Department of Urology, Helios University Hospital Wuppertal, Witten/Herdecke University, Heusnerstrasse 40, 42283, Wuppertal, Germany.
Department of Radiology, St. Franziskus-Hospital Münster, 48145, Münster, Germany.
BMC Urol. 2023 Mar 28;23(1):46. doi: 10.1186/s12894-023-01225-6.
We evaluated the hydrostatic pressure of the renal pelvis (RPP) as a radiation-free alternative to fluoroscopic nephrostogram to assess ureteral patency after percutaneous nephrolithotomy (PCNL).
Retrospective non-inferiority study analyzing 248 PCNL-patients (86 female (35%) and 162 males (65%)) between 2007 and 2015. Postoperatively, RPP was measured using a central venous pressure manometer in cmHO. The primary endpoint was to assess RPP depending on the patency of the ureter and the nephrostomy tube removal. Secondary, the upper limit of normal RPP of [Formula: see text] 20 cmHO was assessed as an indicator of an unobstructed patency.
The median procedure duration was 141 min (112-171.5) with a stone free rate of 82% (n = 202). RPP was significantly higher in patients with obstructive nephrostogram with 25.0 mmHO (21.0-32.0) versus 20.0 mmHO (16.0-24.0; p < 0.001). The pressure was lower in successful nephrostomy removal with 18 cmHO (15-21) versus 23 cmHO (20-29) in the leakage group (p < 0.001). The analysis of a cut-off of [Formula: see text] 20 cmHO showed a sensitivity of 76.9% (95% CI [60.7%; 88.9%]) and a specificity of 61.5% (95% CI [54.6%; 68.2%]). The negative predictive value was 93.4% (95% CI: [87.9%; 97.0%]) and the positive predictive value 27.3% (95% CI [19.2%; 36.6%]). The accuracy of the model showed an AUC = 0.795 (95% CI [0.668; 0.862]).
The hydrostatic RPP seems to allow a bedside evaluation of ureteral patency after PCNL.
我们评估了肾盂静水压力（RPP）作为一种无辐射的替代荧光透视尿路造影术的方法，以评估经皮肾镜碎石取石术（PCNL）后输尿管通畅情况。
这是一项回顾性非劣效性研究，分析了 2007 年至 2015 年间 248 例接受 PCNL 治疗的患者（86 名女性（35%）和 162 名男性（65%））。术后，使用中心静脉压测压计以 cmHO 为单位测量 RPP。主要终点是根据输尿管通畅情况和肾造瘘管的去除情况评估 RPP。其次，评估[Formula: see text]20 cmHO 的正常 RPP 上限作为无阻塞通畅的指标。
中位手术时间为 141 分钟（112-171.5），结石清除率为 82%（n=202）。在梗阻性尿路造影中，RPP 明显较高，为 25.0 mmHO（21.0-32.0）与 20.0 mmHO（16.0-24.0；p<0.001）。在成功去除肾造瘘管的情况下，压力较低，为 18 cmHO（15-21）与漏液组的 23 cmHO（20-29）相比（p<0.001）。分析[Formula: see text]20 cmHO 的截断值显示，敏感性为 76.9%（95%CI[60.7%；88.9%]），特异性为 61.5%（95%CI[54.6%；68.2%]）。阴性预测值为 93.4%（95%CI：[87.9%；97.0%]），阳性预测值为 27.3%（95%CI[19.2%；36.6%]）。模型的准确性显示 AUC 为 0.795（95%CI[0.668；0.862]）。
RPP 似乎可以在 PCNL 后进行床边评估输尿管通畅情况。
