Is multiple tract percutaneous nephrolithotomy a safe approach for staghorn calculi?
Purpose To explore the safety of multiple tract percutaneous nephrolithotomy (PNL) in terms of complication and draw a nomogram to predict the possibility of significant renal function decline (SRFD). Materials and methods Patients with complex renal calculi appropriate for PNL at our institution be...
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Published in | World journal of urology Vol. 39; no. 6; pp. 2121 - 2127 |
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Main Authors | , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Berlin/Heidelberg
Springer Berlin Heidelberg
01.06.2021
Springer Nature B.V |
Subjects | |
Online Access | Get full text |
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Summary: | Purpose
To explore the safety of multiple tract percutaneous nephrolithotomy (PNL) in terms of complication and draw a nomogram to predict the possibility of significant renal function decline (SRFD).
Materials and methods
Patients with complex renal calculi appropriate for PNL at our institution between August 2016 and February 2018 were included in the study. The outcome of single and multiple tract PNL was analyzed retrospectively. A nomogram was created to predict the probability of SRFD.
Results
793 (88.4%) patients were treated with single tract PNL (Group 1) and 104 patients (11.6%) treated with multiple tract PNL (Group 2). Group 2 had a significantly greater hemoglobin reduction (16.0 ± 12.5 vs. 11.4 ± 11.8 g/L,
p
< 0.001), higher rate of postoperative fever (19.2% vs. 11.9%,
p
= 0.034) and longer duration of the operation (110.6 ± 39.6 vs. 97.8 ± 34.5 min,
p
< 0.001). A nomogram for predicting the probability of SRFD was constructed based on identified risk factors: patients’ age, positive urine culture (UC +), hemoglobin reduction and embolization. The area of receiver operating characteristic (ROC) curve was 70%. Bootstrapping technique utilized to make the calibration plot showed a high reliability of the nomogram.
Conclusions
Multiple tract PNL had a higher risk of hemoglobin reduction and postoperative fever than single tract PNL. Multiple tracts had no effect on SRFD, but old age, UC + , hemoglobin reduction and embolization were risk factors for SRFD. A nomogram with the aim of predicting the probability of SRFD based on these parameters demonstrated good uniformity in internal validation. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0724-4983 1433-8726 1433-8726 |
DOI: | 10.1007/s00345-020-03420-8 |