Yildirim Ümit, Ezer Mehmet, Uslu Mehmet, Güzel Rasim, Sarica Kemal
Medical School, Department of Urology, Kafkas University, Şehitler Mah., Kafkas Ünv., 36100, Merkez/Kars, Turkey.
Department of Urology, Medistate Kavacık Hospital, Istanbul, Turkey.
Urolithiasis. 2023 Jan 11;51(1):30. doi: 10.1007/s00240-022-01404-4.
The purpose of this article is to identify the factors that predict the success of retrograde intrarenal surgery (RIRS), with a focus on the effect of renal parenchymal thickness and anticoagulant use on stone-free rates. From February 2014 to April 2022, cases of kidney stones treated with RIRS at our clinic were retrospectively screened. The study included 642 cases meeting all inclusion and exclusion criteria. The patients who were observed to be stone free after a single session of RIRS were assigned to Group F, while those with residual fragments were assigned to Group R. Group F comprised 472 patients, while Group R included 170 patients. The two groups have compared certain preoperative and postoperative laboratory and radiological parameters. The infundibulopelvic angle was significantly more acute in Group R (45.63 ± 16.25 vs. 49.28 ± 15.36, p = 0.011) while patients in Group F tended to have thicker parenchyma (27.39 ± 8.38 vs. 22.88 ± 5.56, p < 0.001). In our analysis of multivariate logistic regression, stone size (OR: 1.074, 1.037-1.113; p < 0.001), lower calyceal location (OR: 0.550, 95% CI 0.364-0.831; p = 0.005), multiple numbers of stones (OR 0.254, 95% CI 0.166-0.389; p = < 0.001), the value of parenchymal thickness (OR 0.911, 95% CI 0.882-0.941; p = < 0.001) and more importantly use of anticoagulants/antiplatelets (OR 0.557, 95% CI 0.333-0.933; p = 0.026) appeared to be independent predictors of stone-free status after RIRS. Further evaluation of the data revealed that the cut-off value of the renal parenchymal thickness for an effective stone-free status in a ROC curve analysis was 24.5 with 62.9% sensitivity and 56.8% specificity (area under curve value: 0.654 [95% CI 0.608-0.699, p < 0.001]). The endourologist may be able to make more informed decisions by evaluating renal parenchymal thickness in addition to patient-related factors like anticoagulant use, which we find significantly affects outcomes, along with the stone and renal anatomy-related factors.
本文旨在确定预测逆行性肾内手术（RIRS）成功的因素，重点关注肾实质厚度和抗凝剂使用对结石清除率的影响。2014年2月至2022年4月，对我院采用RIRS治疗肾结石的病例进行回顾性筛选。该研究纳入了642例符合所有纳入和排除标准的病例。单次RIRS术后结石清除的患者被分配到F组，有残余结石碎片的患者被分配到R组。F组包括472例患者，R组包括170例患者。比较了两组术前和术后的某些实验室及影像学参数。R组的肾盂漏斗角明显更尖锐（45.63±16.25 vs. 49.28±15.36，p = 0.011），而F组患者的肾实质往往更厚（27.39±8.38 vs. 22.88±5.56，p < 0.001）。在多因素逻辑回归分析中，结石大小（OR：1.074，1.037 - 1.113；p < 0.001）、下盏位置（OR：0.550，95%CI 0.364 - 0.831；p = 0.005）、结石数量多（OR 0.254，95%CI 0.166 - 0.389；p < 0.001）、肾实质厚度值（OR 0.911，95%CI 0.882 - 0.941；p < 0.001），更重要的是抗凝剂/抗血小板药物的使用（OR 0.557，9�%CI 0.333 - 0.933；p = 0.026）似乎是RIRS术后结石清除状态的独立预测因素。对数据的进一步评估显示，在ROC曲线分析中，有效结石清除状态的肾实质厚度临界值为24.5，敏感性为62.9%，特异性为56.8%（曲线下面积值：0.654 [95%CI 0.608 - 0.699，p < 0.001]）。除了患者相关因素如抗凝剂使用外，通过评估肾实质厚度，泌尿外科医生可能能够做出更明智的决策，我们发现抗凝剂使用对结果有显著影响，同时还有结石和肾脏解剖相关因素。
