Ruiyu Yue, Shao Zhang, Kahriman Islam, Jesur Batur, Youquan Zhao, Xiaochuan Wang, Jun Li
{"title":"微创PCNL治疗维吾尔族和汉族儿童上尿路结石的疗效、安全性及复发预测","authors":"Ruiyu Yue, Shao Zhang, Kahriman Islam, Jesur Batur, Youquan Zhao, Xiaochuan Wang, Jun Li","doi":"10.1159/000548385","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the efficacy, safety, and recurrence risk of minimally invasive percutaneous nephrolithotomy (PCNL) in Uyghur and Han pediatric patients with upper urinary tract calculi and develops predictive models with nomograms for postoperative recurrence.</p><p><strong>Methods: </strong>Clinical data from 231 children (159 Uyghur, 72 Han) treated with Mini-PCNL or Microperc between June 2019 and June 2024 were retrospectively reviewed. Recurrence-free survival was analyzed using Kaplan-Meier estimates. Cox regression was applied to construct two models: Model 1 (Outpatient Clinical Predictive Model, OCPM) based on clinical variables, and Model 2 (Comprehensive Inpatient Predictive Model, CIPM) incorporating imaging and urine culture. Nomograms were established, and model performance was assessed using time-dependent ROC curves, calibration curves, and 10-fold cross-validation. Clinical utility was evaluated by decision curve analysis (DCA) and clinical impact curves (CIC).</p><p><strong>Results: </strong>Stone-free and complication rates were comparable between groups, but Uyghur children had a higher recurrence rate (25.2% vs. 13.9%, HR = 2.31, 95% CI: 1.30-4.10). Model 1 (OCPM, age, ethnicity, urine pH, serum creatinine) showed good discrimination for outpatient screening (AUC 0.79-0.85), while Model 2 (CIPM, adding stone size, laterality, multiplicity, and hydronephrosis) achieved superior accuracy (AUC > 0.90) and calibration at higher-risk levels.</p><p><strong>Conclusion: </strong>PCNL is effective and safe in both ethnic groups, but Uyghur patients have a higher recurrence risk. The predictive models provide valuable tools for optimizing postoperative management and follow-up strategies.</p>","PeriodicalId":23414,"journal":{"name":"Urologia Internationalis","volume":" ","pages":"1-21"},"PeriodicalIF":1.3000,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy, Safety, and Recurrence Prediction of Minimally Invasive PCNL in Uygur and Han Pediatric Patients with Upper Urinary Tract Calculi.\",\"authors\":\"Ruiyu Yue, Shao Zhang, Kahriman Islam, Jesur Batur, Youquan Zhao, Xiaochuan Wang, Jun Li\",\"doi\":\"10.1159/000548385\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To evaluate the efficacy, safety, and recurrence risk of minimally invasive percutaneous nephrolithotomy (PCNL) in Uyghur and Han pediatric patients with upper urinary tract calculi and develops predictive models with nomograms for postoperative recurrence.</p><p><strong>Methods: </strong>Clinical data from 231 children (159 Uyghur, 72 Han) treated with Mini-PCNL or Microperc between June 2019 and June 2024 were retrospectively reviewed. Recurrence-free survival was analyzed using Kaplan-Meier estimates. Cox regression was applied to construct two models: Model 1 (Outpatient Clinical Predictive Model, OCPM) based on clinical variables, and Model 2 (Comprehensive Inpatient Predictive Model, CIPM) incorporating imaging and urine culture. Nomograms were established, and model performance was assessed using time-dependent ROC curves, calibration curves, and 10-fold cross-validation. Clinical utility was evaluated by decision curve analysis (DCA) and clinical impact curves (CIC).</p><p><strong>Results: </strong>Stone-free and complication rates were comparable between groups, but Uyghur children had a higher recurrence rate (25.2% vs. 13.9%, HR = 2.31, 95% CI: 1.30-4.10). Model 1 (OCPM, age, ethnicity, urine pH, serum creatinine) showed good discrimination for outpatient screening (AUC 0.79-0.85), while Model 2 (CIPM, adding stone size, laterality, multiplicity, and hydronephrosis) achieved superior accuracy (AUC > 0.90) and calibration at higher-risk levels.</p><p><strong>Conclusion: </strong>PCNL is effective and safe in both ethnic groups, but Uyghur patients have a higher recurrence risk. The predictive models provide valuable tools for optimizing postoperative management and follow-up strategies.</p>\",\"PeriodicalId\":23414,\"journal\":{\"name\":\"Urologia Internationalis\",\"volume\":\" \",\"pages\":\"1-21\"},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2025-09-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Urologia Internationalis\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1159/000548385\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Urologia Internationalis","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000548385","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Efficacy, Safety, and Recurrence Prediction of Minimally Invasive PCNL in Uygur and Han Pediatric Patients with Upper Urinary Tract Calculi.
Objectives: To evaluate the efficacy, safety, and recurrence risk of minimally invasive percutaneous nephrolithotomy (PCNL) in Uyghur and Han pediatric patients with upper urinary tract calculi and develops predictive models with nomograms for postoperative recurrence.
Methods: Clinical data from 231 children (159 Uyghur, 72 Han) treated with Mini-PCNL or Microperc between June 2019 and June 2024 were retrospectively reviewed. Recurrence-free survival was analyzed using Kaplan-Meier estimates. Cox regression was applied to construct two models: Model 1 (Outpatient Clinical Predictive Model, OCPM) based on clinical variables, and Model 2 (Comprehensive Inpatient Predictive Model, CIPM) incorporating imaging and urine culture. Nomograms were established, and model performance was assessed using time-dependent ROC curves, calibration curves, and 10-fold cross-validation. Clinical utility was evaluated by decision curve analysis (DCA) and clinical impact curves (CIC).
Results: Stone-free and complication rates were comparable between groups, but Uyghur children had a higher recurrence rate (25.2% vs. 13.9%, HR = 2.31, 95% CI: 1.30-4.10). Model 1 (OCPM, age, ethnicity, urine pH, serum creatinine) showed good discrimination for outpatient screening (AUC 0.79-0.85), while Model 2 (CIPM, adding stone size, laterality, multiplicity, and hydronephrosis) achieved superior accuracy (AUC > 0.90) and calibration at higher-risk levels.
Conclusion: PCNL is effective and safe in both ethnic groups, but Uyghur patients have a higher recurrence risk. The predictive models provide valuable tools for optimizing postoperative management and follow-up strategies.
期刊介绍:
Concise but fully substantiated international reports of clinically oriented research into science and current management of urogenital disorders form the nucleus of original as well as basic research papers. These are supplemented by up-to-date reviews by international experts on the state-of-the-art of key topics of clinical urological practice. Essential topics receiving regular coverage include the introduction of new techniques and instrumentation as well as the evaluation of new functional tests and diagnostic methods. Special attention is given to advances in surgical techniques and clinical oncology. The regular publication of selected case reports represents the great variation in urological disease and illustrates treatment solutions in singular cases.