| Objective:Urinary calculi,especially the upper urinary calculi is one of the most common diseases and frequently occurring diseases in the urology system.Flexible ureteroscopy lithotripsy is a popularized operative method in recent years,and is applicable to the minimally invasive treatment of renal calculus and upper ureteral calculus.At present,there are many preoperative scoring systems for predicting the stone free rate of upper urinary calculi,but the scoring system designed for flexible ureteroscopic lithotripsy is less,and none of them can be recognized by most researchers.The purpose of this study is to investigate the factors influencing the stone free rate of flexible ureteroscopic lithotripsy,and to modify the scoring system suitable for predicting the stone free rate of flexible ureteroscopic lithotripsy,and verify its prediction effect.Methods:Retrospective analysis the cases that collecting according to the inclusion and discharge standards.A collection of 28indicators of age,gender,height,weight,calculi size,calculi diameter,calculi location,calculi hardness,staghorn calculi,hydronephrosis,preoperative serum creatinine,white blood cell of urine,the operation side,operation time,hospitalization time,postoperative complications.SPSS 23.0 software is used for data processing.First,the single factor analysis of all the indicators that may affect the stone free rate is carried out,the measurement data were showed with(x?s),and the independent sample t test was used,and P<0.05has statistical significance for differences;The difference between the stone free group and the residual group was detected by X~2 test,and P<0.05 has statistical significance for differences.Second,multi factor Logistic regression analysis was carried out for the significant factors of single factor analysis.P<0.05 has statistical significance for differences,and the factors affecting the stone free rate were obtained.According to the above results,the modified S.T.O.N.E.scoring system was obtained on the basis of the original S.T.O.N.E.scoring system.We used RUSS scoring system,original S.T.O.N.E.scoring system and modified S.T.O.N.E.scoring system to score 127 cases in our hospital,and drew the receiver operating characteristic(ROC)curve respectively,and evaluated the performance of the three scoring systems according to the area under curve(AUC).Results:According to the standard of case inclusion and discharge,a total of 127 cases were collected.Univariate analysis showed that the calculi diameter(P=0.004),inferior renal calyx calculi(P=0.018),the number of calculi(P<0.001),anatomic malformations(P=0.034),whether or not it is a staghorn calculi(P<0.001)and operation time(P=0.010)was associated with stone free rate,the difference was statistically significant.Multivariate Logistic regression analysis showed that calculi diameter(P=0.046),the number of calculi(P=0.038),and whether or not it is a staghorn calculi(P=0.048)were correlated with stone free rate,and the difference was statistically significant.The area under curve(AUC)of Receiver operating characteristic(ROC)curves for the modified S.T.O.N.E.scoring system was 0.811(95%CI 0.716-0.907).The area under curve(AUC)of Receiver operating characteristic(ROC)curves for the RUSS scoring system was 0.750(95%CI 0.648-0.852).The area under curve(AUC)of Receiver operating characteristic(ROC)curves for the original S.T.O.N.E.scoring system was 0.663(95%CI 0.551-0.775).There was no significant difference in the areas under the curves(AUC)for the modified S.T.O.N.E.scoring system and the RUSS scoring system(0.811(95%CI 0.716-0.907)and 0.750(95%CI0.648-0.852);P=0.393).There was significant difference in the areas under the curves(AUC)for the modified S.T.O.N.E.scoring system and the original S.T.O.N.E.scoring system(0.811(95%CI0.716-0.907)and 0.663(95%CI0.551-0.775);P=0.048).Conclusions:The stone free rate after operation in patients with the flexible ureteroscopic lithotripsy was influenced by many factors,including the diameter of calculis,the location of calculis,the number of calculis,the anatomic abnormalities,and whether the calculis are staghorn calculi,and the operation time.The area under curve(AUC)of Receiver operating characteristic(ROC)curves for the modified S.T.O.N.E.scoring system was the largest.The score comparison showed that the modified S.T.O.N.E.score was equivalent to the RUSS score in predicting the stone free rate after flexible ureteroscopic lithotripsy,but it was significantly better than the original S.T.O.N.E.scoring system. |
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