Objective To investigate the value of calculi CT value,infection possibility score(IPS),and Toll-like receptor(TLR)mRNA level of peripheral blood mononuclear cells in predicting urinary sepsis after percutaneous nephrolithotomy(PCNL).Methods Forty-three patients with urinary sepsis after PCNL were selected as sepsis group,while 105 patients without sepsis after PCNL were selected as control group according to propensity score.The postoperative calculi CT value,IPS and TLR mRNA level of peripheral blood mononuclear cells were compared between two groups,and receiver operating characteristic(ROC)curve was drawn to analyze the value of each index in predicting urinary sepsis after PCNL.Results The calculi CT value,IPS,TLR2 mRNA and TLR4 mRNA levels in sepsis group were significantly higher than those in control group(P<0.05).Compared with control group,sepsis group had higher proportion of stone diameter≥2.0 cm,proportion of staghorn stone,postoperative ratio of neutrophil to lymphocyte and postoperative procalcitonin,but lower postoperative albumin,with statistical differences(P<0.05).The area under ROC curve of calculi CT value,IPS,TLR2 mRNA,TLR4 mRNA and the combination of the 4 indexes to predict urinary sepsis after PCNL were 0.669,0.794,0.710,0.584 and 0.907,respectively.Conclusion The increases of calculi CT value,IPS,TLR2 mRNA and TLR4 mRNA after PCNL are associated with urinary sepsis.A comprehensive consideration of these 4 indicators is of high value for predicting urinary sepsis in clinic.

Objective To investigate the value of calculi CT value,infection possibility score(IPS),and Toll-like receptor(TLR)mRNA level of peripheral blood mononuclear cells in predicting urinary sepsis after percutaneous nephrolithotomy(PCNL).Methods Forty-three patients with urinary sepsis after PCNL were selected as sepsis group,while 105 patients without sepsis after PCNL were selected as control group according to propensity score.The postoperative calculi CT value,IPS and TLR mRNA level of peripheral blood mononuclear cells were compared between two groups,and receiver operating characteristic(ROC)curve was drawn to analyze the value of each index in predicting urinary sepsis after PCNL.Results The calculi CT value,IPS,TLR2 mRNA and TLR4 mRNA levels in sepsis group were significantly higher than those in control group(P<0.05).Compared with control group,sepsis group had higher proportion of stone diameter≥2.0 cm,proportion of staghorn stone,postoperative ratio of neutrophil to lymphocyte and postoperative procalcitonin,but lower postoperative albumin,with statistical differences(P<0.05).The area under ROC curve of calculi CT value,IPS,TLR2 mRNA,TLR4 mRNA and the combination of the 4 indexes to predict urinary sepsis after PCNL were 0.669,0.794,0.710,0.584 and 0.907,respectively.Conclusion The increases of calculi CT value,IPS,TLR2 mRNA and TLR4 mRNA after PCNL are associated with urinary sepsis.A comprehensive consideration of these 4 indicators is of high value for predicting urinary sepsis in clinic.

【Objective】 To explore the safety and efficacy of a novel endoscopic two-wire guided dilation in the creation of channels in percutaneous nephrolithotomy (PCNL). 【Methods】 Clinical records of 180 patients undergoing PCNL during Oct.2020 and Oct.2022 were retrospectively analyzed. The patients were divided into three groups, 60 in AMD group (fascial amplatz dilation), 60 in OSD group (one shot dilation) and 60 in END group (endoscopic dilation). Time to establish channels, operating time, failure of access, stone clearance rate, drop in hemoglobin, embolization rate, fever rate, blood transfusion rate and postoperative hospitalization were compared among the three groups. 【Results】 There were no significant differences in the general data among the three groups (P>0.05). Compared with AMD and OSD groups, END group needed significantly reduced time to establish the first channel [(5.6±0.8) min vs. (4.9±1.4) min vs. (4.2±0.5) min, (P<0.05)] . Compared with OSD group, END and AMD groups had significantly more hemoglobin drop [(14.0±17.6) g/L vs. (19.4±12.6) g/L vs. (10.2±6.8) g/L, (P<0.05)] . There were no significant differences in terms of failure of establishing channels, operating time, stone clearance rate, embolization rate, fever rate, blood transfusion rate and postoperative hospitality. Four patients needed selective renal artery embolization (1 case in AMD group and 3 in OSD group). No serious complications such as organ injuries, septic shock or death occurred. 【Conclusion】 Endoscopic two-wire guided dilation is simple, with few complications and good application value.