Department of Urology, Peking University People's Hospital, 11 Xizhimen South Street, Xicheng District, Beijing, 100034, People's Republic of China.
Peking University Applied Lithotripsy Institute, Peking University, Beijing, 100034, People's Republic of China.
World J Urol. 2024 Sep 2;42(1):501. doi: 10.1007/s00345-024-05206-8.
To analyze the risk factors for complications in patients with struvite stones following percutaneous nephrolithotomy (PCNL) or flexible ureteroscopy (fURS), and to establish a nomogram for postoperative complications in patients following PCNL.
A retrospective analysis was conducted on patients with struvite stones after PCNL and fURS at the Department of Urology, Peking University People's Hospital, from January 2012 to March 2022. The common pathogens and antimicrobial susceptibilities in preoperative midstream urine culture were analyzed. Logistic regression analyses were used to evaluate the risk factors. Receiver-operating characteristic (ROC) curve, calibration plots, and decision curve analysis (DCA) were used to assess the discrimination, accuracy, and practicability of the nomogram.
332 patients with struvite stones received one-stage PCNL or fURS, including 243 cases of PCNL and 89 cases of fURS. 72 patients (21.69%) developed postoperative complications. The most common pathogens in preoperative urine cultures were Escherichia coli, Proteus mirabilis, and Enterococcus faecalis. Multivariate logistic regression analysis showed that preoperative hemoglobin (OR = 0.981, P = 0.042), staghorn stone (OR = 4.226, P = 0.037), and positive preoperative midstream urine culture (OR = 2.000, P = 0.043) were independent risk factors for postoperative complications in patients following PCNL. The nomogram showed good performance in discrimination, accuracy, and applicability.
Preoperative hemoglobin, staghorn stone, and positive preoperative midstream urine culture were independent risk factors for postoperative complications in patients with struvite stones following PCNL. A nomogram was developed to predict the probability of postoperative complications.
分析经皮肾镜碎石取石术（PCNL）或软性输尿管镜碎石术（fURS）后尿石症患者发生并发症的危险因素，并建立 PCNL 术后并发症的列线图。
回顾性分析 2012 年 1 月至 2022 年 3 月北京大学人民医院泌尿外科接受 PCNL 和 fURS 治疗的尿石症患者的临床资料。分析术前中段尿培养的常见病原菌及药敏情况。采用 logistic 回归分析评估危险因素。采用受试者工作特征（ROC）曲线、校准图和决策曲线分析（DCA）评估列线图的判别、准确性和实用性。
332 例患者接受一期 PCNL 或 fURS 治疗，其中 243 例行 PCNL，89 例行 fURS。72 例（21.69%）患者术后发生并发症。术前尿培养最常见的病原菌为大肠埃希菌、奇异变形杆菌和粪肠球菌。多因素 logistic 回归分析显示，术前血红蛋白（OR=0.981，P=0.042）、鹿角形结石（OR=4.226，P=0.037）和术前中段尿培养阳性（OR=2.000，P=0.043）是 PCNL 术后并发症的独立危险因素。列线图在判别、准确性和适用性方面表现良好。
术前血红蛋白、鹿角形结石和术前中段尿培养阳性是 PCNL 术后尿石症患者发生并发症的独立危险因素。构建了预测术后并发症概率的列线图。
