Fatores preditores de sucesso na ureterorrenoscopia flexível para tratamento de cálculo renal único

Abstract

Introduction: Flexible renal ureteroscopy (FRU) is a highly effective therapeutic approach in the treatment of kidney stones. Different parameters may be associated with the post-FRU stone-free state. Objective: to evaluate predictive factors in stone-free rates. Method: Prospective study of patients diagnosed with kidney stones and undergoing FRU. Logistic regression was employed for multivariate analysis in predicting residual stones (RS). Results: RS were diagnosed in 23 patients (19.5%) post-FRU. Regarding the location of the stone, 7(5.98%) were in the upper calyx, 5(4.27%) in the middle calyx, 54 (46.15%) in the lower calyx and 51 (43.60%) in the renal pelvis. Preoperative Double J was used in 51(43.60%) patients and in 117 patients (100%) postoperatively. Analysis using the ROC curve showed that stones with volumes above 413.5 mm³ had a higher probability of RS (sensitivity of 91% and specificity of 68.4%, AUC of 0.84). Independent predictive factors for RS were volume above 413.5 mm³ [Oddis ratio (OR)=7.40, 95% CI 1.01-17.23; p=0.00], pelvic location (OR=2.55, 95% CI 1.87-28.49; p=0.00) and inferior calyceal location (OR:1.61; 95% CI 1.22 -8.10; p= 0.05); use of double J preoperatively was protective (OR= 0.08, 95% CI 1.01-0.49; p=0.01). Conclusion: Kidney stone volume and location in the renal pelvis were significant factors in the persistence of RS, while the use of preoperative double J was protective. These results may help identify patients at increased risk of RS, allowing for personalized decisions regarding treatment.