Quality of nephrolithiasis surgical treatment – what is it influenced by?


Authors: V. Kováčik 1,2;  M. Maciak 3;  P. Bujdák 2,4;  V. Baláž 1;  R. Školka 5;  M. Rusňák 6
Authors‘ workplace: II. Urologická klinika Slovenskej zdravotníckej univerzity, FNsP F. D. Roosevelta Banská Bystrica 1;  LF Slovenskej zdravotníckej univerzity v Bratislave 2;  Katedra pravděpodobnosti a matematické statistiky, Matematicko-fyzikální fakulta Univerzity Karlovy, Praha 3;  Urologická klinika Slovenskej zdravotníckej univerzity v Bratislave 4;  II. Gynekologicko-pôrodnícka klinika Slovenskej zdravotníckej univerzity, FNsP F. D. Roosevelta Banská Bystrica 5;  Oddelenie Cievnej chirurgie, FNsP F. D. Roosevelta Banská Bystrica 6
Published in: Rozhl. Chir., 2018, roč. 97, č. 2, s. 82-87.
Category: Original articles

Overview

Introduction:
Identifying factors effecting the quality of nephrolithiasis surgical treatment could improve medical care for patients suffering from kidney stone disease. The objective of the article is to identify factors influencing reintervention rate after surgical treatment of kidney stone disease either by percutaneous nephrolitholapaxy or flexible ureterorenoscopy.

Method:
A retrospective study was conducted on 149 patients who underwent a surgery for a kidney stone disease at the Urological department of F.D. Roosevelt hospital Banská Bystrica from January 2015 till June 2015. The cohort included 60 women at average age of 57 (range 28–91) and 89 men at average age of 58 (range 30–92). Patients were treated by percutaneous litholapaxy (67 cases) and flexible ureterorenoscopy (82 cases, including 72 using dusting technique). Factors with potential influence on probability of repeated intervention during following 12 months have been studied and statistically analyzed. For the statistical analysis we used the generalized linear regression framework (GLM − Generalized Linear Model) with the stepwise forward modeling approach.

Results:
Using the significance level of 5% the statistically significant factors affecting the probability of the re-intervention for ipsilateral kidney stone disease are the stone size (p-value 0.0035) and the postoperative stone free status (p-value 0.0418). Other studied factors as demographical data (age, gender), surgical method (percutaneous nephrolitolapaxy or flexible ureterorenoscopy), stone count, postoperative draining system (nefrostomy or JJ stent) did not have any statistically significant impact.

Conclusion:
Patients could benefit from early diagnosis which could lead to earlier identification of smaller stones. Perfect operative technique with intraoperative achievement of stone free status is important to lower the need of repeated intervention.

Key words:
kidney stone disease – reintervention − residual fragments


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Labels
Surgery Orthopaedics Trauma surgery
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