Effect of access sheath diameter used in percutaneous nephrolithotomy on renal function: a prospective randomized study.

IF 2 2区医学 Q2 UROLOGY & NEPHROLOGY

Urolithiasis Pub Date : 2024-06-26 DOI:10.1007/s00240-024-01582-3

Deniz Noyan Özlü, Mithat Ekşi, Selçuk Şahin, Alev Kural, Murat Sipahi, Taner Kargı, Alper Bitkin, Ali İhsan Taşçı

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Abstract

We aimed to determine the effect of the access sheath diameter used in percutaneous nephrolithotomy (PNL) on renal function. We also investigated the predictors of impaired renal function. Data were prospectively collected from patients who underwent PNL from December 2020 to December 2021. The patients were randomized into two groups according to access sheath diameter: Group 1 (22 Fr, n = 44) and Group 2 (28 Fr, n = 44). Relative renal function (RRF) was calculated by technetium-99 m dimercaptosuccinic acid scintigraphy, and glomerular filtration rate (GFR) was calculated by diethylenetriamine pentaacetic acid scintigraphy. A difference of 5% or more in RRF was considered a significant functional change. Preoperative and postoperative Kidney Injury Molecule-1 (KIM-1) levels were measured. Preoperative demographic data and stone characteristics were similar between the groups. There were also no statistically significant differences between the groups in terms of scar development, changes in RRF, GFR, or KIM-1/creatinine (Cr) (p > 0.05). Significant deterioration in RRF was detected in a total of six (6.8%) patients, three in each group. The factors predicting loss of function were analyzed by regrouping the patients without loss of function as Group A (n = 82) and those with loss as Group B (n = 6). Only stone volume was statistically significant in multivariate analysis (p = 0.002). Access sheath diameter had no significant effect on renal function after PNL. However, the stone volume was found to independently correlate to a loss of renal function after PNL.

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经皮肾镜碎石术所用入路鞘直径对肾功能的影响：一项前瞻性随机研究。

我们旨在确定经皮肾镜碎石术（PNL）中使用的入路鞘直径对肾功能的影响。我们还调查了肾功能受损的预测因素。我们对 2020 年 12 月至 2021 年 12 月期间接受经皮肾镜取石术的患者进行了前瞻性数据收集。根据入路鞘直径将患者随机分为两组：第一组（22 Fr，n = 44）和第二组（28 Fr，n = 44）。相对肾功能（RRF）通过锝-99 m二巯基丁二酸闪烁扫描计算，肾小球滤过率（GFR）通过二乙烯三胺五乙酸闪烁扫描计算。RRF相差5%或更多被认为是显著的功能变化。测量术前和术后肾损伤分子-1（KIM-1）水平。两组患者术前的人口统计学数据和结石特征相似。在疤痕发展、RRF、GFR 或 KIM-1/creatinine (Cr) 变化方面，各组之间也没有统计学意义上的显著差异（P > 0.05）。共有六名（6.8%）患者的 RRF 出现明显恶化，每组三名。将未丧失功能的患者重新分组为 A 组（82 人），将丧失功能的患者重新分组为 B 组（6 人），对预测功能丧失的因素进行了分析。在多变量分析中，只有结石体积具有统计学意义（P = 0.002）。入路鞘直径对 PNL 后的肾功能没有明显影响。但是，结石体积与 PNL 后肾功能丧失有独立相关性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Urolithiasis UROLOGY & NEPHROLOGY-

CiteScore

4.50

自引率

6.50%

发文量

期刊介绍： Official Journal of the International Urolithiasis Society The journal aims to publish original articles in the fields of clinical and experimental investigation only within the sphere of urolithiasis and its related areas of research. The journal covers all aspects of urolithiasis research including the diagnosis, epidemiology, pathogenesis, genetics, clinical biochemistry, open and non-invasive surgical intervention, nephrological investigation, chemistry and prophylaxis of the disorder. The Editor welcomes contributions on topics of interest to urologists, nephrologists, radiologists, clinical biochemists, epidemiologists, nutritionists, basic scientists and nurses working in that field. Contributions may be submitted as full-length articles or as rapid communications in the form of Letters to the Editor. Articles should be original and should contain important new findings from carefully conducted studies designed to produce statistically significant data. Please note that we no longer publish articles classified as Case Reports. Editorials and review articles may be published by invitation from the Editorial Board. All submissions are peer-reviewed. Through an electronic system for the submission and review of manuscripts, the Editor and Associate Editors aim to make publication accessible as quickly as possible to a large number of readers throughout the world.