Abstract：
Objective: To investigate the association between psoas muscle mass (PMM) and failure of ureteral access sheath (UAS) insertion and complications from retrograde intrarenal surgery (RIRS). Materials and Methods: A multicenter retrospective case-control study was conducted that included patients who underwent RIRS despite failure of UAS insertion (Cohort 1) and confounder-matched control patients who underwent RIRS after successful UAS insertion (Cohort 2). For morphometric analysis of PMM, ipsilateral psoas muscle areas (iPMAs) were measured using the coreslicer.com webkit. After comparing demographic, clinical, and complication rates and iPMAs between cohorts, gender-specific median iPMAs were also determined to further subdivide patients in each cohort as either low iPMAs or high iPMAs. Thereafter, patients were also compared in terms of RIRS complications. Results: Cohort 1 included 86 patients whereas Cohort 2 consisted of 124 matched cases. The median (interquartile range) iPMAs were similar between the cohorts: Cohort 1, 11.05 (6.82-14.44) cm2 versus 11.12 (6.97-13.69) cm2 for Cohort 2 (P ˃ .05). There was a significant inverse relationship between iPMAs with age (r = -0.222) and Charlson comorbidity index (r = -0.180) for all patients (P ˂ .05). Perioperative and postoperative complication rates were 8.1% and 16.3% for Cohort 1 and 6.5% and 21% for Cohort 2, respectively. The complication rates were not statistically different between patients with high iPMAs and those with low iPMAs, in male or female patients (P > .05). Conclusions: These results show that failure of UAS was not associated with PMM. Furthermore, since the complication rates were similar between patients with high PMM and low PMM, RIRS may be a reliable treatment choice for sarcopenic patients as well as in nonsarcopenic patients.
摘要：
目的：探讨腰大肌质量（PMM）与输尿管入路鞘管（UAS）插入失败以及逆行肾内手术（RIRS）并发症之间的关系。材料和方法：进行了一项多中心回顾性病例对照研究，其中包括尽管UAS插入失败但仍接受RIRS的患者（队列1）和在成功插入UAS后接受RIRS的混杂匹配对照患者（队列2）。对于PMM的形态分析，使用coreslicer.comwebkit测量同侧腰大肌面积（iPMA）。在比较人口统计后，临床,以及队列之间的并发症发生率和iPMA，还确定了性别特异性iPMA中位数,以进一步将每个队列中的患者细分为低iPMA或高iPMA.此后,还比较了患者的RIRS并发症.结果：队列1包括86例患者，而队列2包括124例匹配病例。队列之间的中位数（四分位数范围）iPMA相似：队列1，11.05（6.82-14.44）cm2与队列2的11.12（6.97-13.69）cm2（P^0.05）。所有患者的iPMA与年龄（r=-0.222）和Charlson合并症指数（r=-0.180）之间存在显着负相关（P＜0.05）。队列1的围手术期和术后并发症发生率分别为8.1％和16.3％，队列2的并发症发生率分别为6.5％和21％。高iPMA患者和低iPMA患者的并发症发生率无统计学差异。男性或女性患者（P>0.05）。结论：这些结果表明，UAS的失败与PMM无关。此外，由于高PMM和低PMM患者的并发症发生率相似，RIRS可能是少肌症患者和非少肌症患者的可靠治疗选择。
