Gender-related differences in the performance of sequential organ failure assessment (SOFA) to predict septic shock after percutaneous nephrolithotomy.

The study aims to identify whether gender differences exist in the sequential organ failure assessment (SOFA) score to the extent of affecting its predictive accuracy for septic shock after percutaneous nephrolithotomy (PCNL). A retrospective study of 612 patients undergoing PCNL was performed. The SOFA scores of male and female groups were compared to identify any gender differences. The ROC curve was used to find differences between the original and adjusted SOFA scores. Postoperative septic shock developed in 21 (3.43%) cases. A marginally significant discrepancy in median SOFA scores between genders was discovered in a subgroup of patients < 40 years old (p = 0.048). A gender difference existed in the SOFA score after PCNL, with greater proportion of high scores in female patients (p = 0.011). Male patients had a higher proportion of ≥ 2 sub-score in hepatic and renal systems than female patients, caused by their higher preoperative bilirubin and creatinine (p < 0.05). An adjusted SOFA score was created to replace the original postoperative SOFA score with the perioperative changed values of bilirubin and creatinine. Performance of the adjusted SOFA score for predicting septic shock was comparable with the original SOFA score (AUC 0.987 vs. 0.985, p = 0.932). Under the premise of ensuring 100% sensitivity, the adjusted SOFA score reduced the 43.7% (31/71) false-positive rate for predicting septic shock compared with the original SOFA score. In conclusion, the gender should not be neglected when applying SOFA score for patients after PCNL. The adjusted SOFA score eliminates negative effects caused by gender differences in predicting septic shock.

Propensity Score-Matched Analysis Comparing Retrograde Intrarenal Surgery with Percutaneous Nephrolithotomy for Large Stones in Patients with a Solitary Kidney.

PURPOSE: To evaluate the clinical efficacy, safety, and cost of retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) in the treatment for large renal stones in patients with a solitary kidney. PATIENTS AND METHODS: In this study, 117 patients with a solitary kidney who had undergone PCNL or RIRS for renal stones larger than 2 cm between January 2010 and December 2016 were retrospectively evaluated. The patients' demographic data, clinical characteristics, and perioperative outcomes were collected through a review of their medical records. Forty-three patients treated with PCNL were compared to 43 patients treated with RIRS by propensity score-matched analysis. The stone-free rate, retreatment rate, complication rate, and efficacy quotient (EQ) were assessed in both groups. RESULTS: Initial stone-free rate of the PCNL group after a single procedure was significantly higher compared with the RIRS group (74.42% vs 34.88%, p < 0.001), whereas there was no significant difference in the final stone-free rate after repeated procedures (90.70% vs 88.37%, p = 0.713). PCNL had a significantly lower retreatment rate than RIRS (16.28% vs 63.79%, p < 0.001), and the PCNL group underwent fewer procedures than the RIRS group (p < 0.001). Thus, PCNL group had a higher EQ (78.00% vs 53.52%). Although cost per procedure of PCNL was significantly higher compared with RIRS (p < 0.001), the total costs were comparable. Complication rate of RIRS was lower compared with PCNL with no statistical significance (p = 0.193), and acute kidney injury rates were also comparable (PCNL vs RIRS: 13.95% vs 6.98%, p = 0.533). CONCLUSIONS: With fewer repeated surgical procedures, higher EQ, and comparable total costs, PCNL is recommended as the first choice for the treatment of large renal calculi in patients with a solitary kidney. As for specific indications such as anticoagulant drugs, RIRS is a safer choice with fewer complications and acceptable final stone-free rate.