| Objective:Urinary calculi is one of the most common diseases in urology,especially kidney calculi.Retrograde intrarenal surgery(RIRS)has become a common treatment for kidney stones.There are a variety of preoperative scoring systems for predicting Percutaneous Nephrolithotomy(PCNL)stone-clearing rate,but the scoring system for RIRS is still in the exploratory stage and has not reached consensus in the industry.In this study,the predictive value of five scoring systems for postoperative stone removal rate after RIRS was analyzed by statistical methods.Methods:Information of patients with RIRS who were hospitalized from January 2020 to June 2022 was screened from the medical record system of Huaihe Hospital of Henan University.This study strictly controlled the inclusion and exclusion criteria.Patients with calculi located in the ureter,without CT electronic data of our hospital and patients who did not follow the doctor’s advice to come to the hospital for review during the data collection process were not included in this study.Through case screening and strict control inclusion and exclusion criteria,a total of 169 cases of kidney stone patients with RIRS were collected for retrospective analysis.Age,gender,smoking history,drinking history,height,weight,Body Mass Index calculated by height and weight of these patients were collected,previous chronic history(hypertension,diabetes),ipsilateral urinary system operation history,serum creatinine,blood routine white blood cells,urine routine white blood cells,stone location,antler stone,stone hardness,stone diameter and other 26 related factors and other clinical test indicators.Through the collection of patients’ medical records and postoperative follow-up,according to the plain radiographs of the urinary system reviewed in the hospital one month after the operation,the diameter of residual calculi in plain radiographs > 4mm was defined as stone residue,and the diameter of no residual calculi in plain radiographs or the diameter of residual calculi ≤4mm was defined as stone removal.A total of 59 patients with kidney calculi showed stone residue after RIRS surgery.The 59 patients were set as stone residue group,and the remaining 110 patients as stone removal group.SPSS 26.0software was used to process the data of the two groups of patients.First,the indicators that may affect the stone removal rate after RIRS operation were analyzed by single factor analysis,and the independent sample T-test was used to analyze the measurement data conforming to the normal distribution.The rank sum test was used to analyze the measurement data that did not conform to the normal distribution,and the Chi-square test was used to analyze the count data.When p < 0.05,the difference was considered statistically significant.Then,the statistically significant data from the univariate analysis were substituted into the binary Logistic regression equation for multi-factor regression analysis.After processing the data,the index p < 0.05 was statistically significant,and independent factors affecting the postoperative stone removal rate were obtained.By comparing the correct diagnosis value of screening test,the prediction effect of five scoring systems on stone clearance rate was compared.Results:In the review one month after surgery,110 patients(65.10%)achieved stone clearance status,and 59 patients still had stone residue(34.90%).According to univariate analysis,patients underwent Extracorporeal shock wave lithotripsy(ESWL),antler calculus,inferioral calyx calculus,infundibulopelvic angle < 45°(infundibulopelvic angle,IPA),the number of the most widespread,stones,stones maximum diameter,involving the calyces number,the average CT value stones characteristic differences statistically significant(p = 0.025,respectively(p = 0.004,p < 0.001,p < 0.001,p < 0.001,p < 0.001,p < 0.001,p < 0.001,p <0.001).Multivariate binary Logistic regression analysis showed that IPA < 45°,maximum stone diameter,subrenal calygeal calculi and mean CT value of calculi were independent risk factors for stone removal after RIRS surgery.The modified RUSS,modified S.T.O.N.E,modified S-Re SC,T.O.HO,SHA.LIN Union scoring system was significantly correlated with the postoperative stone removal status of RIRS(p < 0.001).The correct diagnosis indexes of screening tests were 50.27%(modified RUSS),65.79%(modified S.T.O.N.E),48.88%(modified S-Re SC),74.67%(T.O.HO score)and 87.51%(SHA.LIN Union score),respectively.Conclusion:The stone removal rate after retrograde intrarenal surgery is influenced by many factors.The stone location in the lower calyx of the kidney,the maximum stone diameter,the average CT value of the stone and IPA < 45° are independent factors affecting the stone removal rate.The modified RUSS,modified S.T.O.N.E.,S-Re SC,T.O.HO,SHA.LIN Union scoring system was significantly correlated with postoperative stone removal status(p < 0.05),and all of them could predict postoperative stone removal status.The correct diagnosis index was obtained by screening test of the five scoring systems.Among them,the correct diagnosis index of SHA.LIN Union scoring system is the largest among the five scoring systems,which can better predict the status of stone removal after soft ureteroscopy before surgery,and it can be popularized to clinical application. |
PDF Full Text Request