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Üreteral Yaralanma, İmpakte Taşlara Üreteroskopik Litotripsi Sırasında Üreter Duvar Kalınlığı ile Artmaktadır

Year 2020, Volume: 12 Issue: 1, 9 - 14, 30.01.2020

Abstract

Amaç: Bu çalışmada, üreter taşları için üreteroskopi uygulanan hastalarda üreter duvar kalınlığı ile üreter
yaralanmasının taşsızlık oranları ile olası ilişkisini değerlendirdik.
Gereç ve Yöntem: Ekim 2014-Kasım 2015 tarihleri arasında üreteroskopik lazer litotripsi uygulanan 120 olgu (%
71.7, erkek) çalışmaya dahil edildi. Tüm hastalarda impakte taş, ameliyat öncesi, ameliyat sırası ve sonrası hasta
özellikleri değerlendirildi. BT görüntülerinin yardımıyla taşın bulunduğu bölgede üreteral duvar kalınlığı hesaplandı.
Üreteral lezyonlar Postüreteroskopik Lezyon Ölçeğine (PULS) göre derecelendirildi. Clavien sınıflandırma sistemine
göre hastanede yatış süresi, taş yükü, taşsızlık ve komplikasyonlar kaydedildi.
Bulgular: 120 hastadan 38’inde impakte üreter taşı mevcuttu. Taşların büyük çoğunluğu alt üreterde (% 75.8)
bulundu. Ortalama üreter duvar kalınlığı 2.75 ± 0.97 mm idi. 64 hastada (% 53.3) derece 1 lezyon ve 2 hastada (%
1.7) derece 2 lezyon görüldü. Taş boyutu ile üreter duvar kalınlığı arasında zayıf bir ilişki bulunurken (p = 0.011),
taş lokasyonu veya hidronefroz derecesi ile üreter duvar kalınlığı arasında ilişki yoktu. Üreteral duvar kalınlaşması
ile üreteral lezyonlar artmaktaydı (p = 0.044). Üreteral duvar kalınlığı impakte taş hastalarında artamaktaydı ve PULS
derecesi de daha yüksekti.
Sonuç: Üreteroskopik litotripsi sırasında gelişen ureter yaralanmaları PULS ile standardize edilebilir ve sınıflandırılabilir.
Taş ve hastayla ilişkili faktörler arasında üreter duvar kalınlığı ve impakte taş ile üreter lezyonu anlamlı korelasyon
göstermektedir. Ameliyat öncesi planlamada bu faktörlerin dikkate alınması üreteroskopi sürecinin güvenliğini
artırabilir.

