Yaşar Hikmet, Aşik Alper, Erdoğan Erhan, Sarica Göksu, Aydin Abdullah, Yildirim Salih, Sarica Kemal
Department of Urology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, 34785 Istanbul, Turkey.
Medical School, Biruni University, 34015 Istanbul, Turkey.
J Clin Med. 2025 Jul 4;14(13):4739. doi: 10.3390/jcm14134739.
: This study aimed to evaluate the potential impact of stone characteristics, patient factors, and upper tract anatomical parameters in the prediction of residual fragments (RFs) following the flexible ureteroscopic (fURS) management of renal stones. : Between June 2023 and July 2024, a total of 104 cases underwent fURS for the minimally invasive management of medium-sized renal stones (10-25 mm), and 28 cases presenting with RFs 3 months after these procedures were included for further evaluation. In addition to the assessment of patient-related factors, non-contrast computed tomography (NCCT) was performed in all cases in an attempt to assess specific stone characteristics and upper tract anatomical parameters in detail during the 3-month follow-up period. : An evaluation of our findings indicated that, among the evaluated parameters, a higher degree of hydronephrosis (>Grade 2), a larger stone size (>15 mm), and the presence of multiple stones were found to affect the presence of RFs significantly ( = 0.020, = 0.012, and = 0.040, respectively). On the other hand, although the analysis of other parameters such as patient gender, stone side, stone hardness, and the use of an access sheath with univariate regression demonstrated potential correlations, none of these parameters demonstrated a significant impact when analyzed using backward logistic regression. Logistic regression revealed that Grade 2 hydronephrosis (OR = 18.3, = 0.020), stone size > 15 mm (OR = 7.0, = 0.012), and multiple stones (OR = 3.7, = 0.040) significantly increased the risk of residual fragments following fURS. : In light of our findings and published data, we can conclude that endourologists should consider the likelihood of RFs' presence after successful stone disintegration with fURS. A detailed evaluation of the relevant factors revealed that patients with larger stones, higher degrees of hydronephrosis, and multiple calculi may carry the risk of residual fragments after these procedures. Thus, the utilization of such reliable predictive parameters may aid in selecting optimal stone removal strategies and planning subsequent interventions in the rational management of RFs.
本研究旨在评估结石特征、患者因素和上尿路解剖参数在预测经皮肾镜取石术（fURS）治疗肾结石后残留碎片（RFs）方面的潜在影响。2023年6月至2024年7月，共有104例患者接受了fURS治疗中度肾结石（10 - 25mm）的微创手术，其中28例在术后3个月出现RFs的患者被纳入进一步评估。除了评估患者相关因素外，所有病例均进行了非增强计算机断层扫描（NCCT），以试图在3个月的随访期内详细评估特定的结石特征和上尿路解剖参数。对我们研究结果的评估表明，在评估的参数中，肾积水程度较高（>2级）、结石尺寸较大（>15mm）和存在多个结石被发现对RFs的存在有显著影响（分别为P = 0.020、P = 0.012和P = 0.040）。另一方面，虽然对其他参数如患者性别、结石侧别、结石硬度和使用接入鞘进行单因素回归分析显示有潜在相关性，但在使用向后逻辑回归分析时，这些参数均未显示出显著影响。逻辑回归显示，2级肾积水（OR = 18.3，P = 0.020）、结石尺寸>15mm（OR = 7.0，P = 0.012）和多个结石（OR = 3.7，P = 0.040）显著增加了fURS后残留碎片的风险。根据我们的研究结果和已发表的数据，我们可以得出结论，泌尿外科医生在成功进行fURS碎石后应考虑RFs存在的可能性。对相关因素的详细评估表明，结石较大、肾积水程度较高和存在多个结石的患者在这些手术后可能存在残留碎片的风险。因此，利用这些可靠的预测参数可能有助于选择最佳的结石清除策略，并为合理管理RFs规划后续干预措施。
