| Objective: To compare the effects of different degrees of hydronephrosis on stone removal efficiency and stone-free rate of minimally invasive percutaneous nephrolithotomy.Method: The clinical data of 120 patients with renal calculi who underwent minimally invasive percutaneous nephrolithotomy in the Department of Urology,the first affiliated hospital of Fujian Medical University from October 2017 to September2019 were retrospectively analyzed.According to the degrees of hydronephrosis,they were divided into 4 groups: group Ⅰ without hydronephrosis,group Ⅱ with mild hydronephrosis,group Ⅲ with moderate hydronephrosis and group Ⅳ with severe hydronephrosis.The peri-operative indexes were collected,and the preoperative demographic and stone characteristics of the four groups were compared.The operation time,hospital stay,stone-free rate,puncture site,number of channels,hemoglobin reduction,postoperative infection and other complications in each group were analyzed.Univariate and multivariate analysis were used to analyze the risk factors affecting operation time and stone-free rate.Result: A total of 120 patients were included,including 74 males and 46 females,with an average age of 53 ±12.1 years(range from18 to 82 years).There were 39 patients in group Ⅰ with 18 males and 21 females,26 patients in group Ⅱ with 18 males and 8 females,34 patients in group Ⅲ with 22 males and 12 females,and 21 patients in group Ⅳ with 16 males and 5 females.There was no significant difference in gender,age,BMⅠ,history of hypertension,history of diabetes,history of open renal surgery,history of ESWL,blood urea nitrogen,hemoglobin and urine culture before operation in group Ⅰ-Ⅳ(P > 0.05).The level of serum creatinine in group Ⅲ-Ⅳ was significantly higher than that in group Ⅰ(P < 0.05).There was no significant difference in stone side,number of stones,number of renal calyx distribution,stone type,stone density and stone volume in group Ⅰ-Ⅳ(P > 0.05).Ⅰn Ⅰ-Ⅳ group,the S.T.O.N.E.score was(7.3±1.4,7.1±1.6,8.6±1.9,8.7±1.8)points,respectively.The S.T.O.N.E.score in Ⅲ and Ⅳ group was higher than that in group Ⅰ and Ⅱ(P < 0.05)(P < 0.01).Ⅰn group Ⅰ-Ⅳ,the operation time was(37.3±23.8,35.6±29.1,43.5±26.7,58.7±31.2)minutes,respectively,which group Ⅳ was significantly longer than that in group Ⅰ,Ⅱ and Ⅲ(P<0.01,P<0.01,P<0.05).The length of hospital stay was(6.3±2.2,6.0±1.1,6.8±2.3,7.8±3.3)days,respectively,which group Ⅳ was longer than that in Ⅰ and Ⅱ groups(P<0.05,P<0.01).The stone-free rate was(76.9%,84.6%,71.4%,42.9%),respectively.Compared with group Ⅰ,Ⅳ group has lower stone-free rate(P<0.05).The hemoglobin reduction was 16.1±9.2,16.7±11.1,19.8±13.1,24.7±8.8)g/L,respectively.The drop of hemoglobin in group Ⅳ was significantly higher than that in groups Ⅰ and Ⅱ.There was no significant difference in puncture site,number of channels and postoperative complications.Univariate analysis showed that the degrees of hydronephrosis,history of ESWL,number of stones,stone distribution,stone type,stone volume and number of channels were all correlated to operation time.Multiple linear regression analysis showed that the degrees of hydronephrosis,number of stones,stone distribution,stone type and stone volume were independent risk factors.Univariate analysis showed that there were significant differences in the degrees of hydronephrosis,number of stones,stone distribution,stone type,stone volume and number of channels between stone clearance group and residual stone group.Multiple logistic regression analysis showed that severe hydronephrosis number of stones,stone distribution,were the independent factors affecting the stone-free rate.Conclusion: Mild and moderate hydronephrosis does not affect the efficiency and stone-free rate of minimally invasive percutaneous nephrolithotomy.However,severe hydronephrosis has longer operation time,longer hospital stay,lower stone free rate and more blood loss.Therefore,severe hydronephrosis is an independent risk factor affecting the efficiency and stone-free rate of minimally invasive percutaneous nephrolithotomy. |
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