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Medientyp:
E-Artikel
Titel:
Hydrostatic pressure of the renal pelvis as a radiation-free alternative to fluoroscopic nephrostogram following percutaneous nephrolithotomy
Beteiligte:
Dreger, Nici Markus;
Stapelmann, Dominik;
Rebacz, Patrick;
Roth, Stephan;
Brandt, Alexander Sascha;
von Rundstedt, Friedrich-Carl;
Degener, Stephan
Erschienen:
Springer Science and Business Media LLC, 2023
Beschreibung:
<jats:title>Abstract</jats:title><jats:sec>
<jats:title>Background</jats:title>
<jats:p>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).</jats:p>
</jats:sec><jats:sec>
<jats:title>Methods</jats:title>
<jats:p>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<jats:sub>2</jats:sub>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 <jats:inline-formula><jats:alternatives><jats:tex-math>$$\le$$</jats:tex-math><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML">
<mml:mo>≤</mml:mo>
</mml:math></jats:alternatives></jats:inline-formula> 20 cmH<jats:sub>2</jats:sub>O was assessed as an indicator of an unobstructed patency.</jats:p>
</jats:sec><jats:sec>
<jats:title>Results</jats:title>
<jats:p>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<jats:sub>2</jats:sub>O (21.0–32.0) versus 20.0 mmH<jats:sub>2</jats:sub>O (16.0–24.0; p < 0.001). The pressure was lower in successful nephrostomy removal with 18 cmH<jats:sub>2</jats:sub>O (15–21) versus 23 cmH<jats:sub>2</jats:sub>O (20–29) in the leakage group (p < 0.001). The analysis of a cut-off of <jats:inline-formula><jats:alternatives><jats:tex-math>$$\le$$</jats:tex-math><mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML">
<mml:mo>≤</mml:mo>
</mml:math></jats:alternatives></jats:inline-formula> 20 cmH<jats:sub>2</jats:sub>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]).</jats:p>
</jats:sec><jats:sec>
<jats:title>Conclusion</jats:title>
<jats:p>The hydrostatic RPP seems to allow a bedside evaluation of ureteral patency after PCNL.</jats:p>
</jats:sec>