Retrospective Study On Emergency Treatment Of Acute Renal Injury Caused By Ureteral Stone Obstruction By Two Surgical Methods

Objective: To explore the safety and effectiveness of retrograde ureteral intubation and percutaneous nephrostomy in the emergency treatment of acute kidney injury caused by ureteral stone obstruction,and to determine the selection criteria of the best treatment methods by analyzing the risk factors affecting the success rate of these two operations and the incidence of surgical complications.Methods: The clinical data of 155 patients with acute kidney injury due to ureteral stone obstruction admitted to the First Affiliated Hospital of Dali University from June2016 to June 2022 were retrospectively studied.All patients underwent either retrograde ureteral intubation or percutaneous nephrostomy within 24 hours.The failure of one operation was transferred to the other,and hemodialysis treatment was performed after renal function improved and infection control failed in both surgical methods.A total of155 patients underwent retrograde ureteral intubation on 146 sides and percutaneous nephrostomy on 97 sides.Age,conventional white blood cells,white blood cells under uroscopy,blood potassium value,stone diameter,degree of hydronephrosis,preoperative creatinine,preoperative urea nitrogen and surgical success rate were compared between the two groups.Univariate analysis was conducted on the factors affecting the success rate of retrograde ureteroscopic intubation and percutaneous nephrostomy respectively,and the risk factors affecting the success rate were initially screened out,and the risk factors were incorporated into the binary Logistic regression analysis to obtain independent risk factors affecting the two surgical methods respectively.According to the independent risk factors obtained from the analysis,they were divided into the group ≤1.5cm and the group > 1.5cm according to the stone diameter,and the mild hydrops group and the moderate and severe hydrops group according to the degree of renal hydrops.The success rate of surgery and postoperative complications among the groups were compared respectively.Finally,the serum creatinine and blood urea nitrogen values before,1 day,3 days,1 week and 1 month after the two kinds of surgery were statistically analyzed to evaluate and compare the recovery of renal function after the two kinds of surgery.Results:1.There was no statistical significance in the overall success rate of the two surgical methods.There was no statistical significance in the difference of white blood cells in admission routine blood,white blood cells in urine routine blood,blood potassium value,blood creatinine and blood urea nitrogen(P > 0.05),and there were statistical significance in the difference of maximum stone diameter and degree of hydronephrosis(P < 0.05).2.Univariate analysis was performed on the success rate of retrograde ureteral intubation: there were statistically significant differences in uroscopic white blood cell count,maximum diameter of ureteral calculi and degree of hydronephrosis(P < 0.05),but no statistically significant differences in age,blood routine white blood cells,blood potassium value,blood creatinine and blood urea nitrogen(P > 0.05).Further single factor differences were included in multivariate Logistic regression analysis,and the results showed that maximum stone diameter was an independent risk factor for retrograde ureteral intubation.Unifactor analysis of the influence on the success rate of percutaneous nephrostomy showed that there were statistically significant differences in age,degree of hydronephrosis and maximum stone diameter(P < 0.05),but no statistically significant differences in blood routine white blood cells,white blood cells under uroscopy,blood potassium,blood creatinine and blood urea nitrogen(P > 0.05).The differential single factor was further included in Logistic regression analysis,and the results showed that the degree of hydronephrosis was an independent risk factor for percutaneous nephrostomy.3.According to the analysis of independent risk factors affecting the two surgical methods,they were divided into ≤1.5cm group and > 1.5cm group according to the maximum stone diameter,and into mild hydrops group and moderate and severe hydrops group according to the degree of renal hydrops.The power of retrograde ureteral intubation ≤1.5cm was significantly higher than that of the > 1.5cm group.Intraoperative complications were more likely to occur in the > 1.5cm group,with statistical significance(P < 0.05).In percutaneous nephrostomy,the power composition of severe hydrops was significantly higher than that of mild hydrops group,and intraoperative complications were more likely to occur in mild hydrops group,with statistical significance(P < 0.05).There was no significant difference in the overall surgical complications between the two methods(P > 0.05).4.Seventy-nine patients underwent retrograde ureteral intubation and 50 patients underwent percutaneous nephrostomy(excluding those who underwent hemodialysis after retrograde ureteral intubation on one side and percutaneous nephrostomy on the other side and failed operations).There was no significant difference in renal function recovery between the two methods(P > 0.05).Conclusion:1.Both methods are safe and effective in the treatment of acute renal injury due to ureteral obstruction.2.Stone diameter was an independent risk factor for retrograde ureteral intubation,and hydronephrosis was an independent risk factor for the success rate of PCN.3.The success rate of retrograde ureteral intubation decreased and intraoperative complications increased when the stone diameter was more than 1.5cm.In mild hydronephrosis,the success rate of PCN decreased and intraoperative complications increased.4.Retrograde ureteral intubation is recommended when stone diameter is less than1.5cm with mild hydronephrosis,and PCN is recommended when stone diameter is more than 1.5cm with moderate and severe hydronephrosis.