Kim Gyeong Hun, Jung Gyoohwan, Suh Jungyo, Park Juhyun, Cho Sung Yong
Department of Urology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.
Department of Urology, Hanyang University Seoul Hospital, 222-1, Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea.
J Clin Med. 2023 Apr 12;12(8):2820. doi: 10.3390/jcm12082820.
The aim of this study was to evaluate the level of hematuria and the presence of clots during retrograde intrarenal surgery (RIRS) and miniaturized percutaneous nephrolithotomy (mPCNL) to predict surgical outcomes.
The data of patients who underwent RIRS and mPCNL were analyzed separately. A hematuria grading (HG) system was classified into five grades based on the presence of blood clots and any visible stones according to the irrigation settings. Inter-observer reliability of the grading system was assessed using intra-class correlation and Spearman's rho.
The HG system showed high agreement among examiners, with high intra-class reliability and a strong correlation between RIRS and mPCNL groups. The stone density of the Houns-field unit was the most important factor in determining the hematuria across the development and validation groups of RIRS and mPCNL patients. Multivariate logistic regression analysis showed that the HG system was a significant predictor for remnant stones in the PCNL group and the probability of acute pyelonephritis or sepsis in the RIRS group. The high hematuria group showed lower basketing difficulty with the basket with a blue marker instrument than with others.
The new HG system shows excellent inter-observer reliability and a correlation with a gradual increase in stone density and surgical difficulty.
本研究旨在评估逆行性肾内手术（RIRS）和微创经皮肾镜取石术（mPCNL）期间的血尿水平和血凝块情况，以预测手术结果。
分别分析接受RIRS和mPCNL治疗的患者数据。根据冲洗设置下血凝块和任何可见结石的情况，将血尿分级（HG）系统分为五个等级。使用组内相关系数和斯皮尔曼等级相关系数评估分级系统的观察者间可靠性。
HG系统在检查者之间显示出高度一致性，具有较高的组内可靠性，且RIRS组和mPCNL组之间存在强相关性。亨氏单位的结石密度是决定RIRS和mPCNL患者的开发和验证组中血尿情况的最重要因素。多因素逻辑回归分析表明，HG系统是PCNL组残余结石以及RIRS组急性肾盂肾炎或脓毒症发生概率的重要预测指标。血尿程度高的组使用带有蓝色标记器械的篮子时，套篮难度低于使用其他篮子。
新的HG系统显示出优异的观察者间可靠性，并且与结石密度和手术难度的逐渐增加相关。
