İdrar Taşı Olan Yaşlı Hastalarda Şok Dalgası Litotripsi Sonrası Taşsızlık Oranını Etkileyen Faktörlerin Araştırılması

Abstract

Amaç: Üriner taş hastalığı, yaşlı hastalar da dahil olmak üzere tüm yaş gruplarında görülen önemli bir hastalıktır. Böbrek yetmezliği ve idrar yolu enfeksiyonu sorunlarına neden olabilir. Farklı tedavi alternatifleri arasında minimal invaziv olan şok dalga tedavisi böbrek ve proksimal üreter taşlarında 2 cm'den küçük olanlarda tercih edilmektedir. Yaşlı hastalarda bu tedavinin etkinliği ve güvenliği ile ilgili çalışmalar sınırlıdır. Bu çalışmada, üriner taşları olan yaşlı hastalarda şok dalga litotripsi sonrası taşsızlık oranını (stone-free rate, SFR) etkileyen faktörlerin araştırılması amaçlanmıştır. Gereç ve Yöntemler: 2010 ve 2018 yılları arasında Düzce Üniversitesi Tıp Fakültesi Üroloji Anabilim Dalı'nda üriner sistem taş hastalığı nedeniyle ekstrakorporeal şok dalga litotripsi (extracorporeal shock wave lithotripsy, ESWL) uygulanan 65 yaş üstü 120 hastanın verileri retrospektif olarak değerlendirildi. Bu hastalardan elde edilen cinsiyet, yaş, taşın bulunduğu yer (üst, orta veya alt kaliks, renal pelvis, üreter), şok dalgalarının sayısı, taş boyutu ve yardımcı prosedüre duyulan ihtiyacı içeren veriler analiz edildi. Bulgular: 120 hastanın 82'si (%68,3) erkek, 38'i (%31,7) kadındı. 49 hastada komorbidite mevcuttu. Toplam SFR %65,8 (n=79) olarak bulundu. En yüksek SFR %79,3 (29 hastanın 23'ü) ile orta kaliks taşlarında bulundu. 36 (%30) hastada ESWL sonrası yardımcı prosedürlere ihtiyaç duyuldu. İki hastada subkapsüler renal hematom ve piyelonefrit gelişti. Sonuç: ESWL, uygun taş boyutuna sahip yaşlı erkekler için bile ilk seçenektir. Ayrıca, ESWL yaşlı hastalarda kabul edilebilir morbiditeye neden olmuştur.

Keywords

• komorbidite
• yaşlı
• ekstrakorporal şok dalga tedavisi
• urolitiyazis

Investigation of Factors Affecting the Stone-Free Rate in Elderly Patients with Urinary Stones After Shock Wave Lithotripsy

Abstract

Aim: Urinary stone disease is an important disease seen in all age groups, including elderly patients. It can cause kidney failure and urinary infection problems. Shock wave therapy, which is the minimal invasive among the different treatment alternatives, is preferred for kidney and proximal ureteral stones smaller than 2 cm. Studies on the efficacy and safety of this treatment in elderly patients are limited. This study aimed to investigate the factors affecting the stone-free rate (SFR) in elderly patients with urinary stones after shock wave lithotripsy. Material and Methods: The data of 120 patients in the Urology department of Duzce University Faculty of Medicine between 2010 and 2018 over 65 years old who underwent extracorporeal shock wave lithotripsy (ESWL) for urinary system stone disease were evaluated retrospectively. The data obtained from these patients included sex, age, location of the stone (upper, middle, or lower calyx, renal pelvis, ureter), number of shock waves, stone size, and the need for the auxiliary procedure were analyzed. Results: Of the 120 patients, 82 (68.3%) were male and 38 (31.7%) were female. Comorbidity was present in 49 patients. An overall SFR of 65.8% (n=79) was found. The highest SFR was found in middle calyx stones with 79.3% (23 of the 29 patients). Post-ESWL auxiliary procedures were needed in 36 (30%) patients. Two patients developed subcapsular renal hematoma and pyelonephritis. Conclusion: ESWL is an appropriate even the first option for elder male with favorable stone size. Furthermore, ESWL caused acceptable morbidity in older patients.

Keywords

• comorbidities
• elderly
• extracorporeal shock wave lithotripsy
• urolithiasis

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