Acil Durumda Yerleştirilen Perkütan Nefrostomi Kateteri Gelecekteki Perkütan Nefrolitotomi Operasyonu İçin Güvenli ve Etkili Erişim Sağlar

Year 2024, Volume: 16 Issue: 1, 17 - 26, 31.01.2024

Kamil Gökhan Şeker , Yusuf Arıkan , Deniz Noyan Özlü , Ali Ayten , Aysun Erbahçeci Salık , Ekrem Güner

https://doi.org/10.54233/endourologybull-1404594

Abstract

Amaç: Acil durumlarda yerleştirilen perkütan nefrostomi (PCN) kateterinin gelecekteki perkütan nefrolitotomi (PNL) operasyonunda kullanılabilirliğinin araştırılması amaçlandı.
Gereç ve Yöntemler: Ocak 2013 ile Aralık 2018 tarihleri arasında PNL ameliyatı öncesinde acil durumlarda girişimsel radyolog tarafından PCN kateteri takılan hastalar çalışmaya dahil edildi. Demografik özellikler, PCN takılma endikasyonu, taş özellikleri, ameliyat öncesi ve sonrası laboratuvar değerleri, ameliyat sırasındaki veriler, PCN kateterinin renal erişim için kullanılabilirliği/kullanılamazlığı, ameliyat sonrası veriler ve komplikasyonlar kaydedildi.
Bulgular: Çalışmaya toplam 32 hasta dahil edildi. (PCN kullanılabilir: 21, kullanılamaz: 11). Kateter takılma endikasyonu 26 (%81,25) hastada obstrüksiyon, 6 (%18,75) hastada ise idrar yolu enfeksiyonuydu. PNL sırasında 21 (%65,62) hastada PCN kateter yolu kullanılarak renal erişim sağlandı. En yaygın PCN erişimi alt kutuptan kullanıldı. On bir (%34,37) hastada PCN traktı erişim için elverişli değildi. Kaliksin giriş için uygun olmaması nedeniyle PCN’nin kullanılamadığı hastalarda en sık yeni erişim yeri 6 hastada alt kaliks, 3 hastada üst kaliks ve 2 hastada orta kaliks oldu. PCN kateterinin PNL erişimi için kullanılabilir olduğu ve kullanılamadığı iki grup arasında ortalama hastanede kalış süresi dışında (p=0.039) istatistiksel olarak anlamlı fark yoktu (p>0,05).
Sonuç: PNL ameliyatı öncesinde yerleştirilen PCN kateterleri, ameliyat sırasında renal erişim amacıyla etkin ve güvenli bir şekilde kullanılabilir. Ancak acil durumlarda, ileride ameliyat olacak hastalarda PCN kateterinin uygun kaliksten yerleştirilmesi önemlidir.

Keywords

nefrolitotomi, perkütan nefrostomi, böbrek erişimi, girişimsel radyolog, taş

Emergency Placed Percutaneous Nephrostomy Catheter Provides Safe and Effective Access for Future Percutaneous Nephrolithotomy Operation

Abstract

Objective: It was aimed to investigate the feasibility of the percutaneous nephrostomy (PCN) catheter placed in an emergency in the future percutaneous nephrolithotomy (PNL) operation.
Material and Methods: Patients who underwent PCN catheter insertion by an interventional radiologist under emergency situations prior to PNL surgery between January 2013 and December 2018 were included in the study. Demographic characteristics, indication for PCN insertion, stone characteristics, pre- and post-operative laboratory values, intra-operative data, usability/non-usability of PCN catheter for renal access, post-operative data and complications were recorded.
Results: A total of 32 patients were included in the study. (PCN usable: 21, unusable: 11). Indications for catheter insertion were obstruction in 26 (81.25%) patients and urinary tract infection in 6 (18.75%) patients. Renal access was achieved in 21 (65.62%) patients by using the PCN catheter tract during PNL. The most common PCN access was used in the inferior pole. In 11 (34.37 %) patients, the PCN tract was not usable for access. In patients in whom PCN was unusable due to an unsuitable calyx for access, the most common new access site was the inferior calyx in 6 patients, the superior calyx in 3 patients and the middle calyx in 2 patients. There was no statistically significant difference between the two groups in which the PCN catheter was usable and unusable for PNL access (p>0.05), except for the mean length of hospital stay (p=0.039).
Conclusions: PCN catheters inserted prior to PNL surgery can be used effectively and safely for renal access during surgery. However, in emergency cases, it is important that the PCN catheter is inserted through the appropriate calyx in patients undergoing future surgery.

Keywords

nephrolithotomy, percutaneous nephrostomy, renal access, interventional radiology, stone

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