Nizzardo Marco, Li Puma Andrea, Graps Giorgio, Ciamarra Fabio, Lucignani Gianpaolo, Parolin Valentina, Passarelli Federica, Basadonna Ludovico Maria, Longo Fabrizio, De Lorenzis Elisa, Zanetti Stefano Paolo, Montanari Emanuele, Albo Giancarlo, Boeri Luca
Department of Urology, Fondazione IRCCS Ca' Granda- Ospedale Maggiore Policlinico, Milan, Italy.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
World J Urol. 2025 Jul 25;43(1):457. doi: 10.1007/s00345-025-05783-2.
To evaluate the impact of vacuum-assisted mini-percutaneous nephrolithotomy (vamPCNL) vs. vacuum-cleaner mPCNL (vcmPCNL) on the rate of postoperative infectious complications in a cohort of patients with low risk factors for infections.
We retrospectively analysed data from 229 patients who underwent mPCNL between 01/2016 and 09/2024. Patient's demographics, stones characteristics and operative data were collected. vamPCNL and vcmPCNL were performed based on the surgeon's preference. Low-risk patients were defied as: preoperative negative urine culture, no history of previous UTIs and immune system disease, no preoperative indwelling stent or catheter, single-stage procedure. Complications were graded according to modified Clavien classification. Descriptive statistics and logistic regression models were used to identify factors associated with postoperative infectious complications.
Median (IQR) age and stone volume were 56 (47-66) years and 1.7 (0.8-3.6) cm, respectively. vamPCNL and vcmPCNL were performed in 177 (77.2%) and 52 (22.8%) cases, respectively. Infectious complications occurred in 23 (10.0%) cases after surgery. Patients who developed infectious complications were more frequently female (59% vs. 32.3%, p = 0.02), had larger stone volume (p = 0.02) and higher rate of multiple stones (p = 0.02) than those who did not. Infectious complications occurred more frequently after vcmPCNL than vamPCNL (19.6% vs. 6.8%, p = 0.01) in this cohort of low-risk patients. Longer operative time (p < 0.01) and length of stay (p < 0.01) were observed in cases with infectious complications. At multivariable logistic regression analysis, vcmPCNL procedures (OR 4.1, p = 0.01) were independently associated with the risk of infectious complications post mPCNL, after accounting for stone volume. Similarly, female gender (OR 2.6, p = 0.03) emerged as a predictor for infectious complications in low-risk patients even after accounting for vcmPCNL procedures.
In a cohort of patients with kidney stones and low-risk factors for infections, approximately 10% of participants developed infectious complications after mPCNL. Patients with infectious complications had higher stone burden and longer procedural time than those who did not, as expected. vamPCNL confirmed to be associates with lower risk of infections, compared to vcmPCNL, even in patients with low risk factors.
评估真空辅助微创经皮肾镜取石术（vamPCNL）与吸尘器辅助微创经皮肾镜取石术（vcmPCNL）对一组感染风险低的患者术后感染并发症发生率的影响。
我们回顾性分析了2016年1月至2024年9月期间接受微创经皮肾镜取石术的229例患者的数据。收集了患者的人口统计学资料、结石特征和手术数据。vamPCNL和vcmPCNL根据外科医生的偏好进行。低风险患者定义为：术前尿培养阴性、无既往尿路感染和免疫系统疾病史、术前无留置支架或导管、单阶段手术。并发症根据改良的Clavien分类进行分级。使用描述性统计和逻辑回归模型来确定与术后感染并发症相关的因素。
年龄中位数（四分位间距）和结石体积分别为56（47 - 66）岁和1.7（0.8 - 3.6）cm³。分别有177例（77.2%）和52例（22.8%）患者接受了vamPCNL和vcmPCNL。术后有23例（10.0%）发生感染并发症。发生感染并发症的患者比未发生的患者更常为女性（59%对32.3%，p = 0.02），结石体积更大（p = 0.02）且多发结石发生率更高（p = 0.02）。在这组低风险患者中，vcmPCNL后感染并发症的发生率高于vamPCNL（19.6%对6.8%，p = 0.01）。发生感染并发症的病例手术时间（p < 0.01）和住院时间（p < 0.01）更长。在多变量逻辑回归分析中，在考虑结石体积后，vcmPCNL手术（比值比4.1，p = 0.01）与微创经皮肾镜取石术后感染并发症风险独立相关。同样，即使在考虑vcmPCNL手术因素后，女性性别（比值比2.6，p = 0.03）仍是低风险患者感染并发症的预测因素。
在一组肾结石且感染风险低的患者中，约10%的参与者在微创经皮肾镜取石术后发生感染并发症。如预期的那样，发生感染并发症的患者结石负荷更高且手术时间更长。与vcmPCNL相比，vamPCNL即使在低风险因素患者中也被证实感染风险更低。
