Clinical characteristics of infected stones and factors influencing the regression of renal function after endoscopic surgery
Wang Bixiao, Ji Chaoyue, Song Haifeng, Hu Weiguo, Xiao Bo, Li Jianxing
Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Tsinghua University Clinical Institute, Beijing 102218, China
Abstract：Objective: To assess the perioperative clinical characteristics of patients with the stone composition of struvite stone and the factors influencing the regression of renal function after endoscopic lithotripsy. Methods: A retrospective analysiswas performed on the clinical data of 1268 patients with postoperative urinary stones whose main stone composition was struvite stone or calcium oxalate,including 764 males and 504 females, admitted from March 2016 to January 2022. The age ranged from 1 to 89 years. According to the results of postoperative stone analysis, the patients were divided into the calcium oxalate stone group and struvite stone group. There were 869 cases in the calcium oxalate stone group, 614 males and 255 females, with a median age of [52（41,61）] years; 399 cases in the struvite stone group, 150 males and 249 females, with a median age of [50（37,59）] years. The differences between the two groups were compared. Forty-one patients with struvite stones showed a significant change inserum creatininelevels before and after operation, and were divided into the normal renal function group （normal before and after surgery）, renal function recovery group （abnormal before surgery and normal after surgery）, renal function impairment group （normal before surgeryand abnormal after surgery） and abnormal renal function group （abnormal before and after surgery） according to whether the creatinine level was abnormal before and after surgery. There were 276 cases in the normal renal function group, 21 cases in the renal function recovery group, 20 cases in the renal function impairment group, and 82 cases in the renal function abnormality group, and the differences in each clinical parameter between the groups were compared. Results: There were no statistically significant differences in the history of diabetes mellitus, history of urinary tract abnormalities, and preoperative creatinine level between the struvite stone group and calcium oxalate stone group （P>0.05）.The differences in age, body mass index （BMI）, gender, history of previous stones, whether they were antler-shaped stones, the proportion of preoperative creatinine abnormalities, preoperative glomerularfiltrationrate（GFR） the proportion of preoperative fever and positive urine culture cases, differences in perioperative creatinine changes, proportion of abnormal postoperative creatinine, duration of surgery and postoperative hospital stay were significanbetween two groups （P<0.05）. Among the patients with struvite stones, there was a statistically significant difference in the proportion of previous stone history between the normal renal function group and the impaired renal function group （P=0.023）, while the differences in the remaining parameters, including age, BMI, gender, history of diabetes mellitus, history of previous urinary tract abnormalities, maximum straightness of stones, whether they were deerstalker-shaped stones, preoperative fever, preoperative urine culture results, surgical procedure, and mean operative time, were not statistically significant （P>0.05）. Further analysis of patients with preoperative struvite stones with abnormal renal function revealed that there was a significant difference in the maximum diameter of stones between the renal function recovery group and the abnormal renal function group （P=0.001）, while the remaining parameters showed no statistically significant differences （P>0.05）. Conclusion: Female patients with a previous history of stones are more likely to develop struvite stones, which are more likely to be deerstalker-shaped stones compared with calcium oxalate stones. The group of patients with struvite stones is more likely to have preoperative renal impairment, fever, and positive urine culture, and may have longer operative and postoperative hospital stays, as well as more likely to have postoperative renal function abnormalities. Recurrence and stone size are clinical factors that may be used to predict creatinine regression in patients with struvite stones.
王碧霄, 姬超岳, 宋海峰, 胡卫国, 肖博, 李晋庭, 梁磊, 李建兴. 鸟粪石的临床特点和内镜术后肾功能转归的影响因素分析[J]. 微创泌尿外科杂志, 2022, 11(3): 171-177.
Wang Bixiao, Ji Chaoyue, Song Haifeng, Hu Weiguo, Xiao Bo, Li Jianxing. Clinical characteristics of infected stones and factors influencing the regression of renal function after endoscopic surgery. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2022, 11(3): 171-177.
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