Logistic Regression Analysis Relative Factors Of Residual Stones After One Session Percutaneous Nephrolithotomy

Objectives Percutaneous nephrolithotomy is a effective and safe method of lithotomy for treating upper urinary tract calculi,especially,which has the equipment improvement and accumulation of clinical experience of more than 30 years.The majority of patients and doctors’ ideal is that complete treatment of upper urinary calculi with PCNL one time.However,not all get good results.At present,few people study one session PCNL,which is lack of analytical data in system and most of the experience reports,that cannot clear which is the independent factor of the residual stones after one session PCNL and cannot provide scientific evidence yet.We retrospectively analyzed the records of 776 patients who had undergone PCNL in our department from 2010 to 2014.Statistical analysis data was performed to determine the independent risk factors of postoperative residual stones, which can provide scientific basis for follow-up treatment,on the other hand,reduce rate of postoperative residual stones.Methods A retrospectively study was performed to analyze patients with PCNL procedures admitted in our hospital from April 2010 to October 2014.All the patients received KUB/IVU/and ultrasound or CT diagnosis.The demographic information,complication,kidney,stone type,operation time,etc,were the most important foctors for the study.According to the treatment outcomet,the patients were divided into 2 groups,those who became residual stones,which diameter larger than 5mm,and those who did not.Application of SPSS 19.0 statistical software to establish database,the student’s t test,chi-square test,and multiple Logistic regression analysis were performed to determine the statistically significant wariables.Result 1.The date of 776 patients (473 male,303female) were included in our study.Mean±SD patient age was 45.18±14.29 years (range 16 to 76).Median BMI was 23.22kg/m2 (range 16.90 to 32.20).Of the patients 9.7% (n=75) were solitary kidney calculi,17.3% (n=134) were staghorn stones.The mean±SD stone burden was 569.95±302.40mm2(range 263.76 to 1467.95).Hypertension,Diabetes,urinary tract infection,renal insufficiency and hydronephrosiswas present in 155 (20.0%),84 (10.8%),144 (18.6%),82 (10.6%) and 359 (46.3%) patients,respectively.A total of 608 (78.4%) patients were the calcium oxalate kidney stones.An overall residual stones rate of 27.9% (217/776),including staghorn calculi rate in 53.7% (72/134),was achieved after one session PCNL.2.In univariate analysis,factors that didnot affected residual stones after PCNL were gender,BMI,hypertension, diabetes,urinary tract infection,hydronephrosis and stone composition (P>0.05).3.Age (P=0.001),stone size (P<0.001),stone types (P<0.001), stone location (P<0.001),renal pelvis and calices type(P<0.001),renal insufficiency (P<0.001),bleeding volume (P<0.001),the number of accesses (P<0.001),solitary kidney (P=0.007) and operation time (P=0.002) were of the factors significant.4.Binary logistic multivariate regression analysis showed that stone burden (P<0.001,OR=5.201),renal pelvis type (P<0.001,OR=6.009),renal insufficiency (P=0.001,OR=2.724),staghorn stones (P=0.024,OR=1.864) significant affected residual stones after one session PCNL.Conclusion 1.In univariate analysis,factors that affected residual stones after one session PCNLwere age,stone size,location and type,solitary kidney,type of renal pelvis,renal insufficiency,bleeding volume,operation time.2.Stone burden, branch of pelvis,renal insufficiency, staghorn stones with residual stones rate were significantly increased.