Background: To investigate the efficacy and safety of ultrasound-guided percutaneous nephrolithotomy (PCNL) in kidney calculi patients with ankylosing spondylitis (AS).Methods: The data of 22 renal stone patients (25 kidney units) with AS who underwent PCNL in our institute from January 2008 to December 2019 were analyzed retrospectively. General information of these patients, intraoperative and postoperative data were recorded. The primary parameter for efficacy was initial and final stone free rates (SFR) with X-ray kidney, ureter, and bladder (KUB) were performed 1 st or 2 nd day and 1 month after surgery. Preoperative and postoperative laboratory results, surgical procedures and the occurrence of postoperative complications were used to identify the safety PCNL intervention.Results: Most PCNLs were performed with general anesthesia (76%) and prone position (64%). The initial SFR and final SFR were 80% (20 kidney units) and 88% (22 kidney units) respectively. Haemoglobin decreased after PCNL occurred in 22 patients (88.0%) and the mean postoperative hemoglobin drop was 1.32±0.76 g/L (range, 0.10-3.10 g/L), with one patient received blood transfusion. One patient developed postoperative fever (T >38.5 ℃). No other complications such as colon injury, extravasation of urine, perinephric infection and urosepsis occurred. Conclusions:The result of ultrasound-guided PCNL for kidney stone patients with AS is satisfactory with high SFR and security. Operative position, anesthesia method and damage caused by drugs used in the treatment of AS should be considered to achieve better result.
Background: Red blood cell distribution width (RDW) is associated with the severe morbidity and mortality of some Gram-negative associated chronic diseases. We designed this retrospective study to identify whether RDW can be used as a factor to provide reference for the treatment of renal abscess.Methods: All patients with renal abscess in our institution between April 2016 and November 2019 were collected, and 38 cases with the characteristic of initially diagnosis and no prior treatment were enrolled.Conservative treatment group and surgical intervention group were set based on the treatment of patients.Univariate analysis and the regression analysis were adopted to identify the difference between these two groups.Results: Significant differences were found in Diabetes mellitus, RDW and size of renal abscess in both univariate and multifactor analysis. The median value of RDW in all patients was 13.62%, with 13.15% in conservative treatment group and 14.20% receiving surgical intervention (OR: 9.48, 95% CI: 1.15-78.02).Diabetes was present in 42.11% of patients, with the ratio of 20.0% in conservative treatment group and 66.67% in surgical intervention group (OR: 35.22, 95% CI: 1.55-799.05). The cut-off of RDW and size of renal abscess were 14.07% and 3.9 cm respectively.Conclusions: RDW as an independent predictor of mortality in patients with Gram-negative bacteremia showed differences among patients with renal abscess who received different treatments. Since the relationship between RDW and Gram-negative bacteremia related to mortality, higher initial RDW value may represent a higher severity of renal abscess and a greater likelihood of the need of surgical intervention.
Objective To identify possible clinical indicators to guide the choice of treatment in patients with renal abscess. Methods According to different treatment methods, 38 patients initially diagnosed with renal abscess and received no prior treatment (antipyretics excepted) in our institution from April 2006 to November 2019 were divided into conservative treatment group and invasive treatment group, with the clinical data of all the cases being analyzed retrospectively. Results In the conservative treatment group, 19 patients got success and 1 failed in initial treatment, while in the invasive treatment group, 15 patients got success and 3 failed. Of the 4 patients who failed the initial treatment, 3 had a renal abscess between 3 cm and 5 cm, and 1 failed due to long-term use of bone marrow suppressive drugs. In univariate analysis, there were significant differences between the two groups in the following factors: diabetes mellitus, body temperature ≥ 38.5℃, PLT, RDW, BUN, PLR, AG, WBC in urine, size of abscess. In logistic regression analysis, diabetes mellitus, RDW and size of renal abscess were retained. The cut-off of RDW and size of renal abscess were 14.07% and 3.9 cm respectively. Conclusions Size of renal abscess is still the most important factor that determining treatment modalities. Other than size, high RDW and the comorbidity of diabetes mellitus may also be used as the possible clinical indicators for the determination of invasive treatment, especially in patients with renal abscess between 3 ~ 5 cm in size.
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