Department of Urology, University of California, San Francisco, 400 Parnassus Ave, A632, San Francisco, CA, 94143-0738, USA.
Department of Urology, New York University Langone Health, New York, NY, USA.
Urolithiasis. 2022 Dec;50(6):759-764. doi: 10.1007/s00240-022-01365-8. Epub 2022 Oct 14.
Ureteral obstruction after percutaneous nephrolithotomy (PCNL) may require prolonged drainage with a nephrostomy tube (NT) or ureteral stent, but it is not well understood how and why this occurs. The goal of this study was to identify risk factors associated with postoperative ureteral obstruction to help guide drainage tube selection.
Prospective data from adult patients enrolled in the Registry for Stones of the Kidney and Ureter (ReSKU) who underwent PCNL from 2016 to 2020 were used. Patients who had postoperative NTs with antegrade imaging-based flow assessment on postoperative day one (POD1) were included. Patients with transplanted kidneys or those without appropriate preoperative imaging were excluded. We assessed the association between patient demographics, stone characteristics, and intraoperative factors using POD1 antegrade flow, a proxy for ureteral patency, as the primary outcome. Stepwise selection was used to develop a multivariate logistic regression model controlling for BMI, stone location, stone burden, ipsilateral ureteroscopy (URS), access location, estimated blood loss, and operative time.
We analyzed 241 cases for this study; 204 (84.6%) had a visual clearance of stone. Antegrade flow on POD1 was absent in 76 cases (31.5%). A multivariate logistic regression model found that stones located anywhere other than in the renal pelvis (OR 2.63, 95% CI 1.29-5.53; p = 0.01), non-lower pole access (OR 2.81, 95% CI 1.42-5.74; p < 0.01), and concurrent ipsilateral URS (OR 2.17, 95% CI 1.02-4.65; p = 0.05) increased the likelihood of obstruction. BMI, pre-operative stone burden, EBL, and operative time did not affect antegrade flow outcomes.
Concurrent ipsilateral URS, absence of stones in the renal pelvis, and non-lower pole access are associated with increased likelihood of ureteral obstruction after PCNL. Access location appears to be the strongest predictor. Recognizing these risk factors can be helpful in guiding postoperative tube management.
经皮肾镜碎石取石术后（PCNL）可能需要长时间留置肾造瘘管（NT）或输尿管支架，但其发生机制尚不清楚。本研究旨在确定与术后输尿管梗阻相关的危险因素，以帮助指导引流管选择。
回顾性分析 2016 年至 2020 年期间在肾脏和输尿管结石登记处（ReSKU）登记的接受 PCNL 的成年患者的前瞻性数据。纳入术后第 1 天（POD1）行逆行尿路造影评估发现存在 NT 且有顺行尿路显影的患者。排除移植肾患者或无适当术前影像学检查的患者。我们使用 POD1 顺行尿路显影评估患者的人口统计学、结石特征和术中因素，以评估输尿管通畅性，作为主要结局。使用逐步选择方法建立多变量逻辑回归模型，控制体重指数（BMI）、结石位置、结石负荷、同侧输尿管镜检查（URS）、入路位置、估计失血量和手术时间。
本研究共分析了 241 例患者；204 例（84.6%）结石完全清除。76 例（31.5%）患者 POD1 时无顺行尿路显影。多变量逻辑回归模型发现，结石位于肾盂以外部位（OR 2.63，95%CI 1.29-5.53；p=0.01）、非下极入路（OR 2.81，95%CI 1.42-5.74；p<0.01）和同侧同期 URS（OR 2.17，95%CI 1.02-4.65；p=0.05）增加了梗阻的可能性。BMI、术前结石负荷、失血量和手术时间均未影响顺行尿路显影结果。
同侧同期 URS、肾盂内无结石和非下极入路与 PCNL 后输尿管梗阻的发生风险增加相关。入路位置似乎是最强的预测因素。识别这些危险因素有助于指导术后导管管理。