References

  • 1. Traxer O, Thomas A (2013) Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 189(2):580-4. https://doi:10.1016/j.juro.2012.08.197
  • 2. Schoenthaler M, Wilhelm K, Kuehhas FE, Farin E, Bach C, Buchholz N, Miernik A (2012) Postureteroscopic lesion scale: a new management modified organ injury scale--evaluation in 435 ureteroscopic patients. J Endourol 26(11):1425-30. https://doi:10.1089/end.2012.0227
  • 3. Schoenthaler M, Buchholz N, Farin E, Ather H, Bach C, Bach T, Denstedt JD, Fritsche HM, Grasso M, Hakenberg OW, Herwig R, Knoll T, Kuehhas FE, Liatsikos E, Liske P, Marberger M, Osther PJ, Santos JM, Sarica K, Seitz C, Straub M, Traxer O, Trinchieri A, Turney B, Miernik A (2014) The Post-Ureteroscopic Lesion Scale (PULS): a multicenter video-based evaluation of inter-rater reliability. World J Urol 32(4):1033-40. https://doi: 10.1007/s00345-013-1185-1
  • 4. Guzelburc V, Guven S, Boz MY, Erkurt B, Soytas M, Altay B, Albayrak S (2016) Intraoperative Evaluation of Ureteral Access Sheath-Related Injuries Using Post-Ureteroscopic Lesion Scale. J Laparoendosc Adv Surg Tech A 26(1):23-6. https://doi: 10.1089/lap.2015.0294
  • 5. Sarica K, Kafkasli A, Yazici Ö, Çetinel AC, Demirkol MK, Tuncer M, Şahin C, Eryildirim B (2015) Ureteral wall thickness at the impacted ureteral stone site: acritical predictor for success rates after SWL. Urolithiasis 4 (1):83-8. https://doi: 10.1007/s00240-014-0724-6.
  • 6. Elibol O, Safak KY, Buz A, Eryildirim B, Erdem K, Sarica K (2017) Radiological noninvasive assessment of ureteral stone impaction into the ureteric wall: A critical evaluation with objective radiological parameters. Investig Clin Urol 58(5):339-345. https://doi: 10.4111/icu.2017.58.5.339
  • 7. Coleman S.L., Monga M (2015) Difficult Case: The Impacted Ureteral Stone. In: Patel S., Nakada S. (eds) Ureteral Stone Management. Springer, Cham
  • 8. Morgentaler A, Bridge SS, Dretler SP (1990) Management of the impacted ureteral calculus. J Urol 143:263–6.
  • 9. Mugiya S, Maruyama S, Hadano S, Nagae H (2004) Endoscopic features of impacted ureteral stones. J Urol 171:89–91
  • 10. Huffman JL, Bagley DH, Lyon ES (1985) Abnormal ureter and intrarenal collecting system. In: Urologic endoscopy: a manual and atlas. Boston: Little Brown and Co, pp 59–73. Chapter 6.
  • 11. Perez Castro E, Osther PJ, Jinga V, Razvi H, Stravodimos KG, Parikh K, Kural AR, de la Rosette JJ (2014) CROES Ureteroscopy Global Study Group. Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or multiple ureteral locations: the Clinical Research Office of the Endourological Society ureteroscopy global study. Eur Urol. 66(1):102-9. https://doi: 10.1016/j.eururo.2014.01.011.
  • 12. Chew B.H., Paterson R.F., Lange D (2015) Ureteral Stents. In: Patel S., Nakada S. (eds) Ureteral Stone Management. Springer, Cham

Ureteral Injury Increases with Ureteral Wall Thickness During the Ureteroscopic Lithotripsy of Impacted Stones

Year 2020, Volume: 12 Issue: 1, 9 - 14, 30.01.2020

Abstract

Aim: In this study, along with the patient and stone related features, we evaluated the possible relation of ureteral

wall thickness and ureteral injury with stone free rates in patients who had undergone ureteroscopy for ureteral

stones.

Material and Methods: 120 cases (71.7%, male) who underwent ureteroscopic laser lithotripsy between October

2014 and November 2015 was enrolled to this study. Pre-, intra- and postoperative patient characteristics, including

impacted stoneevaluation was done in all patients. Ureteral wall thickness was calculated at the stone site with the

help of CT images. Ureteral lesions were graded according to Postureteroscopic Lesion Scale (PULS). Hospitalization

time stone burden, stone clearance, and complications according to Clavien classification system were recorded.

Results: 38 patients among 120 patients had impacted ureteral stones. Vast majority of the stones were located in the lower ureter (%75.8). Mean ureteral wall thickness was 2.75±0.97 mm. A grade 1 lesion was seen in 64 (53.3%) and grade 2 lesion in 2 patients (1.7%). While there was weak relation between stone size and ureteral wall thickness (p=0.011), either location or hydronephrosis degree did not show relation with ureteral wall thickness. Ureteral lesions was increasing with ureteral wall thickening (p=0.044). Ureteral wall thickness was larger in impacted stone patients and PULS grade was higher as well.

Conclusion: Ureteral wall injuries may happen during ureteroscopic stone management which can be standardized and classified with PULS. Among the stone and patient related factors ureteral wall thickness and impacted stones had significant correlation with ureteral lesion. Considering these factors in the preoperative planning may increase the safety of the ureteroscopy process.

