Outcomes of more than 1 000 percutaneous nephrolithotomies and validation of Guy's stone score.

Autor: de Souza Melo PA; Division of Urology, Men's Health Centre, Hospital Brigadeiro, Sao Paulo, SP, Brazil., Vicentini FC; Division of Urology, Men's Health Centre, Hospital Brigadeiro, Sao Paulo, SP, Brazil., Beraldi AA; Division of Urology, Men's Health Centre, Hospital Brigadeiro, Sao Paulo, SP, Brazil., Hisano M; Division of Urology, Men's Health Centre, Hospital Brigadeiro, Sao Paulo, SP, Brazil., Murta CB; Division of Urology, Men's Health Centre, Hospital Brigadeiro, Sao Paulo, SP, Brazil., de Almeida Claro JF; Division of Urology, Men's Health Centre, Hospital Brigadeiro, Sao Paulo, SP, Brazil.
Jazyk: angličtina
Zdroj: BJU international [BJU Int] 2018 Apr; Vol. 121 (4), pp. 640-646. Date of Electronic Publication: 2018 Feb 01.
DOI: 10.1111/bju.14129
Abstrakt: Objective: To present the experience with percutaneous nephrolithotomy (PCNL) at a high-volume Brazilian centre and to evaluate Guy's stone score (GSS) as a predictor of success and complications in PCNL.
Patients and Methods: We prospectively evaluated patients who underwent PCNL between June 2011 and October 2016. Indications for PCNL included renal stones >2 cm in size and stones <2 cm in size in which first-line techniques had failed. All patients underwent a complete preoperative evaluation, including non-contrast-enhanced abdominal computed tomography (CT). Stone complexity was assessed using GSS. Success was defined as the absence of fragments >2 mm on CT on postoperative day 1. Complications were classified according to the Clavien grade.
Results: A total of 1 066 PCNLs were performed on 891 patients. In all, 20.2% were classified as GSS1, 27.4% as GSS2, 35.0% as GSS3, and 17.4% as GSS4. The mean operating time was 108.44 min, and the mean fluoroscopy time was 13.57 min. The overall immediate success rate based on postoperative day 1 CT was 43.8%. Complications occurred in 14.9% of cases, and the mean length of hospital stay was 54.55 h. Stratifying patients according to GSS, success rate was inversely proportional to the calculus complexity: GSS1: 87.9%; GSS2: 62.1%; GSS3: 44.0%; and GSS4: 24.3% (P < 0.001). Higher GSS categories were significantly correlated with the number of puncture tracts (P < 0.001), operating time (P < 0.001), fluoroscopy time (P < 0.001), blood transfusion rate (P < 0.001), complications (P < 0.001) and length of stay (P < 0.001).
Conclusion: In a high-volume centre, PCNL was a reliable surgical technique, with low morbidity and short hospital stay. GSS was confirmed to be a very useful tool for predicting the outcomes of PCNL, and its use should be encouraged.
(© 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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