Efficacy of Super-Mini-PCNL and Ureteroscopy in Kidney Stone Sufferers and Risk Factors of Postoperative Infection

Abstract

To investigate the efficacy of super-mini-PCNL (SMP) and ureteroscopy in kidney stone (KS) sufferers and learn the risk factors of postoperative infection. A retrospective analysis was performed on 180 KS sufferers who were diagnosed and treated in our hospital from May 2019 to May 2021. They were enrolled into an observation group (OG, n = 104) and a control group (CG, n = 76) based on different treatment methods. Therein, the former was treated with SMP, while the latter was treated with ureteroscopy. The operation time, blood loss, hospital stay, recent stone-free rate (one week after operation), changes of serum creatinine (SCr), blood urea nitrogen (BUN), and cystatin C (CysC) levels before and after operation and complications were compared. Those sufferers were assigned to infected and uninfected groups based on their postoperative infection. The risk factors were assessed through logistic regression, and the model formula was established. The predictive value of this model for infection was tested through RO. Compared with CG, the operation time of the OG was longer, the blood loss and hospital stay were lower P < 0.05 , and the stone-free rate was higher P < 0.05 . Renal function indexes before and after treatment P > 0.05 and postoperative complications revealed no significant difference P > 0.05 . Logistic regression analysis manifested that preoperative urinary tract infection (OR: 4.690, 95% CI: 1.170–18.802), preoperative blood glucose level (OR: 11.188, 95% CI: 2.106–59.442), positive urine culture (OR: 10.931, 95% CI: 2.453–48.705), and infectious stones (OR: 3.951, 95% CI: 1.020–15.300) were independently related to infection. The risk prediction equation is logit p = − 8.913 + 1.545 × X 1 + 2.415 × X 2 + 2.392 × X 3 + 1.374 × X 4 , with a goodness-of-fit value of 0.545. The AUC is 0.930, so SMP is superior to ureteroscopy in KS sufferers. Preoperative urinary tract infection, preoperative blood glucose level, positive urine culture, and infectious stones are independently related to infection.

Super-Mini Percutaneous Nephrolithotomy for Nephrolithiasis: A Systematic Review and Meta-Analysis

“…SFRs were from 60% to 90% when PCNL was miniaturized using ultra-mini PCNL (UMP), mini-perc, and micro-perc. Compared to previous minimally invasive PCNL investigations, the SMP group had a higher SFR [3,18,21]. Negative pressure suction is used to remove stone fragments during the SMP treatment, with the objective of leaving the patient stone-free at the end of the surgery [22,23].…”

“…We included two RCTs [7,12], one single-arm trial [5], and 11 cohort studies assessing SMP either alone or compared with different modalities [6,[8][9][10][11][13][14][15][16][17][18]. Table 1 and Table 2 exhibit the main summary and baseline characteristics of included studies.…”

“…Forest plot of the single-arm pooled analysis of operative time in patients who underwent super-mini percutaneous nephrolithotomy [5][6][7][8][9][10][11][12][13][14][15][16][17][18].…”

“…RR or MD 95% CI lower limit 95% CI upper limit Forest plot of the pooled analysis of operative time in patients who underwent SMP versus RIRS [7,15,17], mini-PCNL [8,9,11,13], ureteroscopy [14,18], and sPCNL [12]. SMP = super-mini percutaneous nephrolithotomy; mini-PCNL = mini-percutaneous nephrolithotomy; sPCNL = standard percutaneous nephrolithotomy; RIPS = retrograde intrarenal surgery; 95% CI = 95% confidence interval; IV = inverse variance…”

“…Recently, several studies were performed to compare the safety and efficacy of SMP with other mini-PCNL techniques [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Guddeti et al performed a randomized clinical trial (RCT) to evaluate the efficacy of SMP versus standard PCNL in the management of renal calculi (<2 cm).…”