A Comparative Clinical Study Of Three Intraoperative Drainage Methods In The Treatment Of Renal Stones And Upper Ureteral Stones Of 1.5-3cm With Single-Channel MPCNL In One Stage

Objective:To analyse the perioperative efficacy of the three methods by comparing the clinical data of three intraoperative drainage methods in the treatment of 1.5-3 cm stones in the upper part of the kidney and ureter with single-channel MPCNL in phase I.To provide reference and decision-making for clinicians.METHODS:A total of 150 patients with renal and upper ureteral(above the lower margin of L4)stones admitted through the Department of Urology of the General Hospital of the Northern War Zone of the Chinese People’s Liberation Army between September2020 and October 2022 were included as study subjects.Inclusion criteria were:patients with single-channel MPCNL and successful surgery;simple kidney stones or ureteral stones above the lower edge of L4;stones in the lower calyces and ureter≥1.5 cm and the rest of the kidney stones≥2 cm;urinary stones with a maximum diameter≤3 cm;no obstruction or injury to the distal ureter;and patients aged>18 years.Exclusion criteria were:patients with significant intraoperative injury to the collecting system;patients with severe hydronephrosis resulting in a renal cortical thickness<4 mm;complex stones such as deerstalker stones;isolated kidney stones,transplanted kidney stones or combined intraparenchymal stones;history of previous ipsilateral urological surgery or concurrent other surgery;and incomplete preoperative relevant data.The patients were divided into50 patients in the microchannel percutaneous nephrolithotomy(MPCNL)group,50patients in the partially tubeless microchannel percutaneous nephrolithotomy(TMPCNL)group and 50 patients in the completely tubeless microchannel percutaneous nephrolithotomy(TTMPCNL)group according to the intraoperative drainage method.The preoperative general clinical data,operative time,postoperative 24h VAS score,postoperative time out of bed,Hb change value,Scr change value,postoperative discharge time,hospital cost,postoperative 4-week SFR and postoperative complications of the three groups were compared using SPSS23.0 statistical software.Results:A total of 150 patients were included in the study,containing a total of 85 male and 65 female patients,aged 25-89 years,with a mean of(54.1±13.0)years,BMI of 16.4-34.8 kg/m~2,with a mean of(24.1±3.4)kg/m~2,and CT values of stones of 612-1576 HU,with a mean of(1103.0±217.6)HU.According to the location of the stones,11 patients(7.3%)had stones in the upper ureter,24 patients(16.0%)had stones in the upper renal calyces,48 patients(32.0%)had stones in the middle renal calyces,29 patients(19.3%)had stones in the lower renal calyces and 38 patients(25.3%)had stones in the renal pelvis.According to the degree of hydronephrosis,25 patients(16.7%)had no hydronephrosis,51 patients(34.0%)had mild hydronephrosis,52 patients(34.7%)had moderate hydronephrosis,and 22 patients(14.6%)had severe hydronephrosis.The American Society of Anesthesiologists(ASA)physical status classification was used preoperatively and could be divided into 72 patients(48.0%)with ASA class I,56 patients(37.3%)with ASA class II and 22 patients(14.7%)with ASA class III.No patients with ASA class IV or ASA grade IV and ASA grade V patients were not included.The basic preoperative clinical study data of the three groups were not significantly different(p>0.05)and were comparable.The postoperative time out of bed,24h VAS score,postoperative discharge time and hospital costs of the three groups were:TTMPCNL group<TMPCNL group<MPCNL group,and there were statistical differences between the groups after multiple comparisons(p<0.05).The results of comparing the operative time of the three groups using the Bonferroni method showed that the TMPCNL group(62.0±16.5)min and the TTMPCL group(61.3±16.2)were shorter than the MPCNL group(70.2±13.0)min,with a statistically significant difference(p<0.05),while the difference between the TMPCNL and TTMPCNL groups The difference was not statistically significant(p>0.05).There were no statistically significant differences in the change in Hb,change in Scr,SFR at 4weeks postoperatively and postoperative complications between the three groups(p>0.05).CONCLUSION:MPCNL,TMPCNL and TTMPCNL drainage modalities are safe and effective in the treatment of selected upper urinary tract stones.Among them,MPCNL has a long operative time,long hospital stay,high hospital costs and high postoperative analgesic needs;TMPCNL has a relatively moderate hospital stay,hospital costs and postoperative analgesic needs,and is more suitable for patients with residual stones after surgery;TTMPCNL has a short operative time,short hospital stay,low hospital costs and low postoperative analgesic needs,but is relatively demanding on the surgeon’s skills and has relatively demanding requirements on stone size and The requirements for stone size and location are also relatively demanding.Therefore,in high-volume medical centres,experienced surgeons can choose TTMPCNL when stone residuals are small and intraoperative bleeding is minimal.