Analysis of risk factors of stone escape in elderly patients with upper urinary tract stones treated with flexible ureteroscope lithotripsy / 国际外科学杂志

ABSTRACT

Objective:To analyze the risk factors of the elderly patients with upper urinary tract stones treated by flexible ureteroscope lithotripsy affect the patients′ stone escape.Methods:A retrospective study of 160 patients with upper urinary tract calculi admitted to Baise People′s Hospital from January 2015 to January 2021, all patients were treated with flexible ureteroscopic lithotripsy, and they were 60-85 years old. According to whether the patients had escaped stones, the patients were divided into stone escape group ( n=53) and stone non-escape group ( n=107). Chi-square test was used for comparison of count data between groups. Multivariate Logistic regression analysis was used to analyze the independent risk factors for stone escape in patients; Use R3.3.2 software and software package rms to build a nomogram prediction model; receiver operating characteristic curve (ROC) was used to evaluate the discrimination of the nomogram model in predicting patients with stone escape, and the results were expressed as the area under the curve (AUC) and the 95% confidence interval (95% CI) of the area. Results:Flexible ureteroscope lithotripsy for the treatment of elderly patients with upper urinary tract stones has been found to have good efficacy, low risk of bleeding and fewer complications. In univariate analysis, compared with the stone not-escape group, in the stone escape group, the proportion of patients with mild or moderate preoperative hydronephrosis, the ureteral tube occluder was not used during the operation, intraoperative pump injection pressure of 0.9% sodium chloride injection >200 mmHg, number of stones >1, the location of the stones in the upper and lower calyces of the kidney were significantly increased ( P<0.05). Multivariate Logistic regression analysis found that the preoperative hydronephrosis was mild or moderate, the ureteral tube occluder was not used during the operation, and the intraoperative pump injection pressure of 0.9% sodium chloride injection >200 mmHg were independent risk factors for stone escape in patients. The consistency index (C-index) of the nomogram prediction model and the AUC of the ROC were 0.804 (95% CI 0.746-0.862) and 0.821 (95% CI 0.763-0.879), respectively, indicating that the model has good discrimination. Conclusion:Mild or moderate preoperative hydronephrosis, no ureteral tube occluder during operation, and intraoperative pump injection pressure of 0.9% sodium chloride injection >200 mmHg are all risk factors for stone escape in patients.