Üreteroskopi Sonrası Üreter Darlığı Gelişme Riskini Öngörmede Nötrofil/Lenfosit Oranı ve Platelet/Lenfosit Oranı Kullanılabilir Mi?

Year 2024, Volume: 16 Issue: 3, 99 - 107, 29.09.2024

Reha Ordulu , Mustafa Aydın , Emrah Küçük , Hakan Yıldız , Mahmut Ulubay , Ekrem Akdeniz , Mustafa Kemal Atilla

https://doi.org/10.54233/endourolbull-1526700

Abstract

Amaç: Bu çalışmanın amacı daha önce endoskopik üst üriner sistem cerrahisi geçiren hastalarda üreter darlığı veya zor/sıkı üreter gelişim riskini öngörmede, nötrofil/lenfosit oranı (NLO) ve platelet/lenfosit oranı (PLO)’nın etkinliğini araştırmaktır.
Gereç ve Yöntemler: Bu gözlemsel çalışma Nisan 2022 ile Nisan 2023 tarihleri arasında Samsun Eğitim ve Araştırma Hastanesi, Üroloji Kliniği’nde yapılmıştır. Çalışmaya daha önce endoskopik üst üriner sistem cerrahisi geçiren 130 hasta alınmıştır. Hastalar üreter darlığı olanlar (Grup 1) ve olmayanlar (Grup 2) olmak üzere iki gruba ayrılmıştır. Üreter darlığı direk endoskopik olarak veya retrograd piyelografi ile konulmuştur. Grupların sosyodemografik özellikleri, klinik verileri, NLO ve PLO değerleri karşılaştırılmıştır.
Bulgular: Çalışmaya alınan hastaların yaş ortalaması Grup 1’de 49,89 ± 14,40 ve Grup 2’de 48,92 ± 14,60 yıl olarak bulundu (p = 0,704). Vücut kitle indeksi, cinsiyet, hidronefroz, komordite açısından gruplar arasında istatistiksel olarak fark izlenmezken; taş düşürme öyküsü ve geçirilmiş operasyon sayısı açısından anlamlı fark izlendi (sırasıyla p = 0,001 ve p <0,001). Grupların NLO değeri sırasıyla 2,62 (0,75-9,18) ve 2,29 (0,80-6,67); PLO değeri 136,57 (55,02-475,45) ve 118,66 (37,50-244,17) olarak bulundu. Her iki değer karşılaştırıldığı zaman gruplar arasında fark izlenmedi (sırasıyla, p = 0,139 ve p = 0,076).
Sonuç: Çalışmamızda NLO ve PLO değerleri üreter darlığı olan grupta daha yüksek tespit edilmesine rağmen bu yükseklik istatistiksel olarak anlamlı bulunamamıştır. Bizim çalışmamıza göre daha önce endoskopik üst üriner sistem cerrahisi geçiren hastalarda üreter darlığı gelişmesini öngörmede NLO ve PLO değerlerinin etkisi yoktur.

Keywords

Üreter darlığı, zor/sıkı üreter, nötrofil/lenfosit oranı, platelet/lenfosit oranı

Can the Neutrophil/Lymphocyte Ratio and Platelet/Lymphocyte Ratio Be Used to Predict the Risk of Ureteral Stricture Following Ureteroscopy?

Abstract

Objective: The purpose of this study was to investigate whether the neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) can be used to predict the development of ureteral stricture or difficult ureter in patients who had previously undergone endoscopic upper urinary tract surgery.
Material and Methods: This observational study was performed between April 2022 and April 2023 at the Samsun Training and Research Hospital Urology Department, Türkiye. One hundred thirty patients who had undergone prior endoscopic upper urinary tract surgery were included. These were divided into two groups, with (Group 1) and without (Group 2) ureteral stricture. The diagnosis of ureteral stricture was based on direct endoscopy or retrograde pyelography. The groups’ sociodemographic characteristics, clinical data, and NLR and PLR values were then compared.
Results: The patients’ mean ages were 49.89±14.40 years in Group 1 and 48.92±14.60 in Group 2 (p = 0.704). No statistically significant differences were observed between the groups in terms of sex, body mass index, or comorbidity. However, significant differences were determined in terms of passage of kidney stones and numbers of surgical procedures performed (p = 0.001 and p <0.001, respectively). The groups’ NLR values were 2.62 (0.75-9.18) and 2.29 (0.80-6.67), and their PLR values were 136.57 (55.02-475.45) and 118.66 (37.50-244.17), respectively. The differences between the groups were not statistically significant (p = 0.139 and p = 0.076, respectively).
Conclusion: Although NLR and PLR values were higher in the group with ureteral stricture in this study, that elevation was not statistically significant. The results show that the evaluation of NLR and PLR values are not useful in predicting ureteral stricture in patients who have previously undergone endoscopic upper urinary tract surgery.

