Sakly Aymen, Khaldi Syrine, Touati Anouar, Dimassi Elyes, Zakhama Walid, Binous Yassine
Department of Urology, Tahar Sfar University Hospital of Mahdia, Mahdia, Tunisia.
Ann Med Surg (Lond). 2024 Aug 30;86(10):5711-5715. doi: 10.1097/MS9.0000000000002502. eCollection 2024 Oct.
Currently, percutaneous nephrolithotomy (PCNL) is the gold standard of treatment for large renal stones. The high prevalence of urolithiasis is associated with a high recurrence rate increasing the risk of re-intervention. This study aimed to compare the effectiveness and complications of PCNL among patients with previous therapeutic interventions for renal stones.
Between August 2018 and September 2023, 245 patients were prospectively enrolled in this study and who underwent PCNL for renal stones at our institution. We compared patients who had no previous renal surgery (group 1: =171) with those who had a history of open renal surgery (group 2: =45) or previous PCNL on the ipsilateral kidney (group 3: =31). All patients underwent surgery in the Galdakao-modified Valdivia position. Data on stone characteristics and perioperative and postoperative parameters were collected. Technical features, success rates and morbidity were analyzed and compared between the groups.
The fluoroscopy time was significantly longer in the group of patients with previous open surgery than in groups 1 and 3 (161.47±52.44, 223.05±33.29, 172.27±30.51 sec, <0.001). Similarly, the operative time was longer in group 2 (138.20±38.86 min, <0.001). The immediate stone-free rates in groups 1, 2, and 3 were 74.8%, 72.1%, and 77.4%, respectively (=0.945). At 1-month, these rates increased to 98.8%, 96.2% and 96.8%, respectively (=0.857). No difference was detected between the groups in terms of complication rate. The average Hb variation was 1.08±0.82, 1.34±1.01 and 0.94±0.69 g/dl for groups 1, 2 and 3, respectively(=0.082). Hospital stay was longer in group 2 than in groups 1 and 3 (2.17±1.03, 2.53±1.22, 1.88±1.00 days, =0.07), respectively.
PCNL in patients with a history of renal surgery was associated with longer fluoroscopy and operative time. However, the success and morbidity rates as a secondary procedure were similar to those of PCNL in patients with no previous intervention.
目前，经皮肾镜取石术（PCNL）是治疗大型肾结石的金标准。尿石症的高患病率与高复发率相关，增加了再次干预的风险。本研究旨在比较既往有肾结石治疗干预史的患者中行PCNL的有效性和并发症。
2018年8月至2023年9月期间，245例患者前瞻性纳入本研究，并在我们机构接受了肾结石PCNL治疗。我们将既往无肾脏手术史的患者（第1组：=171）与有开放性肾脏手术史的患者（第2组：=45）或同侧肾脏既往有PCNL史的患者（第3组：=31）进行比较。所有患者均在改良的加尔达考-瓦尔迪维亚体位下进行手术。收集结石特征以及围手术期和术后参数的数据。分析并比较各组之间的技术特点、成功率和发病率。
既往有开放性手术史的患者组的透视时间明显长于第1组和第3组（161.47±52.44、223.05±33.29、172.27±30.51秒，<0.001）。同样，第2组的手术时间更长（138.20±38.86分钟，<0.001）。第1组、第2组和第3组的即刻无石率分别为74.8%、72.1%和77.4%（=0.945）。在1个月时，这些比率分别升至98.8%、96.2%和96.8%（=0.857）。各组之间在并发症发生率方面未检测到差异。第1组、第2组和第3组的平均血红蛋白变化分别为1.08±0.82、1.34±1.01和0.94±0.69g/dl（=0.082）。第2组的住院时间长于第1组和第3组（分别为2.17±1.03、2.53±1.22、1.88±1.00天，=0.07）。
有肾脏手术史的患者行PCNL与更长的透视时间和手术时间相关。然而，作为二次手术的成功率和发病率与既往无干预的患者行PCNL相似。
