Böbrek ve üreter taşlarında ESWL başarısını öngörmede radyografik ve litotriptör parametrelerinin klinik önemi

Year 2021, , 78 - 84, 29.12.2021

Özgür Efiloğlu , Mehmet Çağlar Çakıcı , Hüseyin Özgür Kazan , Ferhat Keser , Asıf Yıldırım , Gokhan Atis

https://doi.org/10.54233/endouroloji.969883

Cited By: 1

Abstract

Amaç: Ekstrakorporeal şok dalga litotripsi (ESWL), böbrek ve proksimal üreter taşlarının tedavisinde en sık kullanılan yöntemlerdendir. Çalışmamızda, ESWL başarısı için hangi parametrelerin etkili olduğunu saptamayı amaçladık.
Gereç ve Yöntemler: Ocak 2017 ile Aralık 2018 arasında, ESWL uygulanan 253 hasta prospektif olarak elde ettiğimiz ESWL veri tabanımızdan geriye dönük olarak analiz edildi. Kırk dört hastaya üreter taşı nedeniyle ESWL, 209 hastaya böbrek taşı nedeniyle ESWL uygulandı. Taş tipi, taş boyutları, hounsfield birim dansitesi (HBD), taş-cilt mesafesi (TCM) ve taşların yerleşimi, hastaların cinsiyeti ve yaşı, şok dalgalarının gücü ve sayısı ile toplam seans sayısı analiz edildi.
Bulgular: Genel tedavi başarı oranı tüm taşlar için %71,1, böbrek taşları için %70,3 ve üreter taşları için %75 idi. Taş boyutu, şok dalgası sayısı ve HBD böbrek taşlarının başarısını öngörmede etkili parametrelerdi. Yaş ve taş boyutu, tek değişkenli regresyon analizinde üreter taşları için başarının belirleyicileriydi. Çok değişkenli regresyon analizinde hem böbrek hem de üreter taşları için başarıyı öngören tek parametre taş boyutuydu (sırasıyla p=0,002 ve p=0,005). Üreter taşları için başarı oranı, 11,5 mm boyutu kestirim değeri olarak tanımlandığında, %81,8 duyarlılık ve %78 özgüllükle tahmin edilebilir olarak saptandı.
Sonuç: Böbrek taşları ve üreter taşları ESWL ile başarıyla tedavi edilebilir. Daha küçük ve HBD daha düşük olan böbrek taşlarının başarı oranı daha yüksektir. Üreter taşlarında ise daha genç hastalar ve daha küçük taşlar daha etkili bir şekilde parçalanabilir. ESWL başarısı için en önemli parametre taş boyutudur.

Keywords

Vücut dışı şok dalga litotripsi, böbrek taşı, üreter taşı, hounsfield birim dansitesi

Clinical significance of radiographic and lithotripter parameters in predicting ESWL success for kidney and ureteral stones

Abstract

Objective: Extracorporeal shock wave lithotripsy (ESWL) is the most commonly utilized method for treating renal and proximal ureteral stones. We aimed to observe which parameters are efficacious for ESWL success.
Material and Methods: Between January 2017 and December 2018, 253 patients who underwent ESWL were analyzed retrospectively from our prospectively obtained ESWL database. 44 patients underwent ESWL due to ureteral stones and 209 patients due to kidney stones. Stone type, stone sizes, Hounsfield unit density (HUD), stone-skin distance (SSD) and location of stones, gender, and ages of patients, power, and number of shock waves and total sessions were analyzed.
Results: The overall treatment success rate was 71.1% for all stones, 70.3% for renal stones, and 75% for ureteral stones. Stone size, number of shock waves, and HUD were efficacious parameters to predict success for renal stones. In univariate analyses, age and stone size were predictors of success for ureteral stones. In multivariate analyses, just stone sizes were the only predictor of success for renal and ureteral stones (p=0.002 and p=0.005, respectively). The success rate can be predicted for ureteral stones with a sensitivity of 81.8% and specificity of 78% when 11.5 mm size is defined as a cut-off point.
Conclusion: Renal stones and proximal ureteral stones can be treated successfully with ESWL. Renal stones that are smaller and lower HUD have more success rates. When we talk about ureteral stones, younger patients and smaller stones can be fragmentized more effectively. The most important parameter for ESWL success is stone size.

Keywords

Extracorporeal shock wave lithotripsy, renal stone, ureteral stone, hounsfield unit density

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