Perkütan Nefrolitotomi Yapılan Çocuk Hastalarda Kanamayı Etkileyen Faktörlerin Araştırılması

Öz

Amaç: Erişkin hastalarda olduğu gibi çocuk hastaların böbrek taşı tedavisinde de etkili ve güvenle kullanılan perkütan nefrolitotomi PNL ameliyatının sık görülen komplikasyonlarından birisi kanamadır. Bu retrospektif çalışma ile pediatrik PNL olgularında kanamayı etkileyen faktörlerin belirlenmesini amaçladık.Gereç ve Yöntemler: Ocak 2010 ve Mayıs 2018 tarihleri arasında kliniğimizde 57 çocuk hastaya 24 kız, 33 erkek uygulanan 61 pediatrik PNL ameliyatının sonuçları retrospektif olarak değerlendirildi. Bulgular: Hasta popülasyonunun medyan yaşı 13 olarak saptandı. Hastalarımızın medyan taş yükü 420 mm2 iken, taşların %47,5’i kompleks taş özelliğindeydi. Hastaların %88,5’ine tek akses yapıldı ve akseslerin %83,6’sı infrakostal seviyeden gerçekleştirildi. PNL prosedürlerinden sonra ortalama hemoglobin ve hematokrit Htc düşüşü sırasıyla 1,1±1,15 mg/dl ve %3,23±3,26 olarak bulundu. Kan transfüzyonu yapılan hastalarda n=4, %6,5 hemoglobin ve Htcʼde ortalama düşüş sırasıyla 3,1±0,8 mg/dl ve %10,3±2,8 olarak saptandı. Medyan operasyon süresi 90 dk olarak saptandı. Çalışmamızda sadece operasyon süresinin uzun olması, pediatrik PNL olgularında artmış kan kaybıyla anlamlı olarak ilişkili bulundu p

Anahtar Kelimeler

• Nefrolitiyazis, Çocuk, Perkutan nefrolitotomi, Komplikasyon

Investigation of Factors Affecting Bleeding in Children with Percutaneous Nephrolithotomy

Abstract

Objective: One of the most common complications of percutaneous nephrolithotomy PNL , which is also used in the treatment of kidney stones in pediatric patients as in adult patients, is bleeding. In this retrospective study, we aimed to determine the factors affecting bleeding which is a complication of pediatric percutaneous nephrolithotomy. Material and Methods: The results of 61 pediatric PNL operations performed between January 2010 and May 2018 in 57 pediatric patients 24 girls, 33 boys at our clinic were evaluated retrospectively.Results: The median age of the patients was 13 years. The median stone load of our patients was 420 mm2 and 47.5% of the stones were complex stones. Single access was performed in 88.5% of the patients and 83.6% of the accesses were performed at the infracostal level. After PNL procedures, the mean hemoglobin and Htc decrease were 1.1±1.15 mg/dl and 3.23±3.26%, respectively. In patients with blood transfusion n=4, 6.5% the mean decrease in hemoglobin and Htc was 3.1±0.8 mg/dl and 10.3±2.8%, respectively. The median operation time was 90 minutes. Univariate linear regression analysis found that longer operation time p

Keywords

• Nephrolithiasis, Pediatrics, Percutaneous nephrolithotomy, Complication

References

1. Muslumanoglu AY, Binbay M, Yuruk E, Akman T, Te- peler A, Esen T, Tefekli AH. Updated epidemiologic study of urolithiasis in Turkey. I: Changing characteristics of urolithiasis. Urol Res 2011; 39:309-14.
2. Sarica K. Pediatric urolithiasis: Etiology, specific patho- genesis and medical treatment. Urol Res 2006; 34(2):96- 101.
3. Desai MR, Kukreja RA, Patel SH, Bapat SD. Percutane- ous nephrolithotomy for complex pediatric renal calculus disease. J Endourol 2004; 18:24-7.
4. Sahin A, Tekgul S, Erdem E, Ekici S. Hascicek M, Kendi S. Percutaneous nephrolithotomy in older children. J Pe- diatr Surg 2000; 35:1336-8.
5. Elderwy AA, Gadelmoula M, Elgammal MA, Osama E, Al-Hazmi H, Hammouda H, Osman E, Abdullah MA, Neel KF. Percutaneous nephrolithotomy in children: A preliminary report. Urol Ann 2014; 6(3):187-91.
6. Stoller ML, Wolf JS, St Lezin MA. Estimated blood loss and transfusion rates associated with percutaneous neph- rolithotomy. J Urol 1994; 152:1977-81.
7. ter? World J Urol 2011; 29:725-9.
8. Onal B, Dogan HS, Satar N , Bilen CY, Güneş A, Ozden E, Ozturk A, Demirci D, Istanbulluoğlu O, Gurocak S0, Nazli O, Tanriverdi O, Kefi A, Korgali E, Silay MS, Inci K, Izol V, Altintas R, Kilicarslan H, Sarikaya S, Yalcin V, Aygun C, Gevher F, Aridogan IA, Tekgul S. Factors affecting complication rates of percutaneous nephrolitho- tomy in children: results of a multi-institutional retrospec- tive analysis by the Turkish Pediatric Urology Society. J Urol 2014; 191:777-82.

