Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey,
Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey.
Urol Int. 2020;104(5-6):459-464. doi: 10.1159/000505822. Epub 2020 Mar 10.
A number of factors that can impact the outcomes of percutaneous nephrolithotomy (PCNL) procedures have previously been investigated. Complex stones that extend to the anterior calyx could affect the success and complication rates of PCNL.
We analyzed the effect of anterior calyx involvement on the outcomes of patients with complex stones treated with PCNL.
A total of 132 consecutive patients who underwent PCNL due to complex stones (multiple, partial staghorn, or staghorn stones) between 2015 and 2017 were enrolled in this study. They were stratified into two groups based on whether the stone extended to the anterior calyx (group 1, n = 45) or not (group 2, n = 87). The stratification was achieved through contrast-enhanced computerized tomography (CT). Demographics, laboratory tests, and peri- and postoperative findings (operation and fluoroscopy duration, hospital stay, utilization of flexible instruments, access numbers, total blood count change, stone-free rate [SFR], and complications) were compared between the groups. The SFR was evaluated by plain kidney-ureter-bladder radiography or CT.
The demographics, operation and fluoroscopy duration, access number, and hospital stay were similar between the groups (p < 0.05). A higher drop in the hemoglobin level in group 1 was identified (group 1 [2.14 ± 1.49 g/dL] vs. group 2 [1.43 ± 1.31 g/dL]) (p = 0.006). The SFR among the patients with extension to the anterior calyx was 60%, compared to 77% among the patients with no extension to the anterior calyx (p = 0.041). Flexible instruments were utilized in 60% of the patients of group 1, which was a higher rate than for group 2 (36%) (p = 0.007). Complication rates were similar in the two groups according to the Clavien-Dindo classification (p > 0.05).
Our study demonstrated that complicated stones with extension to the anterior calyx are more challenging than cases without extension to the anterior calyx. This was noted by a lower SFR, a more prominent drop in total blood count, and more frequent utilization of flexible scopes.
先前已经研究了许多可能影响经皮肾镜取石术 (PCNL) 结果的因素。延伸至前盏的复杂结石可能会影响 PCNL 的成功率和并发症发生率。
我们分析了前盏受累对接受 PCNL 治疗的复杂结石患者结局的影响。
本研究纳入了 2015 年至 2017 年间因复杂结石（多发、部分鹿角形或鹿角形结石）接受 PCNL 的 132 例连续患者。根据结石是否延伸至前盏（第 1 组，n = 45）或未延伸至前盏（第 2 组，n = 87）将他们分为两组。通过增强计算机断层扫描（CT）进行分层。比较两组之间的人口统计学、实验室检查以及围手术期和术后发现（手术和透视时间、住院时间、使用软性器械、通道数量、全血细胞计数变化、结石清除率[SFR]和并发症）。通过腹部平片或 CT 评估 SFR。
两组患者的人口统计学、手术和透视时间、通道数量和住院时间相似（p < 0.05）。第 1 组的血红蛋白水平下降更明显（第 1 组[2.14 ± 1.49 g/dL] vs. 第 2 组[1.43 ± 1.31 g/dL]）（p = 0.006）。前盏延伸患者的 SFR 为 60%，而无前盏延伸患者的 SFR 为 77%（p = 0.041）。第 1 组中有 60%的患者使用了软性器械，高于第 2 组（36%）（p = 0.007）。两组患者根据 Clavien-Dindo 分级的并发症发生率相似（p > 0.05）。
我们的研究表明，延伸至前盏的复杂结石比无前盏延伸的结石更具挑战性。这表现为 SFR 较低、全血细胞计数下降更明显以及更频繁地使用软性内镜。
