Batagello Carlos A, Barone Dos Santos Hugo D, Nguyen Andrew H, Alshara Luay, Li Jianbo, Marchini Giovanni Scala, Vicentini Fabio C, Torricelli Fabio César Miranda, Danilovic Alexandre, Pereira Jessica Goulart, Rose Emily, Srougi Miguel, Nahas Willian C, Mazzucchi Eduardo, Monga Manoj
Section of Endourology, Division of Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
Can J Urol. 2019 Feb;26(1):9664-9674.
The optimal patient positioning for percutaneous nephrolithotomy (PCNL) based on the complexity of stone burden is not yet defined. Thus, we aimed to evaluate the intraoperative parameters, effectiveness and complications of patients undergoing PCNL between the endoscopic-guided prone split-leg PCNL (ePSL) and the supine PCNL by stratifying patients according to Guy's stone score (GSS).
A retrospective chart review was conducted of patients undergoing PCNL at two high-volume tertiary referral centers. At one center, patients underwent PCNL using the ePSL technique, while at the second center, patients underwent PCNL in supine. Patient demographics and stone characteristics, operative details, complications and effectiveness were compared between groups. The impact of obesity was also investigated.
Of 830 subjects, a total of 449 (54%) underwent PCNL in ePSL and 381 (46%) in supine. The ePSL group had a greater mean age and body mass index. No statistical differences were found in gender, serum chemistry and Charlson comorbidity index. After stratifying patients by GSS, the differences in baseline stone burden between PSL and supine lost significance and both groups could be compared. Complications were not statistically different between both groups. Univariate analysis demonstrated that multiple tracts and lower pole access were more prevalent in supine. In addition, for GSS1-3, ePSL was correlated with reduced operative time, radiation exposure, length of hospital stay and need for secondary procedure. Multivariate analysis correlated ePSL with lower radiation exposure and need for secondary procedures (p = 0.01). In comparison to the whole trial population, the same tendencies were appreciated for obese cohort.
This is the first report focusing on the performance differences between ePSL and supine PCNL stratified by GSS. Both techniques are safe, with a low rate of complications. For GSS1-3, ePSL reduces radiation exposure and requires less need for both multiple access and secondary procedure.
基于结石负荷的复杂性，经皮肾镜取石术（PCNL）的最佳患者体位尚未确定。因此，我们旨在通过根据盖氏结石评分（GSS）对患者进行分层，评估接受内镜引导下俯卧分腿PCNL（ePSL）和仰卧位PCNL的患者的术中参数、有效性和并发症。
对两个高容量三级转诊中心接受PCNL的患者进行回顾性病历审查。在一个中心，患者采用ePSL技术进行PCNL，而在第二个中心，患者采用仰卧位进行PCNL。比较两组患者的人口统计学和结石特征、手术细节、并发症和有效性。还研究了肥胖的影响。
在830名受试者中，共有449名（54%）接受了ePSL下的PCNL，381名（46%）接受了仰卧位PCNL。ePSL组的平均年龄和体重指数更高。在性别、血清化学和查尔森合并症指数方面未发现统计学差异。根据GSS对患者进行分层后，PSL和仰卧位之间基线结石负荷的差异不再显著，两组可以进行比较。两组并发症无统计学差异。单因素分析表明，多通道和下极入路在仰卧位中更为普遍。此外，对于GSS1-3，ePSL与手术时间缩短、辐射暴露减少、住院时间缩短和二次手术需求减少相关。多因素分析显示ePSL与较低的辐射暴露和二次手术需求相关（p = 0.01）。与整个试验人群相比，肥胖队列也有相同的趋势。
这是第一份关注按GSS分层的ePSL和仰卧位PCNL性能差异的报告。两种技术都很安全，并发症发生率低。对于GSS1-3，ePSL可减少辐射暴露，减少多通道和二次手术的需求。
