Iremashvili Viacheslav, Li S, Dresner S L, Best S L, Hedican S P, Nakada S Y
Department of Urology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin Medical Foundation Centennial Building, 1685 Highland Avenue, Madison, WI, 53705, USA.
Urolithiasis. 2021 Oct;49(5):471-476. doi: 10.1007/s00240-021-01255-5. Epub 2021 Feb 11.
Our objective was to analyze and compare the associations between potential risk factors for nephrolithiasis and repeat stone surgery in male and female patients. We retrospectively analyzed 1970 patients who had stone surgery at our institution in the period from January 2009 to May 2017, were older than 18 years and had at least 12 months of postoperative follow-up. Our definition of surgical recurrence included repeat surgery on the same renal unit or on the opposite renal unit if the original imaging did not demonstrate significant stones on that side. Uni- and multivariate Cox regression models were built for each gender. We also explored the interactions between gender and other patient's characteristics in their effect on the risk of recurrence. Ureteroscopy was the most common treatment modality for both first (83%) and repeat (87%) procedures. Over a mean follow-up of 4.3 years (median 3.8, interquartile range 2.2-6.0), 413 (21.0%) patients had a surgical recurrence. In multivariate analyses, hypertension, diabetes, Caucasian race and younger age (less than 60 years) were significantly associated with the risk of surgical recurrence only in females. Interaction between these characteristics and gender was significant indicating a larger effect on the risk of surgical recurrence in females compared to males. Our study demonstrated a number of differences in the predictors of repeat surgery for nephrolithiasis between males and females. If confirmed by future studies these differences may be helpful for optimizing nephrolithiasis prevention efforts.
我们的目标是分析和比较男性和女性患者肾结石潜在风险因素与再次结石手术之间的关联。我们回顾性分析了2009年1月至2017年5月期间在我院接受结石手术、年龄大于18岁且术后至少有12个月随访的1970例患者。我们对手术复发的定义包括，如果原影像学检查未显示对侧有明显结石，则在同一肾单位或对侧肾单位进行再次手术。为每种性别建立单变量和多变量Cox回归模型。我们还探讨了性别与其他患者特征之间在影响复发风险方面的相互作用。输尿管镜检查是初次手术（83%）和再次手术（87%）最常用的治疗方式。在平均4.3年的随访期内（中位数3.8年，四分位间距2.2 - 6.0年），413例（21.0%）患者出现手术复发。在多变量分析中，高血压、糖尿病、白种人和较年轻年龄（小于60岁）仅在女性中与手术复发风险显著相关。这些特征与性别之间的相互作用显著，表明与男性相比，对女性手术复发风险的影响更大。我们的研究显示了男性和女性肾结石再次手术预测因素的一些差异。如果未来研究证实这些差异，可能有助于优化肾结石的预防措施。
