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Abstract：
BACKGROUND: Yucatan stands out as the state with the highest prevalence of urolithiasis in Mexico, placing significant demands on healthcare services, such as consultation and surgical intervention. Staghorn calculi are related to recurrent urinary tract infections, and their management is always surgical. The stone-free rate is a parameter used to measure the success of surgery, with residual stones considered those persisting four weeks after surgical management. There are understudied prognostic factors that can predict the success of achieving stone-free status, taking into account the number of stones, their location, and the anatomical variations of the patient\'s collecting system. The study aims to determine the prognostic factors for residual lithiasis in patients with staghorn calculi treated with percutaneous nephrolithotomy at the High Specialty Regional Hospital of the Yucatan Peninsula.
METHODS: A case-control study was performed including 188 patients, aged 18 years or older, and diagnosed with staghorn calculus from January 2022 to June 2023, grouping the patients according to their stone-free rate evidence on postoperative computed tomography. Data were collected from the records of the Urology Department at a high-specialty hospital in Yucatan. The groups were analyzed, aiming to establish an association between preoperative factors and postoperative outcomes measured in terms of stone-free rate.
RESULTS: A total of 188 patients with staghorn calculi were included, with a predominance in females (58.5%) and a mean age of 45.4 ± 11.9 years. The most common comorbidity was hypertension (29.8%), and 27.7% had a history of recurrent urinary tract infections. Regarding the Sampaio classification, B1 was the most prevalent in our population with 66 cases (35.1%), while Type A2 was the least common (13.8%). According to what was obtained through the multivariate logistic regression model, the calyceal anatomy Type A1 and A2 were associated with residual lithiasis (p= 0.016 OR: 2.994 CI: 1.223-7.331), and Grade IV was associated with a higher rate of residual lithiasis (p=0.005 CI: 1.586-13.100). A statistically significant association was found between stone burden and the presence of residual lithiasis (p=< 0.001).
CONCLUSIONS: Guy\'s Score Grade IV showed a higher incidence of residual lithiasis, seemingly associated with stone burden, leading to the conclusion that both factors were categorized as predictors for the development of post-surgical residual lithiasis. Regarding anatomical variations according to Sampaio, it was observed that types A1 and A2 showed a lower rate of stone-free status. Therefore, we also consider them as variables that may influence the achievement of success in endourological management. Personalized patient assessment allows for more accurate prognostic factors, enabling a more comprehensive surgical planning in the presence of staghorn calculi.
METHODS: A case-control study was performed including 188 patients, aged 18 years or older, and diagnosed with staghorn calculus from January 2022 to June 2023, grouping the patients according to their stone-free rate evidence on postoperative computed tomography. Data were collected from the records of the Urology Department at a high-specialty hospital in Yucatan. The groups were analyzed, aiming to establish an association between preoperative factors and postoperative outcomes measured in terms of stone-free rate.
RESULTS: A total of 188 patients with staghorn calculi were included, with a predominance in females (58.5%) and a mean age of 45.4 ± 11.9 years. The most common comorbidity was hypertension (29.8%), and 27.7% had a history of recurrent urinary tract infections. Regarding the Sampaio classification, B1 was the most prevalent in our population with 66 cases (35.1%), while Type A2 was the least common (13.8%). According to what was obtained through the multivariate logistic regression model, the calyceal anatomy Type A1 and A2 were associated with residual lithiasis (p= 0.016 OR: 2.994 CI: 1.223-7.331), and Grade IV was associated with a higher rate of residual lithiasis (p=0.005 CI: 1.586-13.100). A statistically significant association was found between stone burden and the presence of residual lithiasis (p=< 0.001).
