Department of Urology and General Medicine, Medical Faculty, Medical University of Plovdiv, 4001 Plovdiv, Bulgaria.
Department of Urology, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria.
Medicina (Kaunas). 2022 Mar 13;58(3):422. doi: 10.3390/medicina58030422.
Background and objectives: Although minimally invasive percutaneous nephrolithotomy (MPCNL) has demonstrated its efficacy, complete stone clearance was not always achieved, necessitating a second procedure. The purpose of this study was to evaluate factors associated with residual stone rate, operative duration, complications, and hospital stay, in order to develop algorithms for pre-operative prognosis and planning. Materials and Methods: This retrospective study involved 163 Bulgarian patients who underwent MPCNL with Holmium: YAG lithotripsy for the treatment of kidney stones. Patients were considered stone-free if no visible fragments (<3 mm) were found on nephroscopy at the end of the procedure, as well as on postoperative X-ray and abdominal ultrasound on the first postoperative day. Results: Immediate postoperative stone-free outcome was attained for 83.43% of the patients (136/163). Residuals were associated with staghorn stones (OR = 72.48, 95% CI: 5.76 to 91.81); stones in two locations (OR = 21.91, 95% CI: 4.15 to 137.56); larger stone size (OR = 1.12, 95% CI: 1.006 to 1.25); and higher density (OR = 1.03, 95% CI:1.005 to 1.06). The overall categorization accuracy for these factors was 93.80%, AUC = 0.971 (95% CI: 0.932 to 0.991), 89.71% sensitivity, and 96.30% specificity. Predictors of prolonged operative duration were staghorn stones and volume, R-square (adj.) = 39.00%, p < 0.001. Longer hospitalization was predicted for patients with hydronephrosis and staghorn stones, R-square (adj.) = 6.82%, p = 0.003. Post-operative complications were rare, predominantly of Clavien-Dindo Grade 1, and were more frequent in patients with hydronephrosis. We did not find a link between their occurrence and the outcome of MPCNL. Conclusions: Staghorn stones and stones in more than one location showed the strongest association with residual stone rate. Staghorn stones and larger volume were linked with a longer operative duration. Hydronephrosis increased the risk of complications and longer hospitalization.
尽管微创经皮肾镜取石术（MPCNL）已被证实有效，但并非总能达到完全清除结石的效果，因此需要进行第二次手术。本研究旨在评估与残石率、手术时间、并发症和住院时间相关的因素，以便为术前预后和计划制定算法。
本回顾性研究纳入了 163 名接受钬激光碎石术治疗肾结石的保加利亚患者。如果在手术结束时肾镜检查以及术后第一天的 X 射线和腹部超声检查均未发现可见结石碎片（<3mm），则认为患者结石清除。
83.43%（136/163）的患者术后即刻达到结石清除。残石与鹿角形结石（OR=72.48，95%CI：5.76 至 91.81）、两个部位结石（OR=21.91，95%CI：4.15 至 137.56）、较大结石大小（OR=1.12，95%CI：1.006 至 1.25）和较高密度（OR=1.03，95%CI：1.005 至 1.06）相关。这些因素的整体分类准确性为 93.80%，AUC=0.971（95%CI：0.932 至 0.991），敏感性为 89.71%，特异性为 96.30%。鹿角形结石和体积是手术时间延长的预测因素，R-square（adj.）=39.00%，p<0.001。有肾积水和鹿角形结石的患者住院时间更长，R-square（adj.）=6.82%，p=0.003。术后并发症罕见，主要为 Clavien-Dindo 分级 1 级，且在肾积水患者中更为常见。我们未发现其发生与 MPCNL 结果之间存在关联。
鹿角形结石和多个部位结石与残石率的相关性最强。鹿角形结石和较大体积与手术时间延长相关。肾积水增加了并发症和住院时间延长的风险。
