Department of Urology, La Rabta Hospital, University of Tunis El Manar, Tunis, Tunisie.
Libyan J Med. 2022 Dec;17(1):2084819. doi: 10.1080/19932820.2022.2084819.
Hydatid cyst is a major health problem in developing countries. The kidney is in third position of organs affected by hydatid cyst. One of the complications of renal hydatid cyst is a urinary fistula. The purpose of this study is to identify preoperative predictive factors of urinary fistula in renal hydatid cyst and to develop a scoring system for this disorder. We retrospectively analyzed all patients operated for renal hydatid cysts between January 2000 and December 2020. We divided our patients into two groups according to whether or not the renal hydatid cysts opened in the urinary tract. Predictive factors of the presence of a urinary fistula have been studied to obtain a simple score to predict the presence of a urinary fistula. Differences were considered significant if p < 0.05. Urinary fistula was detected in 33 of 96 patients. Univariate analyses showed significant differences in patient age, cyst size, location, hydaturia, eosinophil count, and platelet count between patients with and without urinary fistula. In multivariate analyses, hydaturia (p < 0.005), eosinophil count >500/mm, (p = 0.01), cyst diameter >5 cm (p = 0.02), and upper or lower renal pole location (p = 0.003) were significant and independent predictors of urinary fistula. A score was developed to predict the opening of the cyst in the urinary tract. The total score varies between 0 and 15. The resulting area under the receiver operator characteristic curve was 0.798 (95% CI, 0.726-0.866; p = 0.023). At a cutoff point ≥8, the specificity achieved was 100%. Preoperative detection and management of urinary fistula are important issues in the treatment of renal hydatid cyst. Developing a scoring system based on routinely measured laboratory and radiologic factors will help the clinician to manage patients with renal hydatid cysts. External studies are needed to validate this new scoring system in routine clinical practice.
肝包虫囊肿是发展中国家的一个主要健康问题。肾脏是肝包虫囊肿的第三大受累器官。肾包虫囊肿的一种并发症是尿瘘。本研究的目的是确定术前预测肾包虫囊肿并发尿瘘的因素，并为此疾病建立一个评分系统。我们回顾性分析了 2000 年 1 月至 2020 年 12 月期间所有接受肾包虫囊肿手术的患者。我们根据肾包虫囊肿是否在泌尿道中打开将患者分为两组。研究了尿瘘存在的预测因素，以获得一个简单的评分来预测尿瘘的存在。如果 p < 0.05，则认为差异具有统计学意义。96 例患者中有 33 例发现尿瘘。单因素分析显示，有尿瘘和无尿瘘患者的年龄、囊肿大小、位置、血尿、嗜酸性粒细胞计数和血小板计数存在显著差异。多因素分析显示，血尿（p < 0.005）、嗜酸性粒细胞计数 >500/mm3（p = 0.01）、囊肿直径 >5 cm（p = 0.02）和上或下极肾位置（p = 0.003）是尿瘘的显著且独立的预测因素。开发了一种评分系统来预测囊肿在泌尿道中的开口。总分为 0-15 分。由此产生的受试者工作特征曲线下面积为 0.798（95%CI，0.726-0.866；p = 0.023）。在截断值≥8 时，特异性为 100%。术前检测和管理尿瘘是治疗肾包虫囊肿的重要问题。基于常规测量的实验室和影像学因素建立评分系统将有助于临床医生管理肾包虫囊肿患者。需要进行外部研究来验证这种新的评分系统在常规临床实践中的有效性。
