Hydrostatic pressure of the renal pelvis as a radiation-free alternative to fluoroscopic nephrostogram following percutaneous nephrolithotomy.

Autor: Dreger NM; Department of Urology, Helios University Hospital Wuppertal, Witten/Herdecke University, Heusnerstrasse 40, 42283, Wuppertal, Germany., Stapelmann D; Department of Urology, Helios University Hospital Wuppertal, Witten/Herdecke University, Heusnerstrasse 40, 42283, Wuppertal, Germany.; Department of Radiology, St. Franziskus-Hospital Münster, 48145, Münster, Germany., Rebacz P; Didactics and Educational Research in Healthcare, Department of Medicine, Faculty of Health, Witten/Herdecke University, 58455, Witten, Germany., Roth S; Department of Urology, Helios University Hospital Wuppertal, Witten/Herdecke University, Heusnerstrasse 40, 42283, Wuppertal, Germany., Brandt AS; Department of Urology, Helios University Hospital Wuppertal, Witten/Herdecke University, Heusnerstrasse 40, 42283, Wuppertal, Germany.; Urologisches Zentrum Euregio, Humboldtstrasse 1, 52152, Simmerath, Germany., von Rundstedt FC; Department of Urology, Helios University Hospital Wuppertal, Witten/Herdecke University, Heusnerstrasse 40, 42283, Wuppertal, Germany., Degener S; Department of Urology, Helios University Hospital Wuppertal, Witten/Herdecke University, Heusnerstrasse 40, 42283, Wuppertal, Germany. stephan.degener@helios-gesundheit.de.
Jazyk: angličtina
Zdroj: BMC urology [BMC Urol] 2023 Mar 28; Vol. 23 (1), pp. 46. Date of Electronic Publication: 2023 Mar 28.
DOI: 10.1186/s12894-023-01225-6
Abstrakt: Background: We evaluated the hydrostatic pressure of the renal pelvis (RPP) as a radiation-free alternative to fluoroscopic nephrostogram to assess ureteral patency after percutaneous nephrolithotomy (PCNL).
Methods: Retrospective non-inferiority study analyzing 248 PCNL-patients (86 female (35%) and 162 males (65%)) between 2007 and 2015. Postoperatively, RPP was measured using a central venous pressure manometer in cmH 2 O. The primary endpoint was to assess RPP depending on the patency of the ureter and the nephrostomy tube removal. Secondary, the upper limit of normal RPP of [Formula: see text] 20 cmH 2 O was assessed as an indicator of an unobstructed patency.
Results: The median procedure duration was 141 min (112-171.5) with a stone free rate of 82% (n = 202). RPP was significantly higher in patients with obstructive nephrostogram with 25.0 mmH 2 O (21.0-32.0) versus 20.0 mmH 2 O (16.0-24.0; p < 0.001). The pressure was lower in successful nephrostomy removal with 18 cmH 2 O (15-21) versus 23 cmH 2 O (20-29) in the leakage group (p < 0.001). The analysis of a cut-off of [Formula: see text] 20 cmH 2 O showed a sensitivity of 76.9% (95% CI [60.7%; 88.9%]) and a specificity of 61.5% (95% CI [54.6%; 68.2%]). The negative predictive value was 93.4% (95% CI: [87.9%; 97.0%]) and the positive predictive value 27.3% (95% CI [19.2%; 36.6%]). The accuracy of the model showed an AUC = 0.795 (95% CI [0.668; 0.862]).
Conclusion: The hydrostatic RPP seems to allow a bedside evaluation of ureteral patency after PCNL.
(© 2023. The Author(s).)
Databáze: MEDLINE
Externí odkaz: