Preoperatif ve İntraoperatif Klinik Bulguların Üreter Taşı Endoskopik Tedavi Başarısına Etkisi

Abstract

Amaç: Üreter taşı nedeniyle üreterorenoskopi (URS) yapılan hastaların klinik verileri ile taşsızlık oranları arasındaki ilişkiyi retrospektif olarak araştırmayı amaçladık. Yöntemler: Çalışmamız kliniğimizde üreter taşı tanısıyla URS yapılan 83 hastanın verilerinin retrospektif analizinden oluşturuldu. Preoperatif ve intraoperatif klinik veriler kaydedildi. Operasyondan 2 hafta sonrasında 4 milimetreden büyük fragmanın saptanmaması başarı olarak kabul edildi. Klinik veriler ile taşsızlık oranı arasındaki ilişki uygun istatistik yöntemlerle değerlendirildi. Bulgular: Ortalama yaş 50.48±14,41 ve erkek/kadın oranı 2 olarak bulundu. Toplam taşsızlık oranı %83,2 idi. Komplikasyon olarak 7 hastada postoperatif ateş, 2 hastada üreteral perforasyon gelişti. Yaş, cinsiyet, taraf, taş sayısı, çapı, hacmi, en geniş yüzey alanı, ortalama Hounsfield ünitesi, üreteral balon dilatasyon kullanımı, litotriptör cinsi (pnömotik, pnömotik + lazer, lazer) açısından başarılı ve başarısız hastalar arasında anlamlı farklılık saptanmazken, preoperatif hidronefroz derecesi (düşük dereceli: %95,2 vs yüksek dereceli: %69,4, p=0,006), taş lokasyonu (distal üreter: %92,9 vs proksimal üreter: %72,5, p=0,014) ve operasyon süresi (başarılı: 60,0 (45,0-60,0) dak. vs başarısız: 85,0 (60,0-97,5) dak. p=0,048) açısından taşsızlık oranında farklılık olduğu bulundu. Ayrıca antiretropulsif Stone cone kullanımında başarı %91,7, kullanılmayanlarda %81,4 olarak saptandı (p=0,347). Sonuç: Başarı oranını artırmak ve ek prosedür gereksinimini azaltmak için özellikle hidronefrotik proksimal üreter taşlarında antiretropulsif aletlerin veya fleksible URS kullanımının tercih edilmesi gerektiğini düşünüyoruz.

Keywords

• Üreterorenoskopi, üreter taşı, endoskopik taş tedavi başarısI

The Effect of Preoperative and Intraoperative Clinical Findings on Success of Endoscopic Management of Ureteral Stone

Abstract

Objective: We investigated the relationship between clinical data of patients who underwent ureterorenoscopy (URS) due to ureteral stone and stone free rates retro­spectively. Methods: Clinical data of 83 patients who underwent URS in our clinic were retrospectively analyzed. Pre­operative and intraoperative clinical parameters were recorded. Success was defined as not to detect > 4mm stone fragments 2 weeks after the operation. Appropriate statistical analysis were done for evaluating relationship between stone free rate and clinical data. Results: Mean age was 50.48±14.41 and male to female ratio was 2. Overall stone free rate was 83.2%. Postop­erative fever, ureteral perforation were detected in 7 and 2 patients, respectively. There were no differences between success and failure groups in terms of age, sex, opera­tion side, stone number, diameter, size, surface area, mean Hounsfield unit, usage of balloon dilatation. How­ever with respect to preoperative grade of hydronephrosis (low grade: 95.2% vs high grade: 69.4%, p=0.006), stone location (distal ureter: 92.9% vs proximal ureter: 72.5%, p=0.014) and operation time (success: 60.0 (45.0-60.0) min. vs failure: 85.0 (60.0-97.5) min. p=0.048) we found statistically significant differences between the study groups. In addition stone free rate was 91.7% with anti-retropulsion device Stone cone, whereas it was 81.4% without any ureteral occlusion (p=0.347). Conclusion: We assume that anti-retropulsion devices or flexible URS should be prefered especially in patients with hydronephrotic proximal ureteral stone for higher stone free rate with lower auxiliary procedure.

Keywords

• Ureterorenoscopy, ureteral stone, endoscopic stone management success

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