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索马里人群肾结石≤2cm 经皮肾镜碎石术与逆行性肾内手术治疗的对比分析。

Comparative Analysis of Super-Mini Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery for the Management of Renal Calculi ≤2 cm Among Somali Population.

机构信息

Department of Urology, Mogadishu Urological Center, Mogadishu, Somalia.

Department of Urology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia.

出版信息

J Endourol. 2024 May;38(5):426-431. doi: 10.1089/end.2023.0675. Epub 2024 Mar 27.

Abstract

Limited data have explored the efficacy of super-mini percutaneous nephrolithotomy (SMP) and retrograde intrarenal surgery (RIRS) in managing ≤2 cm renal calculi. This study aims to comprehensively evaluate the safety and effectiveness of SMP compared with RIRS. This prospective cohort study investigated 210 patients with renal calculi (≤2 cm) undergoing SMP or RIRS, randomly recruited over 4 years. In total, 51.4% underwent SMP and 48.6% underwent RIRS. The mean patient age was 31.3 ± 14.7 years; 56.7% were men, mean stone size of 1.3 ± 0.28 cm, and stone hardness of 1190.1 ± 352.83 Hounsfield units. Pearson's correlation indicated negative correlations for SMP with hospital stays ( = -0.138,  = 0.046), operating time ( = -0.519,  < 0.001), and stone-free rate (SFR) ( = -0.161,  = 0.020); and a positive correlation with a postoperative ureteral catheter ( = +0.389,  < 0.001). With regard to RIRS, the study shows a positive correlation with hospital stay ( = +0.138,  = 0.046), operating time ( = +0.519,  < 0.001), and SFR ( = +0.161,  = 0.020); and a negative correlation with postoperative ureteral catheter ( = -0.389,  < 0.001). Logistic regression, using SMP as the reference, RIRS was associated with β = +0.31, and 1.20 (95% confidence interval [CI], 1.14-1.27,  ≤ 0.001) risk of operation duration and β = +0.37, 1.44 (95% CI, 1.00-2.07,  = 0.047) risk of longer hospital stay. This study investigates the suitability of SMP and RIRS for treating renal calculi ≤2 cm. SMP demonstrated superior efficacy with significantly shorter operating times and reduced hospital stays, suggesting potential advantages for managing lower volume renal stones.

摘要

这项前瞻性队列研究调查了 210 名接受微创经皮肾镜取石术 (SMP) 和逆行性肾内手术 (RIRS) 治疗 ≤2cm 肾结石的患者,他们在 4 年内随机招募。共有 51.4%的患者接受 SMP 治疗,48.6%的患者接受 RIRS 治疗。患者平均年龄为 31.3±14.7 岁;56.7%为男性,平均结石大小为 1.3±0.28cm,结石硬度为 1190.1±352.83 豪斯菲尔德单位。Pearson 相关分析表明,SMP 与住院时间 (r=-0.138,p=0.046)、手术时间 (r=-0.519,p<0.001) 和无结石率 (SFR) (r=-0.161,p=0.020) 呈负相关,与术后输尿管导管呈正相关 (r=+0.389,p<0.001)。对于 RIRS,研究表明与住院时间 (r=+0.138,p=0.046)、手术时间 (r=+0.519,p<0.001) 和 SFR (r=+0.161,p=0.020) 呈正相关,与术后输尿管导管呈负相关 (r=-0.389,p<0.001)。使用 SMP 作为参考的 logistic 回归分析显示,RIRS 与手术时间延长的 β 值为+0.31,风险比为 1.20(95%可信区间[CI],1.14-1.27,p<0.001),与住院时间延长的 β 值为+0.37,风险比为 1.44(95% CI,1.00-2.07,p=0.047)。这项研究调查了 SMP 和 RIRS 治疗 ≤2cm 肾结石的适用性。SMP 显示出更好的疗效,手术时间明显缩短,住院时间缩短,这表明其在处理低体积肾结石方面具有潜在优势。

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