Lin Fuyang, Cai Chao, Deng Huan, Zhang Jianpeng, Wang Mengting, Wang Sizhe, Liu Zezhen, Liu Yongda
Department of Urology and Guangdong Key Laboratory of Urology, the First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1#, Haizhu District, Guangzhou, Guangdong, 510230, China.
Minimally Invasive Surgery Center, the First Affiliated Hospital of Guangzhou Medical University, Kangda Road 1#, Haizhu District, Guangzhou, Guangdong, 510230, China.
BMC Urol. 2025 May 22;25(1):134. doi: 10.1186/s12894-025-01819-2.
Some urologists prefer to perform PCNL by using pure ultrasonography-guided access (USGA), but some potential factors that may cause the residual stones need to be excavated. This retrospective case-control study is designed to confirm the risk factors for residual stones after pure USGA mini-percutaneous nephrolithotomy (mPCNL) in patients and develop a nomogram for predicting postoperative residual stones based on the risk factors.
From October 2019 to August 2021, our department recorded a retrospective record of 227 patients with kidney stones treated with pure USGA mPCNL. The risk factors for postoperative residual stones were confirmed by univariate and multivariate logistic regression analysis, and a nomogram was developed. As a result, the nomogram was accessed with discrimination, calibration, and clinical applicability in mind.
The rate of residual stones in patients was 34.4% during the management of USGA mPCNL. The independent risk factors for residual stones were history of ipsilateral PCNL surgery (OR = 3.163, P = 0.020 ), calyx number with stones (OR = 5.628, P = 0.006 ), stone burden (OR = 1.004, P = 0.008 ). Calculated by receiver operating characteristic (ROC) analysis, the area under the curve (AUC) was 0.884 (95% CI 0.829-0.940). The concordance index (C-index) of calibration curves was 0.842, meaning good concordance. The clinical decision curve analysis (DCA) showed a good clinical practicability in clinical practice.
Patients with history of ipsilateral PCNL surgery, calyx number with stones and stone burden may be at increased risk of residual stones. The nomogram can evaluate the risk of residual stones in patients who undergo USGA mPCNL.
Not applicable.
一些泌尿外科医生倾向于采用单纯超声引导穿刺（USGA）进行经皮肾镜取石术（PCNL），但可能导致结石残留的一些潜在因素仍有待发掘。本回顾性病例对照研究旨在确定患者在接受单纯USGA微创经皮肾镜取石术（mPCNL）后结石残留的危险因素，并基于这些危险因素制定预测术后结石残留的列线图。
2019年10月至2021年8月，我科对227例行单纯USGA mPCNL治疗肾结石的患者进行回顾性记录。通过单因素和多因素逻辑回归分析确定术后结石残留的危险因素，并绘制列线图。结果，该列线图在设计时考虑了区分度、校准度和临床适用性。
在USGA mPCNL治疗过程中，患者的结石残留率为34.4%。结石残留的独立危险因素为同侧PCNL手术史（OR = 3.163，P = 0.020）、有结石的肾盏数量（OR = 5.628，P = 0.006）、结石负荷（OR = 1.004，P = 0.008）。通过受试者工作特征（ROC）分析计算，曲线下面积（AUC）为0.884（95%CI 0.829 - 0.940）。校准曲线的一致性指数（C指数）为0.842，表明一致性良好。临床决策曲线分析（DCA）显示在临床实践中具有良好的临床实用性。
有同侧PCNL手术史、有结石的肾盏数量以及结石负荷的患者结石残留风险可能增加。该列线图可评估接受USGA mPCNL患者的结石残留风险。
不适用。