Keywords

Ureter stenosis, difficult/ stringent ureter, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio

References

• 1. D’Addessi A, Bassi P. Ureterorenoscopy: avoiding and managing the complications. Urol Int. 2011;87(3):251-9. https://doi.org/10.1159/000329286
• 2. Degirmenci T, Gunlusoy B, Kozacioglu Z, et al. Outcomes of ureteroscopy for the management of impacted ureteral calculi with different localizations. Urology. 2012;80(4):811-5. https://doi.org/10.1016/j.urology.2012.05.007
• 3. El-Abd AS, Suliman MG, Abo Farha MO, et al. The development of ureteric strictures after ureteroscopic treatment for ureteric calculi: A long-term study at two academic centres. Arab J Urol. 2014;12(2):168-72. https://doi.org/10.1016/j.aju.2013.11.004
• 4. Nakada SY, Soble JJ, Gardner SM, et al. Comparison of acucise endopyelotomy and endoballoon rupture for management of secondary proximal ureteral stricture in the porcine model. J Endourol. 1996;10(4):311-8. https://doi.org/10.1089/end.1996.10.311
• 5. Cetti RJ, Biers S, Keoghane SR. The difficult ureter: what is the incidence of pre-stenting? Ann R Coll Surg Engl. 2011;93(1):31-3. https://doi.org/10.1308/003588411X12851639106990
• 6. Söylemez H, Yıldırım K, Utangac MM, Aydoğan TB, Ezer M, Atar M. A New Alternative for Difficult Ureter in Adult Patients: No Need to Dilate Ureter via a Balloon or a Stent with the Aid of 4.5F Semirigid Ureteroscope. J Endourol. 2016;30(6):650-4. https://doi.org/10.1089/end.2016.0118
• 7. Baetta R, Corsini A. Role of polymorphonuclear neutrophils in atherosclerosis: current state and futureperspectives. Atherosclerosis. 2010;210(1):1-13. https://doi.org/10.1016/j.atherosclerosis.2009.10.028
• 8. Balta S, Aparcı M, Ozturk C, Demirkol S, Celik T. Neutrophil-lymphocyte ratio as an useful mortality marker. Am J Emerg Med. 2014;32(12):1546-7. https://doi.org/10.1016/j.ajem.2014.09.040
• 9. Timberlake MD, Herndon CD. Mild to moderate postnatal hydronephrosis--grading systems and management. Nat Rev Urol. 2013;10(11):649-56. https://doi.org/10.1038/nrurol.2013.172
• 10. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13. https://doi.org/10.1097/01.sla.0000133083.54934.ae
• 11. Perez Castro E, Osther PJ, Jinga V, et al. 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. 2014;66(1):102-9. https://doi.org/10.1016/j.eururo.2014.01.011
• 12. Ekici O, Gul A, Zengin S, Boyaci C, Kilic M. The Impact of Ureteral Wall Thickness on Spontaneous Passage and Development of Long-term Ureteral Stricture in Patients with Ureteral Stone. J Coll Physicians Surg Pak. 2023;33(1):97-102. https://doi.org/10.29271/jcpsp.2023.01.97
• 13. Moretto S, Saita A, Scoffone CM, et al. Ureteral stricture rate after endoscopic treatments for urolithiasis and related risk factors: systematic review and meta-analysis. World J Urol. 2024;42(1):234. https://doi.org/10.1007/s00345-024-04933-2
• 14. Tan J, Yu Z, Ling X, et al. Main Pathological Changes of Benign Ureteral Strictures. Front Med (Lausanne). 2022;9:916145. https://doi.org/10.3389/fmed.2022.916145
• 15. Lee KS, Ha JS, Koo KC. Significance of Neutrophil-to-Lymphocyte Ratio as a Novel Indicator of Spontaneous Ureter Stone Passage. Yonsei Med J. 2017;58(5):988-93. https://doi.org/10.3349/ymj.2017.58.5.988
• 16. Abou Heidar N, Labban M, Bustros G, Nasr R. Inflammatory serum markers predicting spontaneous ureteral stone passage. Clin Exp Nephrol. 2020;24(3):277-83. https://doi.org/10.1007/s10157-019-01807-5
• 17. Jain A, Sreenivasan SK, Manikandan R, Dorairajan LN, Sistla S, Adithan S. Association of spontaneous expulsion with C-reactive protein and other clinico-demographic factors in patients with lower ureteric stone. Urolithiasis. 2020;48(2):117-22. https://doi.org/10.1007/s00240-019-01137-x
• 18. Elsaraya N, Gordon-Irshai A, Schwarzfuchs D, Novack V, Mabjeesh NJ, Neulander EZ. Neutrophil to lymphocyte ratio as an early indicator for ureteral catheterization in patients with renal colic due to upper urinary tract lithiasis. PLoS One. 2022;17(6):e0270706. https://doi.org/10.1371/journal.pone.0270706
• 19. Yavuzsan AH, Kirecci SL, Ilgi M, et al. Failure of ureteral access sheath insertion in primary flexible ureteroscopy for renal stones: is there any relation with inflammation? Aktuelle Urol. 2022;53(1):67-74. https://doi.org/10.1055/a-1378-2495