CONCLUSIONS: Guy\'s Score Grade IV showed a higher incidence of residual lithiasis, seemingly associated with stone burden, leading to the conclusion that both factors were categorized as predictors for the development of post-surgical residual lithiasis. Regarding anatomical variations according to Sampaio, it was observed that types A1 and A2 showed a lower rate of stone-free status. Therefore, we also consider them as variables that may influence the achievement of success in endourological management. Personalized patient assessment allows for more accurate prognostic factors, enabling a more comprehensive surgical planning in the presence of staghorn calculi.
摘要：
背景：尤卡坦州是墨西哥尿石症患病率最高的州，对医疗服务提出了重大要求，如咨询和手术干预。鹿角状结石与尿路感染复发有关,他们的管理总是手术。结石清除率是衡量手术成功率的一个参数,残余结石被认为是那些在手术治疗后持续四周的结石。有未研究的预后因素可以预测获得无结石状态的成功，考虑到石头的数量，他们的位置,以及患者收集系统的解剖学变化。该研究旨在确定在尤卡坦半岛高专科地区医院接受经皮肾镜取石术治疗的鹿角状结石患者残留结石的预后因素。
方法：进行了一项病例对照研究，包括188例患者，18岁或以上，2022年1月至2023年6月诊断为鹿角状结石,根据术后计算机断层扫描的结石发生率对患者进行分组.数据是从尤卡坦一家高专科医院泌尿科的记录中收集的。对各组进行了分析，旨在建立术前因素与术后结果之间的关联，以结石发生率衡量。
结果：共纳入188例鹿角形结石患者，女性占主导地位（58.5％），平均年龄为45.4±11.9岁。最常见的合并症是高血压（29.8%），27.7%有复发性尿路感染史。关于桑帕约分类，B1在我们的人群中最普遍，有66例（35.1％），而A2型最不常见（13.8%）。根据通过多变量逻辑回归模型得到的结果，肾小管解剖A1型和A2型与残余结石相关（p=0.016OR：2.994CI：1.223-7.331），IV级与较高的残留结石率相关（p=0.005CI：1.586-13.100）。在结石负荷和残留结石的存在之间发现了统计学上的显着关联（p=<0.001）。
结论：Guy的评分IV级显示残留结石的发生率较高，似乎与石头负担有关，得出的结论是，这两个因素都被归类为术后残余结石发展的预测因素。关于根据桑帕约的解剖学变化，观察到A1和A2型无结石状态的发生率较低。因此,我们还将它们视为可能影响在腔内管理中取得成功的变量。个性化的患者评估允许更准确的预后因素，在鹿角状结石的情况下进行更全面的手术计划。
方法：进行了一项病例对照研究，包括188例患者，18岁或以上，2022年1月至2023年6月诊断为鹿角状结石,根据术后计算机断层扫描的结石发生率对患者进行分组.数据是从尤卡坦一家高专科医院泌尿科的记录中收集的。对各组进行了分析，旨在建立术前因素与术后结果之间的关联，以结石发生率衡量。
结果：共纳入188例鹿角形结石患者，女性占主导地位（58.5％），平均年龄为45.4±11.9岁。最常见的合并症是高血压（29.8%），27.7%有复发性尿路感染史。关于桑帕约分类，B1在我们的人群中最普遍，有66例（35.1％），而A2型最不常见（13.8%）。根据通过多变量逻辑回归模型得到的结果，肾小管解剖A1型和A2型与残余结石相关（p=0.016OR：2.994CI：1.223-7.331），IV级与较高的残留结石率相关（p=0.005CI：1.586-13.100）。在结石负荷和残留结石的存在之间发现了统计学上的显着关联（p=<0.001）。
结论：Guy的评分IV级显示残留结石的发生率较高，似乎与石头负担有关，得出的结论是，这两个因素都被归类为术后残余结石发展的预测因素。关于根据桑帕约的解剖学变化，观察到A1和A2型无结石状态的发生率较低。因此,我们还将它们视为可能影响在腔内管理中取得成功的变量。个性化的患者评估允许更准确的预后因素，在鹿角状结石的情况下进行更全面的手术计划。
