Clinical superiority of 3D-assisted percutaneous nephrolithotomy in treating complex upper urinary tract calculi: a single-center study.

OBJECTIVE

To investigate the clinical efficacy of three-dimensional (3D) visualization technology assisted percutaneous nephrolithotomy (PCNL) in the treatment of complex upper urinary tract calculi.

METHODS

This study retrospectively analyzed clinical data from 127 patients with complex upper urinary tract stones admitted to Yongchuan Hospital, Chongqing Medical University from January 2020 to January 2023. According to the treatment methods, the patients were divided into an observation group (3D visualization technology assisted PCNL, n = 69) and a control group (conventional PCNL, n = 58). The operation time, blood loss, postoperative ambulation time, hospitalization duration, surgical puncture (puncture needle number), stone clearance rate, postoperative complications, and levels of urea nitrogen (BUN), creatinine (Cr), and cysteine protease inhibitor C (Cys C) were compared between the two groups before operation (T0) and on the 1st (T1) and 7th (T2) day after operation. The levels of C-reactive protein (CPR), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), prostaglandin E2 (PGE2) and prostaglandin F2α (PGF2α) were measured by ELISA before and after the operation. The clinical efficacy and quality of life of the two groups were observed.

RESULTS

The intraoperative blood loss, operation time, postoperative ambulation time and hospitalization duration in the observation group were significantly less than those in the control group (all P < 0.05). The levels of CRP, TNF-α, IL-6, PGE2 and PGF2α at T1 and T2 in the two groups were significantly higher than those at T0, and the levels of CRP, TNF-α, IL-6, PGE2 and PGF2α at T1 and T2 in the observation group were significantly lower than those in the control group (P < 0.05). The levels of BUN, Cr and Cys C in the two groups at T1 and T2 were significantly higher than those at T0 (P < 0.05), and the above indexes at T2 were significantly lower than those at T1 (P < 0.05). At T1 and T2, the levels of serum BUN, Cr and Cys C in the observation group were significantly lower than those in the control group (P < 0.05). The observation group required fewer punctures and had a higher stone clearance rate, as well as a lower complication rate (all P < 0.05). The total clinical treatment effective rate in the observation group was higher than that in the control group (P < 0.05). At T3, quality of life scores on the WHOQOL-BREF scale were higher in both groups compared to T0, with the observation group scoring higher than the control group (P < 0.05).

CONCLUSION

PCNL assisted by 3D visualization technology offers significant clinical advantages in treating complex upper urinary tract calculi. It reduces intraoperative bleeding, shortens operation and hospitalization time, minimizes postoperative inflammation and renal function damage, improves stone clearance, reduces complications and improves patients' quality of life. Therefore it is worthy of clinical promotion.