9. Yadav SS, Aggarwal SP, Mathur R, Sharma KK, Yadav RG, Tomar V, Teli RD, Jain D. Pediatric Percutaneous Nephrolithotomy-Experience of a Tertiary Care Center. J Endourol 2017; 31(3):246-54.
10. Ozden E, Sahin A, Tan B, Doğan HS, Eren MT, Tekgül S. Percutaneous renal surgery in children with complex stones. J Pediatr Urol 2008; 4:295-8.
11. Citamak B, Altan M, Bozaci AC, Koni A, Doğan HS, Bilen CY, Şahin A, Tekgül S. Percutaneous nephrolit- hotomy in children: 17 years of experience. J Urol 2016; 195:1082-7.
12. Senocak C, Ozbek R, Bozkurt OF, Unsal A. Predictive factors of bleeding among pediatric patients undergo- ing percutaneous nephrolithotomy. Urolithiasis 2018; 46(4):383-9.
13. El-Nahas AR, Shokeir AA, El-Assmy AM Mohsen T, Shoma AM, Eraky I, El-Kenawy MR, El-Kappany HA. Post-percutaneous nephrolithotomy extensive hemorrha- ge: A study of risk factors. J Urol 2007; 177:576-9.
14. Manohar T, Ganpule AP, Shrivastav P, Desai M. Percu- taneous nephrolithotomy for complex caliceal calculi and staghorn stones in children less than 5 years of age. J En- dourol 2006; 20:547-51.
15. Kapoor R, Solanki F, Signhania P, Andankar M, Pathak HR. Safety and efficacy of percutaneous nephrolithotomy in the pediatric population. J Endourol 2008; 22:637-40.
16. Bilen CY, Kocak B, Kitirci G, Ozkaya O, Sarikaya S. Per- cutaneous nephrolithotomy inchildren: Lessons learned in 5 years at a single institution. J Urol 2007; 177:1867-71.
17. Mor Y, Elmasry YE, Kellett MJ, Duffy PG. The role of percutaneous nephrolithotomy in the management of pe- diatric renal calculi. J Urol 1997; 158:1319-21.
18. Şen H, Seckiner I, Bayrak O, Erturhan S, Demirbağ A. Treatment alternatives for urinary system stone disease in preschool aged children: Results of 616 cases. J Pediatr Urol 2015; 11(1):34.e1-5.
19. Rizvi SA, Naqvi SA, Hussain Z Hashmi A, Hussain M, Zafar MN, Sultan S, Mehdi H. Pediatric urolithiasis: De- veloping nation perspectives. J Urol 2002; 168:1522-5.
20. Al-Shammari AM, Al-Otaibi K, Leonard MP, Hosking DH. Percutaneous nephrolithotomy in the pediatric po- pulation. J Urol 1999; 162:1721-4.
21. Gunes A, Ugras M Y, Yilmaz U, Baydinc C, Soylu A. Percutaneous nephrolithotomy for pediatric stone: Dise- ase our experience with adult-sized equipment. Scand J Urol Nephrol 2003; 37:477-81.
22. Bellman GC, Davidoff R. Influence of technique of per- cutaneous tract creation on incidence of renal hemorrha- ge. J Urol 1997; 157:1229-31.
23. Nalbant I, Karakoyunlu AN, Yesil S, Ekici M, Zengin K, Ozturk U, Imamoğlu MA. Comparison of dilation methods in percutaneous nephrolithotomy: Which one is more successful? J Laparoendosc Adv Surg Tech A 2016; 26(6):478-82.
24. Guven S, Frattini A, Onal B, Desai M, Montanari E, Kums J, Garofalo M, de la Rosette J; CROES PCNL Study Group. Percutaneous nephrolithotomy in children in different age groups: Data from the Clinical Research Office of the Endourological Society (CROES) Percu- taneous Nephrolithotomy Global Study. BJU Int 2013; 111:148-56.
25. Benson JS, Hart ST, Kadlec AO, Turk T. Small-bore cat- heter drainage of pleural injury after percutaneous neph- rolithotomy: feasibility and outcome from a single large institution series. J Endourol 2013; 27(12):1440-3.