Ankara Yıldırım Beyazıt University, Faculty of Medicine, Department of Urology, Ankara State Hospital, Universiteler District, Bilkent Street, No:1, Cankaya, 06800, Ankara, Turkey.
Department of Urology, Ankara State Hospital, Ankara, Turkey.
Urolithiasis. 2021 Feb;49(1):57-64. doi: 10.1007/s00240-020-01185-8. Epub 2020 Apr 13.
Retrograde intrarenal surgery (RIRS) is one of the minimally invasive main treatment modalities in renal stone disease. There are many factors which affect stone-free rate (SFR). Our study was based on the hypothesis that higher renal parenchymal thickness (RPT) which may include higher average number of nephrons provides better diuresis. We investigated the efficacy of RPT on success of RIRS. This study is a single-centered prospective surgical cohort study. A total of 383 patients were analyzed. Regularly followed 304 patients with unilateral kidney stone at single pole or renal pelvis and who underwent single-session RIRS were included in the final analysis, and the patients' preoperative and postoperative 1st and 3rd months' data were evaluated. RPT was measured on the non-contrast computed tomography (CT) images. ROC analysis was performed to estimate the cutoff value of RPT for SFR. Univariate and multivariate logistic regression analyses were used to model the relationship between RPT and SFR after RIRS. ROC analysis revealed the best cutoff value of the RPT for predicting residual stone as 19 mm for both the 1st and 3rd month visits with Youden indexes of 0.397 and 0.406, respectively. To the best of our knowledge, this is the first study which evaluated the effect of RPT on the efficacy of RIRS. RPT measurement is a cost-effective method that can be easily performed on routinely applied non-contrast CT and may have predictive value for the surgical success in patients with nephrolithiasis.
逆行性肾内手术（RIRS）是肾结石病的一种微创主要治疗方法。有许多因素会影响结石清除率（SFR）。我们的研究基于这样一个假设，即较高的肾实质厚度（RPT）可能包括较高的平均肾单位数量，可提供更好的利尿作用。我们研究了 RPT 对 RIRS 成功的影响。本研究是一项单中心前瞻性手术队列研究。共分析了 383 名患者。最终分析纳入了 304 名单侧肾结石、单一极或肾盂且接受单次 RIRS 的患者，评估了患者术前、术后第 1 个月和第 3 个月的数据。在非对比 CT 图像上测量 RPT。进行 ROC 分析以估计 RPT 对 SFR 的截断值。使用单变量和多变量逻辑回归分析来建立 RPT 与 RIRS 后 SFR 之间的关系模型。ROC 分析显示，RPT 预测结石残留的最佳截断值为 19mm，在第 1 个月和第 3 个月访视时的 Youden 指数分别为 0.397 和 0.406。据我们所知，这是第一项评估 RPT 对 RIRS 疗效影响的研究。RPT 测量是一种具有成本效益的方法，可以在常规应用的非对比 CT 上轻松进行，并且可能对肾结石患者的手术成功具有预测价值。
