率为 43.8%。14.9%的病例发生并发症，平均住院时间为 54.55 小时。根据 GSS 分层，成功率与结石复杂性呈反比：GSS1：87.9%；GSS2：62.1%；GSS3：44.0%；GSS4：24.3%（P<0.001）。较高的 GSS 类别与穿刺通道数量（P<0.001）、手术时间（P<0.001）、透视时间（P<0.001）、输血率（P<0.001）、并发症（P<0.001）和住院时间（P<0.001）显著相关。
在高容量中心，PCNL 是一种可靠的手术技术，具有低发病率和短住院时间。GSS 被证实是预测 PCNL 结果的非常有用的工具，应鼓励使用。
