Magomedov D M, Kotov S V, Pulbere S A, Bolotov A D, Gradskova T E
FGAOU VO N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia.
Pirogov City Clinical Hospital No.1, Moscow, Russia.
Urologiia. 2025 Mar(1):60-67.
Currently, percutaneous nephrolithotomy (PCNL) is a first-line treatment method for large and staghorn kidney stones. Predicting the efficiency of the performed surgical procedure is relevant at the stage of preoperative counseling of patients.
To develop a universal nomogram for predicting the efficiency of mini-PCNL taking into account the baseline characteristics and features of the patient.
A total of 251 patients with kidney stones who underwent mini-PCNL in the prone position according to the standard method through a single access were included in the study. The preoperative characteristics of patients and their impact on the outcome were evaluated. An achievement of the stone-free rate (SFR) was assessed by the computed tomography (CT).
The analysis revealed factors significantly influencing the achievement of the SFR, such as stone volume >1.39 cm3 (p=0.001), stone area >189.03 mm2 (p=0.001), distance from the lowest point of the Th12 to the lower part of the lower pole calyx (T12-LP) <85.81 mm (p=0.050), distances from the lower calyx to the most cranial part of the iliac crest (ICLP) >49.1 mm (p=0.029), stone size >18.2 mm (p=0.001), number of involved calyxes >3 (p=0.001), number of involved calyxes for staghorn stones >4 (p=0.001), and staghorn stone (p=0.001). Correlation, logistic regression, and ROC analysis were performed for these factors. The area under the curve (AUC) was 0.897. A nomogram has been developed. The sensitivity of the model is 94.4%, specificity is 59.2%, and overall accuracy is 84.4%. A certificate of state registration of a computer program in the IBM SPSS Statistics syntax language "A model for predicting the SFR of mini-PCNL in patients with kidney stones" was obtained.
The nomogram developed on the basis of our data showed a high predictive ability in relation to the SFR with sensitivity of 94%. This nomogram is easy to use and interpret, which makes it convenient for routine practice, however, external validation is necessary to objectify the predictive ability.
目前，经皮肾镜取石术（PCNL）是治疗大型和鹿角形肾结石的一线治疗方法。在患者术前咨询阶段预测所实施手术的效率具有重要意义。
考虑患者的基线特征和特点，制定一种用于预测微创经皮肾镜取石术（mini-PCNL）效率的通用列线图。
本研究共纳入251例肾结石患者，这些患者采用标准方法经单一通道在俯卧位接受了mini-PCNL。评估了患者的术前特征及其对手术结果的影响。通过计算机断层扫描（CT）评估无结石率（SFR）的达成情况。
分析揭示了显著影响SFR达成的因素，如结石体积>1.39 cm³（p = 0.001）、结石面积>189.03 mm²（p = 0.001）、从胸12最低点到下极肾盏下部的距离（T12-LP）<85.81 mm（p = 0.050）、从下肾盏到髂嵴最颅侧部分的距离（ICLP）>49.1 mm（p = 0.029）、结石大小>18.2 mm（p = 0.001）、受累肾盏数量>3个（p = 0.001）、鹿角形结石受累肾盏数量>4个（p = 0.001）以及鹿角形结石（p = 0.001）。对这些因素进行了相关性、逻辑回归和ROC分析。曲线下面积（AUC）为0.897。已制定列线图。该模型的敏感性为94.4%，特异性为59.2%；总体准确率为84.4%。获得了计算机程序“肾结石患者mini-PCNL的SFR预测模型”的IBM SPSS Statistics语法语言国家注册证书。
基于我们的数据开发的列线图对SFR显示出较高的预测能力，敏感性为94%。该列线图易于使用和解读，便于日常实践，但需要外部验证以客观化预测能力。