References

  • 1. Traxer O, Thomas A (2013) Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol 189(2):580-4. https://doi:10.1016/j.juro.2012.08.197
  • 2. Schoenthaler M, Wilhelm K, Kuehhas FE, Farin E, Bach C, Buchholz N, Miernik A (2012) Postureteroscopic lesion scale: a new management modified organ injury scale--evaluation in 435 ureteroscopic patients. J Endourol 26(11):1425-30. https://doi:10.1089/end.2012.0227
  • 3. Schoenthaler M, Buchholz N, Farin E, Ather H, Bach C, Bach T, Denstedt JD, Fritsche HM, Grasso M, Hakenberg OW, Herwig R, Knoll T, Kuehhas FE, Liatsikos E, Liske P, Marberger M, Osther PJ, Santos JM, Sarica K, Seitz C, Straub M, Traxer O, Trinchieri A, Turney B, Miernik A (2014) The Post-Ureteroscopic Lesion Scale (PULS): a multicenter video-based evaluation of inter-rater reliability. World J Urol 32(4):1033-40. https://doi: 10.1007/s00345-013-1185-1
  • 4. Guzelburc V, Guven S, Boz MY, Erkurt B, Soytas M, Altay B, Albayrak S (2016) Intraoperative Evaluation of Ureteral Access Sheath-Related Injuries Using Post-Ureteroscopic Lesion Scale. J Laparoendosc Adv Surg Tech A 26(1):23-6. https://doi: 10.1089/lap.2015.0294
  • 5. Sarica K, Kafkasli A, Yazici Ö, Çetinel AC, Demirkol MK, Tuncer M, Şahin C, Eryildirim B (2015) Ureteral wall thickness at the impacted ureteral stone site: acritical predictor for success rates after SWL. Urolithiasis 4 (1):83-8. https://doi: 10.1007/s00240-014-0724-6.
  • 6. Elibol O, Safak KY, Buz A, Eryildirim B, Erdem K, Sarica K (2017) Radiological noninvasive assessment of ureteral stone impaction into the ureteric wall: A critical evaluation with objective radiological parameters. Investig Clin Urol 58(5):339-345. https://doi: 10.4111/icu.2017.58.5.339
  • 7. Coleman S.L., Monga M (2015) Difficult Case: The Impacted Ureteral Stone. In: Patel S., Nakada S. (eds) Ureteral Stone Management. Springer, Cham
  • 8. Morgentaler A, Bridge SS, Dretler SP (1990) Management of the impacted ureteral calculus. J Urol 143:263–6.
  • 9. Mugiya S, Maruyama S, Hadano S, Nagae H (2004) Endoscopic features of impacted ureteral stones. J Urol 171:89–91
  • 10. Huffman JL, Bagley DH, Lyon ES (1985) Abnormal ureter and intrarenal collecting system. In: Urologic endoscopy: a manual and atlas. Boston: Little Brown and Co, pp 59–73. Chapter 6.
  • 11. Perez Castro E, Osther PJ, Jinga V, Razvi H, Stravodimos KG, Parikh K, Kural AR, de la Rosette JJ (2014) CROES Ureteroscopy Global Study Group. Differences in ureteroscopic stone treatment and outcomes for distal, mid-, proximal, or multiple ureteral locations: the Clinical Research Office of the Endourological Society ureteroscopy global study. Eur Urol. 66(1):102-9. https://doi: 10.1016/j.eururo.2014.01.011.
  • 12. Chew B.H., Paterson R.F., Lange D (2015) Ureteral Stents. In: Patel S., Nakada S. (eds) Ureteral Stone Management. Springer, Cham
There are 12 citations in total.

Details

Primary Language English
Subjects Urology
Journal Section Research Articles
Authors

Mustafa Boz This is me 0000-0002-0159-2090

Vahit Güzelburç

Gökhan Çalık This is me

Mustafa Soytaş This is me

Çağrı Kaçtan This is me

Selçuk Güven 0000-0002-5009-8435

Publication Date January 30, 2020
Published in Issue Year 2020 Volume: 12 Issue: 1

Cite

Vancouver Boz M, Güzelburç V, Çalık G, Soytaş M, Kaçtan Ç, Güven S. Ureteral Injury Increases with Ureteral Wall Thickness During the Ureteroscopic Lithotripsy of Impacted Stones. Endourol Bull. 2020;12(1):9-14.