{"title":"经皮肾镜取石术中仰卧位与俯卧位术后泌尿系统感染率的比较。","authors":"Nattanachoti Batratanakij, Chatchawet Liwrotsap, Teerayut Tangpaitoon","doi":"10.5152/tud.2025.25024","DOIUrl":null,"url":null,"abstract":"<p><p>Objective: Urological infection is a significant complication following percutaneous nephrolithotomy (PCNL), which can be performed in supine or prone positions, but its impact on infection rates remains debated. This study compares postoperative uro- logical infection rates between supine and prone PCNL and identifies associated risk factors. Methods: A retrospective study was conducted on 290 patients who underwent PCNL between January 2014 and August 2023 in the Thammasat University Hospital. Patients were allocated into 2 groups in a 1 : 2 ratio, with 87 patients in the supine group and 203 patients in the prone group. Statistical analysis included t-tests, Mann-Whitney U tests, Fisher's exact test, and logistic regression models. Results: Postoperative infection rates were significantly lower in the supine group, including fever (33.3% vs. 62.1%, P < .001), UTI (11.5% vs. 32.5%, P < .001), and sepsis (6.9% vs. 17.2%, P = .021). Multivariable analysis identified positive preoperative urine culture (RR 4.41, P < .001) and prone positioning (RR 4.38, P = 0.004) as independent risk factors. The operative time was significantly shorter in the supine group (103.9 ± 42.6 vs. 116.3 ± 38.9 min, P = .016). Stone-free rates and blood loss were comparable, whereas pleural complications were higher in the prone group (6.4% vs. 0%, P = .016). Conclusion: Supine PCNL is associated with significantly lower postoperative infec- tion rates, shorter operative times, and reduced pleural complications compared to the prone position. These findings support supine PCNL as a safer and equally effective alternative management for renal calculi.</p>","PeriodicalId":101337,"journal":{"name":"Urology research & practice","volume":"51 1","pages":"22-26"},"PeriodicalIF":0.0000,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128313/pdf/","citationCount":"0","resultStr":"{\"title\":\"A Comparison of Postoperative Urological Infection Rates Between Supine and Prone Positions During Percutaneous Nephrolithotomy.\",\"authors\":\"Nattanachoti Batratanakij, Chatchawet Liwrotsap, Teerayut Tangpaitoon\",\"doi\":\"10.5152/tud.2025.25024\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Objective: Urological infection is a significant complication following percutaneous nephrolithotomy (PCNL), which can be performed in supine or prone positions, but its impact on infection rates remains debated. This study compares postoperative uro- logical infection rates between supine and prone PCNL and identifies associated risk factors. Methods: A retrospective study was conducted on 290 patients who underwent PCNL between January 2014 and August 2023 in the Thammasat University Hospital. Patients were allocated into 2 groups in a 1 : 2 ratio, with 87 patients in the supine group and 203 patients in the prone group. Statistical analysis included t-tests, Mann-Whitney U tests, Fisher's exact test, and logistic regression models. Results: Postoperative infection rates were significantly lower in the supine group, including fever (33.3% vs. 62.1%, P < .001), UTI (11.5% vs. 32.5%, P < .001), and sepsis (6.9% vs. 17.2%, P = .021). Multivariable analysis identified positive preoperative urine culture (RR 4.41, P < .001) and prone positioning (RR 4.38, P = 0.004) as independent risk factors. The operative time was significantly shorter in the supine group (103.9 ± 42.6 vs. 116.3 ± 38.9 min, P = .016). Stone-free rates and blood loss were comparable, whereas pleural complications were higher in the prone group (6.4% vs. 0%, P = .016). Conclusion: Supine PCNL is associated with significantly lower postoperative infec- tion rates, shorter operative times, and reduced pleural complications compared to the prone position. These findings support supine PCNL as a safer and equally effective alternative management for renal calculi.</p>\",\"PeriodicalId\":101337,\"journal\":{\"name\":\"Urology research & practice\",\"volume\":\"51 1\",\"pages\":\"22-26\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-05-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128313/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Urology research & practice\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.5152/tud.2025.25024\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"0\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Urology research & practice","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5152/tud.2025.25024","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"0","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的:泌尿系统感染是经皮肾镜取石术(PCNL)的重要并发症,PCNL可采用仰卧位或俯卧位进行,但其对感染率的影响仍存在争议。本研究比较了仰卧位和俯卧位PCNL术后泌尿系统感染率,并确定了相关的危险因素。方法:对2014年1月至2023年8月在法政大学医院行PCNL的290例患者进行回顾性研究。将患者按1:2的比例分为2组,仰卧位组87例,俯卧位组203例。统计分析包括t检验、Mann-Whitney U检验、Fisher精确检验和logistic回归模型。结果:仰卧位组术后感染率明显降低,包括发热(33.3%∶62.1%,P < 0.001)、尿路感染(11.5%∶32.5%,P < 0.001)、脓毒症(6.9%∶17.2%,P = 0.021)。多变量分析发现术前尿培养阳性(RR 4.41, P < .001)和俯卧位(RR 4.38, P = 0.004)是独立危险因素。仰卧位组手术时间明显短于仰卧位组(103.9±42.6 vs 116.3±38.9 min, P = 0.016)。无结石率和失血量相当,而易感组的胸膜并发症更高(6.4%比0%,P = 0.016)。结论:与俯卧位相比,仰卧位PCNL术后感染率低,手术时间短,胸膜并发症少。这些发现支持仰卧PCNL作为一种更安全、同样有效的治疗肾结石的替代方法。
A Comparison of Postoperative Urological Infection Rates Between Supine and Prone Positions During Percutaneous Nephrolithotomy.
Objective: Urological infection is a significant complication following percutaneous nephrolithotomy (PCNL), which can be performed in supine or prone positions, but its impact on infection rates remains debated. This study compares postoperative uro- logical infection rates between supine and prone PCNL and identifies associated risk factors. Methods: A retrospective study was conducted on 290 patients who underwent PCNL between January 2014 and August 2023 in the Thammasat University Hospital. Patients were allocated into 2 groups in a 1 : 2 ratio, with 87 patients in the supine group and 203 patients in the prone group. Statistical analysis included t-tests, Mann-Whitney U tests, Fisher's exact test, and logistic regression models. Results: Postoperative infection rates were significantly lower in the supine group, including fever (33.3% vs. 62.1%, P < .001), UTI (11.5% vs. 32.5%, P < .001), and sepsis (6.9% vs. 17.2%, P = .021). Multivariable analysis identified positive preoperative urine culture (RR 4.41, P < .001) and prone positioning (RR 4.38, P = 0.004) as independent risk factors. The operative time was significantly shorter in the supine group (103.9 ± 42.6 vs. 116.3 ± 38.9 min, P = .016). Stone-free rates and blood loss were comparable, whereas pleural complications were higher in the prone group (6.4% vs. 0%, P = .016). Conclusion: Supine PCNL is associated with significantly lower postoperative infec- tion rates, shorter operative times, and reduced pleural complications compared to the prone position. These findings support supine PCNL as a safer and equally effective alternative management for renal calculi.